Hyperhidrosis (excessive sweating) may be primary (physiologic, idiopathic, essential; possibly hereditary) or secondary (associated with an underlying condition). Secondary hyperhidrosis is associated with neurologic, endocrinologic, metabolic, or other such disorders; febrile illness; malignancy; or drugs.
Hyperhidrosis is classified as focal or generalized. Focal hyperhidrosis most commonly affects the palms and soles (palmar-plantar hyperhidrosis) and underarms (axillary hyperhidrosis), and least commonly affects the face (craniofacial hyperhidrosis). Generalized hyperhidrosis involves the entire body and usually is associated with an underlying condition.
Generally considered first-line therapy for mild or moderate primary focal hyperhidrosis, including axillary and palmar-plantar hyperhidrosis. An adequate trial of topical aluminum chloride usually is recommended before other therapeutic options (e.g., botulinum toxin injections, iontophoresis, local excision, liposuction, sympathectomy) considered. In severe cases of axillary, palmar, or plantar hyperhidrosis, some clinicians state that aluminum chloride hexahydrate, botulinum toxin injections, or iontophoresis are considered first-line therapy.
One of several options for treatment of craniofacial hyperhidrosis.
Self-medication (Certain Dri®, OTC use) for axillary hyperhidrosis only.
Dosage and Administration
Administration
Topical Administration
Preparations are for external use only.
Apply topically to the skin as a solution or as an antiperspirant stick.
Avoid contact with eyes. If contact occurs, wash affected eye(s) thoroughly with water.
Apply to dry, intact skin only; do not apply to any irritated, broken, or recently shaven areas. May use a hairdryer on warm setting to dry the skin.
Do not apply other deodorants or antiperspirants to treatment area.
For optimum effect, apply at bedtime when sweat glands are least active.
Apply solution using fingers, moistened cotton ball, or applicator (Dab-O-Matic®) supplied by manufacturer. If using the Dab-O-Matic® applicator, remove and discard protective cap prior to use. Push applicator into bottle and twist white cap to secure in place.
Consult individual manufacturer’s prescribing or patient information for complete instructions regarding proper drug application and removal.
Dosage
Adults
Hyperhidrosis
Axillary, Palmar, Plantar, or Craniofacial Hyperhidrosis
Topical
Apply solution to completely dry affected area (e.g., underarms, palms, soles, scalp) once daily at bedtime.
To minimize irritation when using the solution, let alcohol evaporate (may use a hairdryer on cold setting when administered under arms); a thin film of drug should remain on skin.
To prevent drug from rubbing off, cover treated area with a T-shirt for axillary application; use a plastic shower cap for scalp application or plastic wrap and overlying gloves or socks for palmar or plantar application, respectively. Do not use adhesive tape. Some clinicians state that occlusion is not necessary and may increase risk of skin irritation. (See Dermatologic Effects under Cautions.)
After 6–8 hours (usually the following morning), remove garments and/or plastic wrap; to prevent irritation, wash treatment area(s) thoroughly with soap and water or shampoo. Some clinicians also suggest topical application of sodium bicarbonate. Dry with towel.
Repeat applications for ≥2 consecutive nights until desired effect (lack of sweating) achieved. Thereafter, may apply additional treatments once or twice weekly as needed.
Self-medication for Axillary Hyperhidrosis
Topical
Apply sparingly (i.e., a few strokes) to affected areas under each arm. Dry skin completely prior to application.
Allow solution to dry following application.
May repeat treatment until desired effect achieved. Thereafter, apply every other day or as needed.
Cautions
Contraindications
Known hypersensitivity to aluminum chloride hexahydrate or any ingredient in the formulation.
Warnings/Precautions
Warnings
Administration
Self-medication: Apply Certain Dri® to underarms only. (For further information on warnings and precautions associated with administration of aluminum chloride hexahydrate (Drysol®, Xerac® AC, and Hypercare®) and aluminum chloride [Certain Dri®], see Topical Administration under Dosage and Administration.)
Flammability
Aluminum chloride solutions are flammable; do not use near an open flame.
