Iontophoresis is used as a treatment for palmar and plantar hyperhidrosis, or hyperhidrosis that affects the hands and the feet. It is defined as the introduction of an ionized substance through intact skin by the application of a direct current. Scientists are not yet sure why, but when iontophoresis is applied regularly to the hands and feet, the sweating associated with hyperhidrosis is reduced. It was first discovered to be a helpful treatment for hyperhidrosis in 1936 when a man by the name of Ichihashi used iontophoresis with various solutions of histamine, formaldehyde and other substances. He found that sweating on the palms of his subject’s hands was reduced. Later in the early 1950’s another pair of scientists named Bouman and Gruenwald Lentzer published a paper that stated that iontophoresis was an effective treatment and that an ionized substance, or medication, did not need to be added to water for it to have a positive effect on sweat reduction. Further studies revealed that iontophoresis works well, and that about 85% of people who use it see improvement.[1]

Iontophoresis is a good way to manage hyperhidrosis at home. Most people begin using iontophoresis at their doctor’s office and progress to at-home treatments after familiarizing themselves with the process. There are two machines cleared by the FDA that patients can use at home, these are the R.A. Fischer and Hidrex USA. There are also other brands with good reputations that can be safely used at home. Each machine has its own set of instructions, but the general process is similar. Here are instructions on how to perform iontophoresis at home using the Fischer unit:

1. Fill the two trays with room temperature water up to the electrodes.
2. Use the cords that were supplied with the machine and connect the trays to the unit’s output. Make sure the machine is off while doing this.
3. Before using the equipment make sure the patients has no jewelry on and all cuts are covered with vaseline or a similar substance.
4. With the machine off, have the patient place each hand in one tray. The water should reach just above the tops of the hands. The patients should keep their hands in the tray for the entire treatment time. If the patients removes their hands or touches the electrodes the may feel a slight shock. They should rotate their hands around the electrode as time goes on if they feel the skin close to the electrode becoming irritated.
5. Turn the machine on. Begin with the intensity knob at 0 and gradually increase the amperage until it is between 15 to 18 mA. Treat at this level for 10 minutes.
6. Once the 10 minutes are up slowly decrease the current flow to zero.
7. When the meter reads zero and the active light shuts off, switch the direction of the flow. Repeat steps four through six for another 10 minutes. When done, the patient should have been treated for 20 minutes all together, with the current flow going in opposite directions for 10 minutes each.

The same procedure can be followed when treating feet. It is important to remember that for treatment to be effective, patients need to be treated every two to three days for the first five to ten sessions. Then patients can spread treatments out to once a week or once every couple weeks. If someone finds that iontophoresis is not working well for them, there are things that can be done to make iontophoresis more effective. The process for other iontophoresis units will be similar, but not exactly the same. It is important to first learn how to use a personal unit with the assistance of a medical professional. Some people have asserted that iontophoresis makes sweating worse. No studies have found that this occurs, but for those who experience it there is comforting news. Even if sweating gets worse after initiating iontophoresis it almost always improves if treatments are continued.[1]

It is important to make sure people with pacemakers do not attempt iontophoresis, as it can affect a pacemaker ability to function. Some irritation is normal, especially along the water line. Hydrocortisone cream can help as well.

Sources

1. Stolman, L. P. (2008). Hyperhidrosis Medical and Surgical Treatment. Eplasty, 8(22). Retrieved October 9, 2018.

Many people who struggle with hyperhidrosis also struggle with stinky sweat. The medical term for stinky sweat is bromhidrosis. It is one of several conditions that cause physiological issue related to sweating. Bromhidrosis occurs when bacteria present on the surface of the skin digest the substances that make up sweat. This is especially problematic for people who have overactive sweat glands in the axillary region due to the type of sweat glands in the armpit, the fact that the armpit is moist and dark which is where bacteria grow best, and because it is an area that is often affected by hyperhidrosis. This is where the need for antiperspirant and deodorant arises.[1]

Many people don’t understand what antiperspirant is or how it differs from deodorant, but it is an important distinction. Antiperspirant contains an active ingredient that enables it to reduce the amount of sweat a person can produce, while deodorant has antibacterial properties and a scent to mask the smell of body odor. Both deodorant and antiperspirant are powerful tools for someone who has hyperhidrosis.[2] But, for people who also have Bromhidrosis, deodorant is especially important. This is because the antibacterial aspect of deodorant kills the bacteria that convert sweat, which is actually odorless, into bad smelling metabolites. Deodorant also has a scent that acts as insurance, as it helps to mask any stinky smell from the bacteria that manage to escape death from washing and the antibacterial properties of deodorant.

