Hyperhidrosis is more traditionally managed with the use of topical preparations and systemic anticholinergic medications. Glycopyrrolate (glycopyrronium bromide [Robinul; Shionogi Inc]) is a systemic anticholinergic with a short half-life (0.8 hours) that inhibits the sympathetic stimulation of eccrine sweat glands by blocking the M3 muscarinic receptors on glandular tissue. These receptors are the site of action of acetylcholine after release from the presynaptic terminal.9 Glycopyrrolate has been shown to be a safe and effective treatment of hyperhidrosis10 and exhibits less central nervous system adverse effects than other anticholinergic medications because of its inability to cross the blood-brain barrier. However, glycopyrrolate can cause other systemic adverse effects such as dry mouth, mydriasis, increased intraocular pressure, tachycardia, decreased gastric motility and secretion, constipation, and urinary retention,9,10 and it is contraindicated for patients with myasthenia gravis, paralytic ileus, and pyloric stenosis. Patients with cardiovascular disease, gastroesophageal reflux, bladder obstructions, and glaucoma can use glycopyrrolate but should proceed with treatment cautiously.10 Glycopyrrolate is also relatively inexpensive and on most drug formularies. In our patient, a trial of low-dose glycopyrrolate, 1 mg daily, was initially instituted as part of a combination regimen and was continued as a single agent. Systemic glycopyrrolate was an effective, affordable, and well-tolerated medication, which produced significant improvement and sustained clearance of Hailey-Hailey disease in our patient. While dosing should be titrated to the individual needs of the patient, the currently recommended daily maximum dose of glycopyrrolate is 8 mg. In the future, trials may include the use of topical glycopyrrolate as maintenance therapy, which could provide similar therapeutic benefit with an even milder adverse effect profile. This case demonstrates a novel application for oral glycopyrrolate as a potential adjuvant or single agent maintenance therapy in the management of Hailey-Hailey disease.