Topical Aluminum Chloride Research Articles

Aquagenic wrinkling of palm

Aim Aquagenic Wrinkling of Palm (AWP) is an uncommon condition in Paediatric Population. The authors report a clinical case of a 14 years old girl with Idiopathic Aquagenic wrinkling of Palms. Method A Case report and Review of Literature. Results 14 year old healthy girl presented with nine month History of excessive Palmar wrinkling of hands within minutes of exposure of hands to water. There was no history of involvement of feet. Apart from wrinkling, there was swelling and tenderness that followed by development of blisters. There was also excessive shedding of skin particularly around the nail bed. These changes resolved after 30 minutes. There were no signs and symptoms suggestive of Cystic fibrosis or history of any medication. These symptoms resolved spontaneously after two months. Conclusion AWP is a rare dermatological disorder that is well recognised in young adults but rarely reported in children. The exact pathophysiology is unknown. Idipoathic cases have been reported. There is well recognised association with Cystic Fibrosis suggesting that a Chloride Channel defect may be involved. It is also known to be linked with use of COX-2 inhibitors, Salicylates and Tobramycin. Treatment varies from Water Avoidance, Topical aluminium Chloride and in extreme cases, injection of Botulinium Toxins.

Histological localization of aluminum in topical aluminum chloride treatment for palmar hyperhidrosis

Histological localization of aluminum in topical aluminum chloride treatment for palmar hyperhidrosis

Efficacy of iontophoresis with glycopyrronium bromide for treatment of primary palmar hyperhidrosis

There is limited data on the efficacy of iontophoretic treatment of primary palmar hyperhidrosis using glycopyrronium bromide. The first line treatment for primary palmar hyperhidrosis is usually topical aluminium chloride, but clinical experience indicates that it is not effective for more severe disease. To evaluate the efficacy of using glycopyrronium bromide iontophoresis in the treatment of primary palmar hyperhidrosis, and to evaluate if the benefit of treatment varies with the severity of disease. This is an open-label study involving patients undergoing weekly treatment of iontophoresis with glycopyrronium bromide for 4 weeks. Gravimetric measurements of sweat production and subjective scores of palmar sweatiness were recorded prior to starting treatment and 1 week after the last treatment. Side-effects were monitored weekly. Twenty two of the 25 patients recruited completed the 4-week treatment. There was a significant mean improvement of 23.4 mg/min (P = 0.001) between baseline and post-treatment gravimetric measurements. Patients with a higher baseline sweat output demonstrated a trend towards a greater reduction in sweat production (Pearson's correlation correlation coefficient, r = 0.41). The patients experienced dryness of the palms for a mean duration of 5 days after iontophoresis. All patients reported an improvement in satisfaction scores and 81.8% reported an improvement in subjective severity scores. No serious side-effects were encountered during the study. Iontophoresis using glycopyrronium bromide is an effective and well-tolerated treatment for primary palmar hyperhidrosis. The possibility of its greater benefit in patients with more severe baseline disease requires verification.

Aquagenic syringeal acrokeratoderma in an adult man: case report and review of the literature

Aquagenic syringeal acrokeratoderma (ASA) is a rare acquired disorder that develops predominantly in young women. It is clinically characterized by a burning sensation and whitish discolouration on the hands and rarely on the soles after brief immersion in water, which resolves within a short time after drying. Topical aluminium chloride and salicylic acid are reportedly beneficial in some cases. In total, 20 female and 8 male patients with ASA have been reported previously. We present another male patient, who failed to respond to treatment with antihistamines and topical steroids, but responded well to formalin 3% in alcohol without any side-effects.