It has been established that both antiperspirant and deodorant are important tools for people with hyperhidrosis, but which deodorants are the best?

Best Deodorants for People with Hyperhidrosis

Deodorants need to contain certain specific properties in order to help someone with hyperhidrosis. Due to the fact that bacteria cause sweat to stink, a deodorant with strong antibacterial properties is a must. Some deodorants contain antimicrobial metal ions or antimicrobial ceramics that help kill bacteria and prevent the formation of bad smelling molecules that result from the chemical break down of sweat. It is important that any deodorant for someone with hyperhidrosis contains one of these or a comparable antibacterial substitute. Another important feature a strong deodorant needs is a good fragrance. A fragrance can draw attention away from the smell of body odor and mask it so that other people don’t notice it. However, even with these features, deodorant alone is often not enough protection for people with hyperhidrosis because of the volume of sweat they produce.[1]

For someone with hyperhidrosis, sweat control is the main objective. Many people wonder whether they should use antiperspirant or deodorant in order for that to happen. To obtain optimal sweat control, antiperspirant needs to be part of the plan. Luckily, there are antiperspirant deodorants on the market that can reduce sweat production, kill bacteria, and mask the smell of body odor with a fragrance. These are the products that will be most helpful for someone with hyperhidrosis. Antiperspirants are considered to be the first line treatment for hyperhidrosis, and adding the properties of a deodorant on top of that makes antiperspirant deodorants even more effective. It is a good idea to choose a soft-solid antiperspirant deodorant as they tend to be most effective.[1]

It can be difficult to choose the right over-the-counter antiperspirant deodorant, but understand the active ingredients and learning how to read the labels can help. Here are some specific examples of antiperspirant deodorant products on the market that can help control sweat and eliminate odor:

Certain Dri Everyday Strength Clinical Solid - This product contains 20% Aluminum Zirconium Complex as well as deodorant properties to lessen sweat production and keep people smelling good.

Dove Clinical Protection Antiperspirant Deodorant - It contains Aluminum Zirconium Tetrachlorohydrex Gly (20%) to block sweat production and combines it with moisturizer and a deodorant fragrance to mask odor.

In some instances a combination product may not be strong enough, in which case you should move on to a stronger antiperspirant. If you still want the benefits of a deodorant but you really need an antiperspirant, then try using a strong antiperspirant, like SweatBlock Clinical Strength Antiperspirant, and add a regular deodorant with a fragrance you like on top of it to mask any odor.

Unfortunately, antiperspirants can often leave stains, but it is possible to get antiperspirant out of clothes and keep your wardrobe safe. It may take some trial-and-error but you can find an antiperspirant and deodorant or a combination product that works for you. If you feel that antiperspirants and deodorants are not enough to control your sweat then looking into other treatments for axillary hyperhidrosis and finding other ways to manage your sweat can help.

Sources

1. Perera, E., & Sinclair, R. (2013). Hyperhidrosis and bromhidrosis: A guide to assessment and management. Australian Family Physician, 42(5), 266-269. Retrieved November 6, 2018.
2. Zirwas, M. J., & Moennich, J. (2008). Antiperspirant and Deodorant Allergy Diagnosis and Management. The Journal of Clinical and Aesthetic Dermatology, 1(3), 38-43. Retrieved October 3, 2018.

