Localized hyperhidrosis treated with aluminum chloride in a salicylic acid gel base

A total of 238 patients with a clinical diagnosis of localized hyperhidrosis (HH) were treated on 332 anatomic sites (axillae, feet, hands, and groin). The purpose of the study was to evaluate the effectiveness of aluminum chloride hexahydrate (AC), in a salicylic acid gel base (SAGB) containing 4% salicylic acid (SA), for the treatment of localized HH. The SAGE was similar to a keratolytic gel,(1) Keralyt(R) (Westwood Squibb). Because SAGB and anhydrous alcohol (AA), the standard vehicle for AC, have different consistencies, double blinding was not possible. Bromhidrosis (BH) was documented when present, whether of apocrine (axillae and groin) or eccrine (feet) origin. For the sake of uniformity, AC in SAGB was compounded by the same pharmacist. The concentration of AC varied from 10 to 40%, depending on the site to be treated. The improvement of HH was subjectively assessed through a questionnaire as follows: nil = no improvement; poor = < 25%; fair = 25-50%; good = 50-75%; and excellent = > 75%. Armpits: 20% AC was used to control axillary HH. When 20% AC failed to control HH, its concentration was gradually increased to 25% and, rarely, to 30%. When irritation occurred, the concentration of AC was decreased to 15 or 10%, and 1% hydrocortisone (HC) was added to the preparation. Patients were instructed to apply the medication initially 2-3 nights per week, gradually decreasing the frequency as required. When possible, only the active focal area of HH was treated.(2) As with AC in AA, the medication was applied at bedtime. Patients were instructed to avoid rubbing and the application of the medication on recently shaved skin. Hands and feet: for these areas, the concentration of AC was 30% initially, but could be increased up to 40% if necessary.(3) Application was daily at bedtime, and later at gradually longer intervals. Occlusion was never used.