Treatment of Axillary Hyperhidrosis/Bromidrosis Using VASER Ultrasound

Current methods of treatment for axillary hyperhidrosis and/or bromidrosis are palliative (use of topical aluminum chloride or injections of botulinum toxin type A) or surgically based for more permanence (excisional surgery, endoscopic transthoracic sympathectomy, liposuction/curettage). The surgical approaches have mixed effectiveness and incur the risk of significant side effects and complications. Thirteen patients (3 males, 10 females) with significant axillary hyperhidrosis and/or bromidrosis were recruited, treated with the VASER ultrasound, and followed for 6 months. Preoperative assessment of the impact of hyperhidrosis and/or bromidrosis on lifestyle and the degree of sweat/odor were completed. Postoperative assessment of changes relative to lifestyle and degree of sweat/odor reduction and patient and surgeon satisfaction were completed. Eleven of 13 patients had significant reduction in sweat/odor and had no recurrence of significant symptoms at 6 months. Two patients had a reduction in sweat/odor but not to the degree desired by the patients. No significant complications were noted. A simple amplitude and time protocol was established that provides consistent and predictable therapy. The complete procedure takes less than 1 h to treat two axillae using local anesthetic. The VASER is safe and effective for treatment of axillary hyperhidrosis/bromidrosis. The method is minimally invasive with immediate return to basic activities and only temporary minor restriction of arm movement. At 6 months the treatment appears to be long-lasting, but further follow-up is required for verification of permanence. This method has become the standard of care for the treatment of axillary hyperhidrosis/bromidrosis in the authors' practice.

Superiority of Thoracoscopic Sympathectomy over Medical Management for the Palmoplantar Subset of Severe Hyperhidrosis

Severe hyperhidrosis is a disabling disorder whose management is controversial. Medical treatment consists of topical aluminum chloride, oral anticholinergics, ionotophoresis, and botulinum toxin A (Botox) injections. Despite the minimally invasive nature of thoracoscopic sympathectomy, there is a common perception that surgery is only a "last resort." The palmoplantar subtype of hyperhidrosis is particularly problematic for patients professionally and socially. The purpose of our study was to determine the safety, efficacy, and side effects of the various medical treatments vs. bilateral thoracoscopic sympathectomy (BTS) for palmoplantar hyperhidrosis. Consecutive patients (n = 192) were selected based on massive palmar sweating, similar level of plantar sweating, bimodal onset in early childhood or puberty, and exacerbation with ordinary hand lotion. A prospective cohort of 47 patients underwent medical treatment with their responses monitored on a prospective basis, and 145 patients underwent retrospective evaluation of their medical treatment based on their histories. Patients whose medical treatments failed or resulted in intolerable side effects were offered outpatient BTS surgery at the T2-T3 level. Of the 47 prospective patients, 46 received topical aluminum chloride, 40 anticholinergics, six iontophoresis, and 45 BTS surgery. Only one patient was successfully treated with aluminum chloride (2.2%) and one successfully treated with anticholinergics (2.5%), and these did not undergo surgery. Iontophoresis was not successful in any prospectively followed patient. BTS was effective in curing palmar hyperhidrosis in 100% of patients. The superiority of BTS vs. topical aluminum chloride, anticholinergics, and iontophoresis to successfully treat palmar hyperhidrosis was highly statistically significant (p < 0.001). For the retrospective group of 145 patients, 89 had been treated with topical aluminum chloride, 38 with oral anticholinergics, 31 with iontophoresis, eight with Botox, one with no medical treatment, and 144 with BTS surgery. All medical treatments failed with the exception that one patient was satisfied with anticholinergic treatment (2.6%), and this patient did not undergo BTS. BTS was successful in curing bilateral palmar hyperhidrosis in 99.3% (one unilateral failure due to adhesions). BTS was superior in treating palmar hyperhidrosis compared to aluminum chloride, anticholinergics, iontophoresis, and Botox (p < 0.001). The medically treated patients suffered significant side effects ranging from local stinging, cracking, and blistering to xerostomia, xerophthalmia, and blunted mentation. Overall, compensatory hyperhidrosis (CH) was present in 56% of patients undergoing BTS, but only 3.2% of BTS patients had severe CH with significant discomfort; all were men. There were no other significant operative complications. The safety and overwhelming efficacy of BTS compared to medical management of severe palmoplantar hyperhidrosis is demonstrated. Rather than being a "last resort," BTS can be confidently recommended as first-line treatment for the typical, severe form of palmoplantar hyperhidrosis.