Sensitivity Reactions
Dermatologic Effects
Possible local irritation (e.g., burning, stinging, itching, tingling); usually resolves with temporary discontinuance of drug. Because risk of skin sensitivity increases with higher concentrations, some patients may benefit from an initial trial with reduced concentrations (10–12%) of aluminum chloride hexahydrate.
To minimize skin irritation, follow specific instructions provided by each manufacturer on proper drug application and removal. Ensure that skin is completely dry prior to and following drug application. (See Topical Administration under Dosage and Administration.)
If rash or skin reaction develops during therapy, discontinue use and consult a clinician. Topical sodium bicarbonate or a low-dose corticosteroid cream (e.g., 1% hydrocortisone) may be used to limit or treat irritation. Other measures include decreasing concentration or frequency of applications. If persistent skin irritation occurs, refer patient to a dermatologist.
General Precautions
Fabric or Metal Stains
May be harmful to certain fabrics (e.g., cotton) or metals. Allow skin to dry completely following application and thoroughly wash off any residual drug after 6–8 hours of treatment to avoid damage to clothing.
Specific Populations
Pregnancy
The manufacturer of Drysol® and Xerac® AC states that there is no pregnancy category for these drugs; however, they recommend that the drug not be used in pregnant women.
Pediatric Use
Keep preparations out of reach of children.
Infants (especially preterm infants) and children may be at greater risk of aluminum exposure because of immature renal function.
Renal Impairment
Possible increased exposure to any systemically absorbed aluminum in patients with renal impairment; patients with renal impairment should consult a clinician before use. (See Bioavailability and Special Populations under Pharmacokinetics.)
Common Adverse Effects
Local skin irritation (burning, stinging, itching, tingling).
Pharmacokinetics
Absorption
Bioavailability
One manufacturer states that drug is not absorbed; however, some clinicians state that minimal systemic absorption may occur when applied topically.
Onset
Following topical application of aluminum chloride hexahydrate 20% solution to the palms, reduced sweating occurs within 48 hours.
Duration
Following topical application of aluminum chloride hexahydrate 20% to the palms, effects of reduced sweating diminish or disappear within 48 hours after discontinuance of therapy.
Elimination
Elimination Route
Absorbed aluminum is eliminated principally by the kidneys.
Special Populations
Renal impairment: Possible decreased clearance and increased exposure to any absorbed aluminum.
Stability
Storage
Topical
Solution
15–30°C, in tightly closed container when not in use (to prevent evaporation).
Keep away from open flames.
Actions
Pathophysiology of focal hyperhidrosis is poorly understood.
Eccrine (sweat) glands are distributed over nearly the entire body surface with high concentrations in palms, soles, and forehead. These glands are innervated by cholinergic fibers of the sympathetic nervous system.
Since patients with focal hyperhidrosis do not have any histopathologic changes in sweat glands or in their numbers, it has been suggested that a complex dysfunction of the sympathetic nervous system is likely to contribute to hyperhidrosis.
Mechanically blocks eccrine sweat gland ducts, possibly by forming aluminum ion precipitate complexes within the acrosyringium (most superficial) portion of eccrine glands.
Long-term (≥6 months) use appears to cause dilation and atrophy of secretory cells within eccrine sweat glands.
Does not appear to affect apocrine glands.
Advice to Patients
Importance of avoiding contact with eyes. If ocular contact occurs, rinse eye(s) thoroughly with water.
Importance of instructing patients on proper technique for application and removal of drug.
Importance of discontinuing therapy and informing clinician if a rash or skin reaction occurs.
Importance of patients with renal impairment consulting a clinician before starting or continuing to use antiperspirants containing aluminum because of possible increased exposure to any absorbed aluminum.
Importance of informing clinician if accidental ingestion occurs in a pediatric patient.
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.
Importance of informing patients of other important precautionary information. (See Cautions.)
Preparations
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Remember, keep this and all other medicines out of the reach of children,
never share your medicines with others, and use this medication only for the indication prescribed.
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