Iontophoresis is a treatment for palmar and plantar hyperhidrosis that uses a direct current to introduce an ionized substance through the skin. It conveniently allows patients to manage their hyperhidrosis at home. Typically, once a patient obtains a machine, the process is cheap and relatively easy to maintain. Iontophoresis for palmar and plantar hyperhidrosis has been proven to be an effective treatment.[1] However, some people find that iontophoresis is not working for them. There are several modifications people can make to their treatment plan that can make iontophoresis more effective.

Most of the time, a hyperhidrosis patient will learn how to use iontophoresis under a doctor, or other medical care professional’s, guidance. This is important because there are many factors to consider when beginning iontophoresis, such as the machine settings, length of sessions, frequency of sessions, and the strength of the current. Patients should follow their doctor’s instructions carefully.

Sticking to the Plan and Giving It Time

Many times, patients begin iontophoresis sessions at home expecting results. When those results fail to happen, the patient is disappointed and often jumps to the conclusion that iontophoresis is not going to work for them. This may be true, but it is more likely that they just need to give iontophoresis more time to work. Often, sticking to the original plan will yield results if given enough time.

If a patient has not consulted a medical professional and has purchased a machine on their own, the problem may be that they do not have a sufficient plan. They either need to consult a professional, or learn how to use iontophoresis efficiently in order to make a plan that will work.

In most cases, iontophoresis takes at least two weeks of consistent use to show results. Sometimes it can take even longer.[2] For a patient dealing with burdensome symptoms, that is a long time, and it can lead some to change their treatment plan prematurely. When patients discontinue, or alter iontophoresis sessions out of frustration, this can greatly impact results. It is best to give iontophoresis time to work. If no progress is seen after several weeks, a patient should ideally consult their doctor who can help them come up with a new course of action.

Track Progress

Sometimes it is hard to notice changes that occur over time. Monitoring symptoms and writing them down can help patients determine whether or not iontophoresis is helping them. Writing down symptoms will not make iontophoresis work any better, but it will help patients and doctors determine whether changes to the treatment plan need to be made.

Change the Settings

There are several settings on an iontophoresis machine that can be adjusted to increase effectiveness. These include the session length, current strength, type of current, and anode or cathode settings. Turning up the voltage can make iontophoresis more efficient if a lower voltage setting is not working. Unfortunately, a higher voltage is more likely to cause irritation and can make sessions more uncomfortable. Increasing the length of an iontophoresis session can also help in some circumstances. Before changing too many settings, it is wise to speak with a professional who is familiar with iontophoresis and can give advice based on individual circumstances.

Adding New Ingredients

Some people find that iontophoresis with tap water alone is not enough to reduce their sweating. While there are several studies that show tap water iontophoresis is quite effective, in some situations ingredients can be added to increase the potency of iontophoresis.

Add Baking Soda

Tap water in some areas may not have enough mineral content for iontophoresis to work properly. When mineral content is too low the current can’t flow through the water sufficiently for iontophoresis to be effective. This can easily be corrected by adding one teaspoon of baking soda to each tray of water. This should improve the situation and make iontophoresis work if low mineral content is the underlying problem.[1]

Add a Medication

When tap water iontophoresis is not working for an individual, medication can be added to the tap water to make improve treatment.Glycopyrrolate has been used to treat excessive sweating for years, as it is an anticholinergic medication which acts on the autonomic nervous system in such a way that it prevents the body from producing sweat. It is also one of the oral medications for hyperhidrosis that doctors prescribe. When glycopyrrolate is crushed and added to the tap water in iontophoresis trays, it has been shown to enhance the effects of iontophoresis. One study looked at the effectiveness of iontophoresis with tap water, tap water and glycopyrrolate, and a combination of both to determine whether glycopyrrolate made improved iontophoresis. In the study patients were given either bilateral (both hands), unilateral (one hand), or no treatment with glycopyrrolate. It was found that the patients who received bilateral treatment with glycopyrrolate added to the tap water had a reduction in sweating that occurred sooner and lasted longer than the other groups. If a patient decides to begin using the medication, it is suggested that they start with 2 mg tablets of glycopyrrolate crushed and added to the tap water in the iontophoresis trays. The dose can be adjusted up or down based on the patient’s needs. Side effects from glycopyrrolate can occur.[1]