A Comprehensive Approach to the Recognition, Diagnosis, and Severity-Based Treatment of Focal Hyperhidrosis

BACKGROUND Hyperhidrosis can have profound effects on a patient's quality of life. Current treatment guidelines ignore disease severity. OBJECTIVE The objective was to establish clinical guidelines for the recognition, diagnosis, and treatment of primary focal hyperhidrosis. METHODS AND MATERIALS A working group of eight nationally recognized experts was convened to develop the consensus statement using an evidence-based approach. RECOMMENDATIONS An algorithm was designed to consider both disease severity and location. The Hyperhidrosis Disease Severity Scale (HDSS) provides a qualitative measure that allows tailoring of treatment. Mild axillary, palmar, and plantar hyperhidrosis (HDSS score of 2) should initially be treated with topical aluminum chloride (AC). If the patient fails to respond to AC therapy, botulinum toxin A (BTX-A; axillae, palms, soles) and iontophoresis (palms, soles) should be the second-line therapy. In severe cases of axillary, palmar, and plantar hyperhidrosis (HDSS score of 3 or 4), both BTX-A and topical AC are first-line therapy. Iontophoresis is also first-line therapy for palmar and plantar hyperhidrosis. Craniofacial hyperhidrosis should be treated with oral medications, BTX-A, or topical AC as first-line therapy. Local surgery (axillary) and endoscopic thoracic sympathectomy (palms and soles) should only be considered after failure of all other treatment options. CONCLUSIONS These guidelines offer a rapid method to assess disease severity and to treat primary focal hyperhidrosis according to severity.

Whitish papules on the palm

A 21-year-old woman presented with a 1-month history of whitish bubbling of the palms after brief exposure to water. The symptoms arose within 3-5 min after immersion in water, as a white sponge-like appearance, and resolved after a variable drying period. She was otherwise healthy and did not complain of hyperhidrosis. There was no family history of similar lesions. Physical examination revealed a healthy appearance of the palms; however, 5 min after immersion of the hands in warm water, the central part of the left palm became swollen and tiny white papules with dilated puncta appeared. The right palm also showed similar changes. These asymptomatic papules with a tendency to coalesce became more prominent with prolonged exposure (Figs 1 and 2). The lesions resolved completely approximately 30 min after removal of the hands from water. A biopsy taken from the lesional skin revealed dilatation of intraepidermal eccrine ducts and a spongy appearance in the corneal layer (Fig. 3). A diagnosis of aquagenic syringeal palmar keratoderma was made on the basis of these clinical and histopathologic findings. A short course of treatment with topical aluminum chloride resulted in a remarkable response in 1 week. She had no recurrence after 1 year.

A Comprehensive Approach to the Recognition, Diagnosis, and Severity-Based Treatment of Focal Hyperhidrosis: Recommendations of the Canadian Hyperhidrosis Advisory Committee

Hyperhidrosis can have profound effects on a patient's quality of life. Current treatment guidelines ignore disease severity. The objective was to establish clinical guidelines for the recognition, diagnosis, and treatment of primary focal hyperhidrosis. A working group of eight nationally recognized experts was convened to develop the consensus statement using an evidence-based approach. An algorithm was designed to consider both disease severity and location. The Hyperhidrosis Disease Severity Scale (HDSS) provides a qualitative measure that allows tailoring of treatment. Mild axillary, palmar, and plantar hyperhidrosis (HDSS score of 2) should initially be treated with topical aluminum chloride (AC). If the patient fails to respond to AC therapy, botulinum toxin A (BTX-A; axillae, palms, soles) and iontophoresis (palms, soles) should be the second-line therapy. In severe cases of axillary, palmar, and plantar hyperhidrosis (HDSS score of 3 or 4), both BTX-A and topical AC are first-line therapy. Iontophoresis is also first-line therapy for palmar and plantar hyperhidrosis. Craniofacial hyperhidrosis should be treated with oral medications, BTX-A, or topical AC as first-line therapy. Local surgery (axillary) and endoscopic thoracic sympathectomy (palms and soles) should only be considered after failure of all other treatment options. These guidelines offer a rapid method to assess disease severity and to treat primary focal hyperhidrosis according to severity.

