Your physician has reviewed your medical information and has prescribed Drysol (20% aluminum chloride hexahydrate) antiperspirant to treat your hyperhidrosis (excessive sweating). Many people who suffer from hyperhidrosis never talk to a doctor or seek treatment for it because they don’t realize it’s a treatable medical condition. You have already taken positive steps by sharing your symptoms with your doctor and starting this treatment plan. With the information below, you are empowering yourself to better understand this condition and improve your quality of life.

Note that this treatment plan is for your general educational and informational purposes only. It is not intended to substitute the personalized medical advice of your physician. It is essential for you to understand the potential risks and benefits of treatment. Always follow your physician’s treatment instructions, and let your physician know if your symptoms persist or if you experience new symptoms or side effects after you begin taking your medication. If you have any questions or concerns about your treatment after reading the information provided here or in the package insert, please contact your Ro-affiliated physician or primary care provider for additional guidance.

Telemedicine has the advantage of convenience, but it relies on your honesty and your involvement in the process. Keep every healthcare provider informed of what you are taking. If any of the following occur, please contact your Ro-affiliated physician:

• Your health status changes or you experience new symptoms

• You experience side effects

• The medicine does not work or stops working over time

• You are prescribed new medications or change how you are taking your existing medications Your physician has prescribed a medication as part of your treatment plan. Being fully informed is the only way for you to know if it suits your needs and if you want to accept it as presented. You may reject it or you may want to request a modification to the plan. Please, do not hesitate to make your voice heard. Contact us with any questions.

Let’s begin. Read everything below and don’t forget to read the package insert included here as well—and when it arrives with your medicine. Keep all the materials handy in case your medical status changes and you need to refer back to it.

Hyperhidrosis (“hyper-hy-DRO-sis”) is the medical term for excessive sweating. The parts of the body that are most frequently affected are the armpits, palms of the hands, and/or soles of the feet. It can also affect the face, scalp, groin, and under breasts. The sweating that occurs is much, much more than normal and occurs regardless of temperature, exercise, or situation, and frequently has a negative impact on quality of life.

What causes hyperhidrosis? Hyperhidrosis is due to overactive signals in the central nervous system, specifically, the sympathetic nervous system, which is responsible for the body’s “fight or flight” response, which includes sweating (as opposed to the parasympathetic nervous system, which mediates “rest and digest”). The sweat glands themselves are normal, they just produce a lot more sweat than they should. There may be an underlying genetic component to the condition, but it’s poorly understood.

The sweating itself is not dangerous, but can be debilitating, and sometimes can cause the skin to become broken down (“macerated”) because of the constant moisture. For example, if your hands are excessively sweaty, you may have tried to avoid shaking other people’s hands, or had trouble doing work or engaging in hobbies that require a dry grip.

Because the cause of the sweating is in the central nervous system, the sweating is almost always on both sides (for example, both armpits, both palms of your hands, or both soles of your feet).

You may not have talked to a doctor about your excessive sweating before, which is actually the case for a lot of other people with hyperhidrosis—60% of people with hyperhidrosis don’t know it’s an actual medical condition, and about half (47%) think there’s nothing that can be done to treat it. Sweating isn’t your fault and it’s a very treatable medical condition.

Your doctor has diagnosed you with primary hyperhidrosis, meaning there’s no underlying cause for your excessive sweating. They’ve investigated for other underlying causes—some of the most important ones include hot flashes, certain medications, and other medical conditions that can cause excessive sweating.

The first line treatment for hyperhidrosis is an antiperspirant. The most widely used active ingredients in topical antiperspirants (either over-the-counter or by prescription) are metallic salts. (“Salt” here refers to a type of chemical compound. Salts are found all throughout nature, and table salt, or sodium chloride, is just one example.) Drysol’s active ingredient is aluminum chloride, which reacts chemically with the lining of sweat ducts, which then become clogged, preventing sweat from forming.

Drysol commonly causes itching and burning at sites where it is applied.

See below under “Important Medication Information” for more on warnings.

An internet rumor from the late 1990s claimed a possible link between antiperspirants and breast cancer and that toxins from antiperspirants could be absorbed and cause cancerous mutations. This has not been conclusively supported by evidence, and the American Cancer Society reports there is no clear link between antiperspirants and breast cancer.

Early research on Alzheimer’s disease from the 1960s found higher levels of aluminum in the brains of people with dementia, and so it was suggested that exposure to aluminum is a risk factor for Alzheimer’s disease. These findings, however, have not been replicated. It is possible that a small amount of aluminum is absorbed into the bloodstream, but high quality research has shown that aluminum and specifically the aluminum in antiperspirant is not associated with Alzheimer’s disease.