Another medication that can be added to tap water is botulinum toxin, or botox. Botox is a neurotoxin, produced by the bacteria Clostridium botulinum, that can prevent neurotransmitters from activating eccrine sweat glands. Botox injections for the treatment of axillary hyperhidrosis are approved by the FDA, and have been successfully used to reduce sweating in the hands and feet. One study of eight patients with palmar hyperhidrosis demonstrated that botox can make symptoms of hyperhidrosis lesson. The patients in the study who were given botox mixed with tap water experienced symptom relief at one week versus the patients in the other group who experienced relief at three weeks.[3]

Consider Combination Therapy

If iontophoresis is only partially effective, even with added medications and adjustments, patients should consider combination therapy. This often means combining clinical strength over-the-counter antiperspirants or prescription antiperspirants with an iontophoresis regimen. Mixed therapy allows patients to use iontophoresis less frequently, which can in turn increase convenience and patient compliance.[1] Patients can also use iontophoresis along with other treatment options as their doctors see fit.

Iontophoresis really does work for most hyperhidrosis patients who try it. The struggle patients go through to get iontophoresis to work is usually worth it, as iontophoresis is one of the safest effective treatments available for palmar and plantar hyperhidrosis.

Sources

1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Philadelphia, PA: Elsevier.
2. Walling, H. W., & Swick, B. L. (2011). Treatment Options for Hyperhidrosis. American Journal of Clinical Dermatology, 12(5), 285-295. Retrieved October 9, 2018.
3. Benson, R A, et al. “Diagnosis and Management of Hyperhidrosis.” British Medical Journal, vol. 347, 25 Nov. 2013, doi:10.1136/bmj.f6800.

About 25% of people with hyperhidrosis suffer from overactive sweat glands on both their hands and feet.[1] While there are several treatment modalities available, iontophoresis for palmar and plantar hyperhidrosis offers a relatively convenient and noninvasive treatment option. But, is iontophoresis really effective? Research says, that for the most part, it is.

The idea of using iontophoresis for the treatment of hyperhidrosis was first mentioned in medical texts in 1936. By 1952, a study on the efficacy of iontophoresis had been completed. This study found that 85% of the people in the study saw significant improvement after using tap water iontophoresis. The study was comprised of 113 participants who were given a simple galvanic device which allowed them to perform iontophoresis at home. This study demonstrated that iontophoresis could be effective when only tap water was used. That fact was important because it was done at a time when people were questioning the use of tap water for iontophoresis and trying to discover how to make iontophoresis more effective.[1]

More recent data also supports the use of iontophoresis. A study was conducted in 1989 in which patients were given either real or fake iontophoresis. After a median of 10 treatments, the participants who received real iontophoresis demonstrated an 81% reduction in sweat production when tested by a gravimeter (a tool used to measure the weight of the sweat a person produces).[1] An even more recent study, which took place in 2002, consisted of 112 patients who had palmar hyperhidrosis, also had promising results. It showed that sweating was reduced by 81.2% when compared to a patient’s baseline after eight treatments. The improvements were recorded 20 days after the last iontophoresis session and symptoms began to return 35 days after the last session.[1] These studies demonstrate that iontophoresis is quite effective in most patients, although iontophoresis must be continued regularly for results to last.

Studies have shown that iontophoresis is effective, but how does it work? Many doctors and scientists have asked that same question, and unfortunately, no one truly knows. Iontophoresis is defined as the introduction of an ionized substance through intact skin by the application of a direct current. It is currently thought that the action of iontophoresis effectively plugs sweat glands so that sweat cannot escape to the surface of the skin. This is the current belief because the effects of iontophoresis can be reversed by stripping cellophane tape over areas of “inactivated” sweat glands that were previously treated by iontophoresis. It is thought that the cellophane removes plugs formed by iontophoresis.[3] Some, however, disagree with the idea that sweat glands are mechanically plugged during iontophoresis. One research team looked at eccrine (sweat gland) cells from the palm of a patient both before and after receiving iontophoresis treatment. The team used light and electron microscopy to examine the cells and found no changes to them.[4]