Effectiveness and patient satisfaction with topical aluminum chloride and endoscopic transthoracic sympathectomy for primary axillary hyperhidrosis: A literature review

Effectiveness and patient satisfaction with topical aluminum chloride and endoscopic transthoracic sympathectomy for primary axillary hyperhidrosis: A literature review

Disorders of sweating.

The clinical spectrum of sweating disorders includes sudomotor excess and deficiency. Hyperhidrosis is characterized by sweating beyond that required to maintain a constant internal body temperature. Hypohidrosis and anhidrosis are distinguished by a reduced or absent ability to generate sweat for the purpose of evaporative heat dissipation. Whereas hyperhidrosis is usually benign, anhidrosis may predispose to hyperthermia. Either hyperhidrosis or anhidrosis may accompany a more serious underlying disorder. Correct diagnosis depends on determining the anatomical pattern of sweating and localizing the lesion within the autonomic nervous system. Sudomotor deficits may involve the frontal operculum, hypothalamus, brain stem, spinal cord, sympathetic chain ganglia, peripheral nerve, or eccrine sweat glands. Treatments for hyperhidrosis include topical aluminum chloride, oral anticholinergic agents, intradermal botulinum toxin for some localized syndromes, and thoracic ganglionic sympathotomy or sympathectomy for refractory palmar hyperhidrosis.

Remission of Facial and Scalp Hyperhidrosis With Clonidine Hydrochloride and Topical Aluminum Chloride

Axillary and palmar hyperhidrosis are featured prominently in the literature, but no previous studies have detailed a treatment regimen for specific excessive localized sweating of the face and scalp. In this report, a patient was treated for this condition with a combination of clonidine hydrochloride (0.3 mg to 0.4 mg, with 0.25 mg to be taken at bedtime, to prevent daytime sedation) [corrected] and a topical solution of 20% aluminum chloride in anhydrous ethyl alcohol (Drysol). Over a period of 2 or 3 weeks, the patient achieved a complete remission of symptoms, while having only mild side effects. The treatment regimen also had the added advantage of lowering generalized anxiety.

Remission of Facial and Scalp Hyperhidrosis With Clonidine Hydrochloride and Topical Aluminum Chloride

Remission of Facial and Scalp Hyperhidrosis With Clonidine Hydrochloride and Topical Aluminum Chloride

Botulinum toxin type A in the treatment of focal, axillary and palmar hyperhidrosis and other hyperhidrotic conditions

Focal essential hyperhidrosis is a common and often disabling disorder mainly involving the palms, axillae, face, and soles of the feet. Focal hyperhidrosis may also arise from several neurological or internal diseases. Current therapeutic options include topical aluminium chloride salts, systemic anticholinergic drugs, tap‐water iontophoresis, and a number of surgical approaches. However, none of these are entirely satisfactory. In recent studies, injection of botulinum toxin type A (BTX‐A) into the hyperhidrotic area has proved very effective in reducing or abolishing focal sweating of different aetiologies without major side effects. BTX‐A therefore has the potential to replace more invasive therapies.

Botulinum toxin for palmar hyperhidrosis

A 26-year-old otherwise healthy woman had had continuous excessive sweating of palms and soles for 10 years. She was unable to work for 9 months because of the sweating. Inpatient treatment, including iontophoresis and topical aluminium chloride, was ineffective and abandoned after 6 weeks. Neurological examination was unremarkable apart from excessive hyperhidrosis. There were no other signs or symptoms of autonomic dysfunction. Nerve conduction studies, sympathetic skin responses, and autonomic tests of cardiovagal innervation and of sympathetic vasomotor function were normal.