Drysol should be applied to the areas where you experience sweating: your armpits, palms of your hands, and/or soles of your feet. Apply a thin layer to affected areas at bedtime (when you’re least likely to be sweating excessively). Your skin should be dry—if needed, you can use a hair dryer on the cool setting to dry off the skin before applying. Apply your usual antiperspirant in the morning.

Apply Drysol every night to begin with, until the sweating is significantly better. For most people, this is within two weeks or so. After the sweating is controlled, you can apply it less frequently, usually once or twice a week or as directed by your doctor.

You should avoid applying Drysol to your armpits if you have recently shaved them. Do not apply if your skin is irritated. If applying it every night is too irritating, tell your doctor—they may recommend that you apply it less frequently.

Your doctor may also recommend that you cover your armpits, hands, and/or feet after applying Drysol, for example with nitrile or latex gloves (available at most pharmacies) over the hands, to help keep Drysol on the skin and prevent it from getting on sheets and other items.

Drysol (and any antiperspirant) may be less effective on the hands and feet than on the armpits, due to thicker skin on the palms and soles. Drysol often causes itching when you first apply it, which usually lasts for a few minutes. It can also cause skin irritation and burning, and shouldn’t be used if you have an active rash or broken skin.

Drysol should only be applied to the armpits, palms of the hands, or soles of the feet. It should not be applied on the face, chest, or back.

Store Drysol at room temperature.

There are several alternative treatments for hyperhidrosis. Most of these are more invasive than Drysol and should generally be used only if a more conservative treatment like Drysol doesn’t work. You should talk with your primary care doctor about specific pros and cons for you. Alternative treatments include:

• Botox injections: these temporarily (~6 months) paralyze the sweat glands. It can be very effective but also painful and expensive.

• Glycopyrronium cloth wipes (Qbrexza): this is a relatively new treatment, and there is some evidence of its effectiveness, but no long term studies. Qbrexza is an anticholinergic medication (blocks part of the nervous system) and can have anticholinergic side effects (dry mouth, blurry vision, etc). It is relatively expensive compared to other, similar treatment options that have been on the market longer.

• Iontophoresis (the no-sweat machine): can be used in people whose hands and feet are affected. The affected areas are immersed in water and a low-voltage electric current is sent through the water, temporarily shutting down the sweat glands. It doesn’t work for everybody and is time-consuming (20-40 minutes several times a week).

• Microwave thermolysis: similar mechanism to iontophoresis; expensive, not easily available, not many studies of effectiveness.

• Systemic anticholinergic drugs (oral glycopyrrolate, oral oxybutynin): these may be effective but cause anticholinergic side effects (dry mouth, blurry vision, etc).

• Suction curettage: this is a surgical procedure done under local anesthesia that involves an instrument inserted under the skin through small incisions in the armpit that scrapes out the sweat glands. This is more invasive than Botox and may not be more effective. It can’t be done on the hands or feet and potential risks include infection and loss of sensation.

• VATS (video-assisted thoracoscopic surgery) sympathectomy: this is a last resort that should only be used in people who fail other treatment modalities and whose quality of life is severely affected by hyperhidrosis. It is a major surgical operation done under general anesthesia. It can be very effective for people with palmar sweating, but in addition to the risks of general anesthesia and major thoracic surgery, there is a risk of rebound/compensatory hyperhidrosis after the surgery, which is (ironically and unfortunately) sweating in other areas of the body. It is also less effective for axillary (armpit) hyperhidrosis.

The information below is taken from the Prescribers’ Digital Reference (PDR), which can be found here.

Side Effects

Reported side effects for Drysol are skin irritation (burning) and itching. These are relatively common and affect up to 10% of people who use it.

Contraindications

Drysol is contraindicated in any patient with a known hypersensitivity to aluminum chloride or any of the product components.

Precautions

• Do not apply to any skin abrasion or inflamed, broken, wet, or recently shaved skin, since excessive irritation may occur. If rash, redness, irritation, or swelling occurs, depending on the severity of the symptoms, frequency of application should be decreased (or discontinued altogether).

• Avoid direct contact with the eyes.

• An FDA pregnancy risk category has not been assigned to aluminum chloride prescription antiperspirant products. Potential benefits of treatment should be weighed against possible risks to the mother and fetus.

• It is not known whether topical prescription strength aluminum chloride is excreted in breastmilk. Minimal systemic absorption is expected following maternal use, and thus, minimal exposure in breast milk would be expected. Consider benefits of breast-feeding, risk of drug exposure, and risk of an untreated or inadequately treated condition.

Drug interactions

There are no listed drug interactions associated with Drysol.