Iontophoresis really does work, regardless of the fact that scientists are not sure why. It provides patients with a treatment option that is safe, effective, and cheap. If someone finds that tap water is ineffective, other substances can be added to make iontophoresis more effective. Many times, when a patient finds that iontophoresis isn't working it is because they don't know how to perform iontophoresis properly, or they need to make adjustments to their treatment. However, for some people, iontophoresis will not be the right answer. Some patients complain that iontophoresis makes their sweating worse but there have not been any current studies that corroborate this. Luckily, for those that do feel that iontophoresis increases their sweating it appears to be a temporary situation that usually improves over time if treatment is continued. If iontophoresis is not working for you, there are other options like botox for palmar and plantar hyperhidrosis and oral medications for hyperhidrosis that can help alleviate symptoms. For those with severe symptoms that don’t respond to other treatments, a type of surgical treatment for primary focal hyperhidrosis called endoscopic thoracic sympathectomy may be an option.

Sources

1. Eze, N. M., Njoku, H. A., Eseadi, C., Akubue, B. N., Ezeanwu, B. A., Ugwu, U. C., & Ofuebe, J. I. (2017). Alcohol consumption and awareness of its effects on health among secondary school students in Nigeria. Medicine, 96(48). doi:10.1097/MD.0000000000008960
2. Huddle, J. R. (2014). Hyperhidrosis: Causes, Treatment Options and Outcomes. New York, NY: Nova Science.
3. Paton, A. (2005). Alcohol in the Body. British Medical Journal, 330, 85-87. doi:10.1136/bmj.330.7482.85
4. Morozova, T. B., Mackay, T. F., & Anholt, R. R. (2014). Genetics and genomics of alcohol sensitivity. Molecular Genetics and Genomics, 289(3), 253-269. doi:10.1007/s00438-013-0808-y
5. Skin Diseases and Conditions - Hyperhidrosis; Researchers from Umea University Detail Findings in Hyperhidrosis (Primary hyperhidrosis: Implications on symptoms, daily life, health and alcohol consumption when treated with botulinum toxin). (2016, October). Health and Medicine Week.

Hyperhidrosis is known to affect around 3% of the American population, and about half of those people will have plantar hyperhidrosis, or excessive sweating on the soles of their feet.[1][2] When someone is diagnosed with primary focal hyperhidrosis, the type of hyperhidrosis that causes excessive sweating on specific areas of the body, they are first directed to use conservative treatments. For those with plantar hyperhidrosis, the conservative treatment options include topical over-the-counter treatments (antiperspirant), iontophoresis for plantar hyperhidrosis, botox for plantar hyperhidrosis and oral medications for hyperhidrosis. For some people with severe plantar hyperhidrosis these treatments, and even combinations of these treatments, do not seem to be enough. At this point, doctors may begin to talk to patients about surgical treatments for primary focal hyperhidrosis. Most of the time a procedure called an endoscopic thoracic sympathectomy is suggested for people who have palmar hyperhidrosis. There is a similar surgical procedure for people with plantar hyperhidrosis called endoscopic lumbar sympathectomy. However, this surgery comes with some very big risks and many sources advise against its use.

What It Is and How It Works

An endoscopic lumbar sympathectomy is a surgery used to stop excessive sweating from overactive sweat glands on the soles of feet by disrupting nerve signals from the sympathetic nervous system to the feet. This essentially blocks sympathetic nerves from telling the eccrine glands on the feet to produce sweat, thereby preventing excessive sweating. The procedure is similar to how an endoscopic thoracic sympathectomy is performed, only it is performed on a lower level of the spine, usually around L3 and L4.[3]

