From the Research
The first line of treatment for excessive sweating in the hands and soles (palmoplantar hyperhidrosis) is typically topical antiperspirants containing aluminum chloride hexahydrate, such as Drysol (20% concentration). This treatment works by forming plugs in the sweat gland ducts and causing atrophy of secretory cells, as supported by studies such as 1 and 2. Apply the solution to completely dry skin at bedtime, leave it on overnight, and wash it off in the morning. Treatment should be used nightly until sweating is controlled, then reduced to 1-2 times weekly for maintenance. Cover treated areas with plastic wrap or wear cotton gloves/socks to enhance effectiveness. If skin irritation occurs, reduce frequency or apply hydrocortisone cream. Most patients see improvement within 1-2 weeks of consistent use.
Some key points to consider when using aluminum chloride hexahydrate include:
- Apply to completely dry skin at bedtime
- Leave on overnight and wash off in the morning
- Use nightly until sweating is controlled, then reduce to 1-2 times weekly for maintenance
- Cover treated areas with plastic wrap or wear cotton gloves/socks to enhance effectiveness
- If skin irritation occurs, reduce frequency or apply hydrocortisone cream
If aluminum chloride proves ineffective after 4-6 weeks, alternative treatments include:
- Iontophoresis (using electrical current to temporarily block sweat glands)
- Oral anticholinergics
- Botulinum toxin injections
- Referral to a dermatologist for consideration of more invasive options, as discussed in studies such as 3 and 4.
It's essential to note that the treatment approach may vary depending on the severity of the condition and individual patient needs, as emphasized in 4. A therapeutic ladder approach is recommended, taking into account disease severity, benefit-to-risk profile, treatment cost, patient preference, and clinician expertise.