Histiocytic Reaction Associated with Topical Aluminum Chloride (Drysol Reaction)

In the past few years, dermatologists have begun to use aluminum chloride (Drysol) as a hemostatic agent for minor surgical procedures. An unusual histiocytic reaction was noted in biopsies of skin previously treated with aluminum chloride. This reaction consisted of a proliferation of histiocytic cells that contained prominent basophilic cytoplasmic granules. To determine the cause of this reaction and the nature of the basophilic granular material within the histiocytic cells. Four cases are presented in which re-excised tissue previously treated with aluminum chloride were examined with special histochemistry staining and roentgen diffraction studies. The granules of these histiocytes stained positively with the aluminon stain, a stain specific for aluminum, although no aluminum was found using the less sensitive roentgen diffraction studies. These studies support the concept that aluminum chloride can cause a proliferative histiocytic reaction when used as a topical cauterizing agent.

Aluminum Chloride Hexahydrate Versus Palmar Hyperhidrosis

ABSTRACT: The efficacy of topical aluminium chloride hexahydrate 20% W/W ethanol (ACH) in the treatment symptomatic palmar hyperhidrosis was studied in 12 patients. A half‐sided control single blind (assessor blind) study was done. Patients applied ACH on one palm daily for 4 weeks. The response to treatment was measured objectively with an evaporimeter. There was significant fall of skin water vapor loss (SVL) on treated palms compared with untreated palms. The basal mean SVL of treated palms and untreated palms were 79·9 and 77·9 g water/m2/h, respectively (n.s.). The mean SVLs of treated vs. untreated palms at week 7, 2, 3, and 4 were 66·4 vs. 79·7 (p &lt; 0·05), 56·6 vs. 72·2 (p &lt; 0·001), 58·2 vs. 72·5 (p = 0·1), and 51·4 vs. 72·7 (p &lt; 0·001) g water/m2/h, respectively. The mean SVL of treated palms returned near basal rate within 1 week of stopping treatment. Four patients developed skin irritation from ACH; in three this disappeared after 1 week and they were able to continue with treatment; one withdrew from the study because of the severe irritation. All patients reported that the ACH reduced palmar sweating within 48 hours of application; its effect disappeared within 48 hours after stopping treatment. ACH appeared to be useful in rapid control of palmar hyperhydrosis.

5% Aluminium chloride hexahydrate and sebum excretion rate

The present study was designed to assess whether 5% aluminium chloride hexahydrate in absolute alcohol exerted any effect on sebaceous gland excretory activity. Eleven acne patients controlled with long-term antibiotics applied active and placebo solutions in a double-blind trial. The sebum excretion rate was measured on two control visits and thereafter at fortnightly intervals for a further 6 weeks. Patients preferred the ´active´ solution, many claiming increased dryness of their skin. However, neither the ´active´ nor ´placebo´ solution had a significant demonstrable effect on sebum excretion rate. The beneficial effect of topical aluminium chloride hexahydrate is therefore assumed to be due to factors other than an alteration in sebum excretion.

Treatment of recurrent bullous eruption of the hands and feet (Weber-Cockayne disease) with topical aluminum chloride

Treatment of recurrent bullous eruption of the hands and feet (Weber-Cockayne disease) with topical aluminum chloride

Aluminium chloride for hyperhidrosis

Hyperhidrosis is often embarrassing, and when it is severe most antiperspirants sold over the counter are ineffective. The first line of therapy is to correct any underlying medical disorder such as acromegaly or hyperthyroidism. However, in the majority of patients symptomatic treatment alone is appropriate. Specialists have long prescribed topical aluminium chloride hexahydrate for axillary hyperhidrosis and two preparations are available for general use, Anhydrol Forte (Dermal) and Odaban (Bracey).