Before surgery, a patient is administered general anesthesia. A surgeon will mark the areas where they are going to make small incisions. The incisions are made somewhere between the end of the rib cage and the top of the hip bone, and a tiny camera is inserted so the surgeon can see inside the body. Once this has been done the surgeon inserts a balloon into the retroperitoneal cavity and inflate it to make room for the surgeon to visualize and carry out the procedure. Once the sympathetic nerve chain is located the surgeon will clamp it (or use another technique to disrupt it) between the T3 and T4 vertebrae. The procedure can be done unilaterally (on one side only) or bilaterally (both sides) depending on the surgeon and the patient’s needs. The surgeon must be extremely careful not to damage other important nerves, the ureters, lymphatic vessels, the lumbar vein, and other anatomy in that region.[3]

Depending on the surgeon, a patient may be allowed to leave several hours after surgery, or they may have to stay in the hospital for a few days.[3] Most patients do experience significant pain which can last for longer than ten days, in some instances it has been to last for up to three months.[1]

Efficacy

The efficacy of endoscopic lumbar sympathectomy surgery needs to be studied further before any final conclusions about the procedure can be drawn. The studies that have been done on the procedure seems to demonstrate that the surgery is effective at reducing sweating of the feet. One study claimed that ELS could eliminate hyperhidrosis symptoms of the feet over 95% of the time. This shows that the surgery is effective, but the same study also reported that over two-thirds of the patients developed unwanted side effects, specifically neuralgia and compensatory sweating. Overall, the study found that even in patients who suffered from side effects, they still had a statistically significant improvement in their quality of life.[4] Another study, which collected data on a group of women undergoing ELS found that 53% of the patients were unhappy with the aesthetic alterations caused by the surgery. The same study reported that overall the patients in the study had an increased quality of life afterward.[2] Endoscopic lumbar sympathectomy appears to be effective at reducing sweating of the feet, but at a high cost, that many deem unnecessary. Interestingly, 60% of patients who undergo endoscopic thoracic sympathectomy, a type of surgical treatment for palmar hyperhidrosis, also sweat significantly less from their feet.[1]

Complications and Dangers of Surgery

There are several complications that can occur during or after ELS surgery, and it is extremely important for patients to take this into consideration. One of the most dramatic side effects of surgery is ejaculatory impotence in men, and it can be assumed that surgery may also affect women’s genitosexual innervation as well. Some surgeons will only perform the surgery on women, but the practice is questionable because they can suffer nerve damage as well.[5] One study said that out of 92 bilateral ELS surgeries only one man suffered impotence, however, that is a rate of higher than 1%.[4] Another complication is compensatory sweating, which is when sweating becomes worse on other areas of the body once sweating on the original problem area is treated. There is a high incidence of compensatory sweating after ELS, with 87.5% of patients developing it in one study.[6] Postoperative neuralgia, which is considered to be pain of the groin, thigh, or back of varying intensity, is probably the third most significant side effect. One study concluded that two-thirds of patients developed either compensatory sweating or neuralgia.[4] There are other surgical dangers that can occur if a surgeon makes a mistake during a procedure as they are operating near vital organs and nerves.

Overall, endoscopic lumbar sympathectomy seems to be an effective procedure that is rife with complications and serious side effects. Patients should be cautious when thinking about this operation, as many doctors who manage hyperhidrosis cases strictly advise against it.

Sources

1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Philadelphia, PA: Elsevier.
2. De Paula Loureiro, M., De Campos, J., Kauffman, P., Jatene, F. B., Weigmann, S., & Fontanac, A. (2008). Endoscopic Lumbar Sympathectomy for Women: Effect on Compensatory Sweat. Clinics,63(2), 189-196. Retrieved October 1, 2018.
3. Reisfeld, R. (2010). Endoscopic Lumbar Sympathectomy for Focal Plantar Hyperhidrosis Using the Clamping Method. Surg Laparosc Endosc Percutan Tech, 20(4), 321-236. Retrieved October 2, 2018.
4. Rieger, R., Pedevilla, S., & Lausecker, J. (2015). Quality of Life After Endoscopic Lumbar Sympathectomy for Primary Plantar Hyperhidrosis. World Journal of Surgery, 39, 905-911. doi:10.1007/s00268-014-2885-4
5. Collin, J., & Whatling, P. (2000). Treating hyperhidrosis Surgery and botulinum toxin are treatments of choice in severe cases. BMJ, 320(7244), 1221-1222. Retrieved October 2, 2018.
6. Wolosker, N., Ishy, A., Yazbeck, G., Milanez de Campos, J. R., Kauffman, P., Puech-Leão, P., & JateneII, F. B. (2013). Objective evaluation of plantar hyperhidrosis after sympathectomy. Clinics,68(3), 311-315. doi:10.6061/clinics/2013(03)OA05

It can be challenging to decide which antiperspirant is the right one for you, especially when many people don't understand what antiperspirant does and how it is different than deodorant. Antiperspirants actually block the production of sweat, while deodorants have antibacterial properties and contain scents to mask the smell of body odor. There are a plethora of over-the-counter topical treatments for hyperhidrosis, which can make it overwhelming when trying to figure out which one will be most effective. Antiperspirants are considered to be the first-line treatment for someone with primary focal hyperhidrosis as they are easily accessible, noninvasive and quite effective for many people. They are advantageous because they can be used on a wide variety of body parts that are affected by excessive sweating such as the palms of the hands, soles of the feet, the armpits, the face, and even the groin and back.[1] The key to finding the right antiperspirant is understanding the ingredients that are used in them and understanding what is written on the label.

Antiperspirant Strength

Antiperspirants come in a variety of strengths and it is important to understand what this actually means. Typically, brands have a regular strength option and a clinical strength option. The regular strength option may contain a different active ingredient than the clinical strength version, or it may have the same active ingredient but contain a smaller percentage of it.[1] There is also a significant price difference between the two. For example, Dove has a regular strength antiperspirant (they call it Advanced Care) that uses Aluminum Zirconium Tetrachlorohydrex Gly 15.2% as it’s active ingredient, while its clinical strength version uses Aluminum Zirconium Tetrachlorohydrex Gly 20%. On Amazon, the price of the regular strength is $8.10 for two bottles and it is $8.52 for one bottle of the clinical strength version. The clinical strength version of Dove contains 5% more of the active ingredient, but the price is about 50% higher than the regular. This demonstrates why it is so important to read the information about an antiperspirant product before you buy it. Clinical strength products are less likely to cause irritation and almost always contain a newer generation of active ingredients that are typically more effective.[1] Some of the brands that include a clinical strength option are Dove, Gillette, Secret, Arrid, Sure, PerspireX, Certain-Dri, SweatBlock, Degree, Hydrosa and various others.

Antiperspirant Ingredients

The active ingredient is what makes an antiperspirant work. The most common active ingredients used in antiperspirants are aluminum chloride and aluminum chloride hexahydrate. Many antiperspirants also use other metallic salts as an active ingredient, which act in a similar way as aluminum chloride. All over-the-counter antiperspirants have active ingredients that mechanically block overactive sweat glands from producing more sweat. Here is a break down of the common active ingredients in antiperspirants, and how they work:

Aluminum Chloride

Aluminum prevents sweat from being produced by obstructing eccrine sweat gland ducts so that sweat cannot be released. Aluminum chloride is in a partially neutralized form, as opposed to aluminum chloride hexahydrate, which is in an active form. Metal ions in the aluminum interact with other molecules in the skin in such a way that the epithelial cells in sweat glands are damaged and form a sort of plug. Sweat glands can still produce sweat, but the sweat cannot make it to the surface of the skin because of the plug. The plug formed by aluminum chloride lasts for about 24 hours. Eventually, the epithelial cells of the sweat glands recover and a new layer of aluminum chloride must be applied. Long-term histologic studies have shown that when people use aluminum chloride for a long period of time the aluminum actually damages some of the secretory cells within the sweat glands. This can cause a permanent reduction in the amount of sweat produced and, therefore, reduced symptoms of hyperhidrosis. Aluminum chloride is effective at reducing sweat production, but some studies have found that aluminum chloride can be quite irritating. Doctors may recommend using 1% hydrocortisone cream to treat irritation caused by aluminum chloride. Several years ago there was controversy over whether or not aluminum antiperspirants cause cancer, but it has been found that they do not.[1]

Aluminum Chloride Hexahydrate

Antiperspirants with aluminum chloride hexahydrate are usually clinical strength. When offered in a concentration of 20% or higher a prescription is required. Aluminum chloride hexahydrate is typically used if aluminum chloride alone is not effective.[1] Aluminum chloride hexahydrate is thought to work in a similar way to aluminum chloride, but its exact mechanism is not understood. Some researchers posit that there is an interaction between aluminum chloride hexahydrate and keratin in sweat ducts that causes the ducts to close. Another theory is that aluminum chloride hexahydrate works on secretory epithelial cells within sweat ducts. In either case, it has studies have proven that aluminum chloride hexahydrate is very effective at reducing sweat production.[1]

Irritation From Aluminum Antiperspirants

One of the drawbacks of using aluminum chloride or aluminum chloride hexahydrate is that they can be very irritating. This is partly because hydrochloric acid forms when a body part with aluminum chloride or aluminum chloride hexahydrate is exposed to water. Sometimes patients are told to use 1% hydrocortisone cream in order to combat irritation.[1] One study found that when mixed with salicylic acid, aluminum chloride hexahydrate produced much less irritation and still effectively reduced sweating. Some products now use both of these ingredients together in order to reduce side effects. Several products on the market today use this successful combination.[3]

Aluminum Zirconium Trichlorohydrex

Newer, clinical strength over-the-counter antiperspirants often use an ingredient called aluminum zirconium trichlorohydrex to reduce sweating associated with hyperhidrosis. These products have been shown to provide more sweat protection and cause less irritation than aluminum chloride products. They produce less irritation because produce as much as 80% HCl than aluminum chloride. Aluminum zirconium trichlorohydrex blocks sweat ducts in a similar way to aluminum chloride, but at a more superficial level. The type of blockage made by aluminum zirconium trichlorohydrex lasts for around seven days. It also produces much less HCl, the chemical that causes skin irritation, than typical aluminum chloride formulations. These newer products may provide a solution for people with sweating in more sensitive areas.[1]

Aluminum Sesquichlorohydrate

Another active ingredient called aluminum sesquichlorohydrate is now being used in some of the newest antiperspirants on the market. It is said to cause less irritation but still effectively reduces sweating. Currently there are no major studies corroborating its effectiveness although these may come in the future.

Choosing an Antiperspirant

Once a person is able to understand how to read an antiperspirant label, and the advantages and disadvantages of each type of active ingredient, they can pick an antiperspirant that will work for them. It is also important to consider the part of the body the antiperspirant will be used on. If, for example, someone needs an antiperspirant for the face or groin, which are sensitive areas they should be careful to only use formulations designed for sensitive skin. They may want to choose a product with aluminum chloride hexahydrate mixed with salicylic acid, aluminum sesquichlorohydrate, or use one of the newer generation products with aluminum zirconium trichlorohydrex.

It is best to try the regular strength products before moving on to stronger formulations, as they are less likely to cause irritation. Formulations with 10 to 15% aluminum chloride hexahydrate can be used to treat axillary hyperhidrosis, while those who need treatment for sweaty hands or feet will probably need to use 30% aluminum chloride. Make sure to apply antiperspirant correctly, or it may be less effective. If over-the-counter antiperspirants are not enough, then prescription antiperspirants are the next step. It can also be helpful for people with hyperhidrosis to employ some other strategies to manage their hyperhidrosis via alternative methods like choosing clotheing that promotes less excessive sweating and learning how to put antiperspirant on correctly.

Sources

1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Philadelphia, PA: Elsevier.
2. Ellis, H., & Scurr, J. H. (1979). Axillary hyperhidrosis - topical treatment with aluminium chloride hexahydrate. Postgraduate Medical Journal, 65(650), 868-869. doi:10.1136/pgmj.55.650.868
3. Huddle, J. R. (2014). Hyperhidrosis: Causes, Treatment Options and Outcomes. New York, NY: Nova Science.