How do I use Drysol (aluminum chloride hexahydrate) to treat maceration on the feet?

Drysol Should Not Be Used for Foot Maceration

Drysol (aluminum chloride hexahydrate) is an antiperspirant designed to treat hyperhidrosis, not maceration, and using it on macerated feet would be inappropriate and potentially harmful. Maceration requires moisture removal and treatment of underlying causes, not sweat reduction.

Understanding the Problem

• Maceration occurs from prolonged moisture exposure, causing skin breakdown that complicates wound healing, particularly in chronic conditions 1
• In diabetic patients at risk for foot ulceration, maceration in interdigital spaces must be treated to prevent ulceration and infection 2
• The International Working Group on the Diabetic Foot (IWGDF) emphasizes that treating maceration, fissuring, and scaling in toe spaces can eradicate pathogen colonization and reduce recurrent infection risk 2

Correct Management of Foot Maceration

Immediate Interventions

• Keep feet dry by washing daily with careful drying, particularly between the toes, as recommended by the IWGDF 2
• Remove moisture away from affected skin through proper dressing selection that controls exudate while maintaining appropriate moisture balance 3
• Avoid footbaths entirely as they induce further maceration 2

Address Underlying Causes

• Treat any fungal infections (tinea pedis) that commonly coexist with interdigital maceration, as fungi thrive in moist environments 2, 4
• Prescribe appropriate footwear that accommodates foot shape, allows ventilation, and prevents excessive moisture accumulation 2
• Apply absorbent antifungal powders containing miconazole, clotrimazole, or tolnaftate in shoes and on feet 2

Ongoing Prevention

• Wear cotton, absorbent socks and change them when damp 2
• Use protective footwear (not walking barefoot or in thin slippers) to prevent trauma to macerated skin 2
• Inspect feet daily for progression of maceration or development of pre-ulcerative lesions 2

Why Drysol Is Inappropriate

• Drysol is formulated for hyperhidrosis (excessive sweating), typically applied to intact skin on areas like axillae or palms 5
• Macerated skin is already damaged from moisture overexposure—applying an irritating aluminum salt solution would cause further breakdown 1, 6
• The mechanism is wrong: maceration needs moisture removal and barrier protection, not sweat gland blockade 6, 3
• Risk of complications: aluminum chloride on compromised skin can cause irritation, and in the case described, even caused miliaria (blocked sweat ducts) on intact skin 5

Critical Pitfall to Avoid

• Never apply topical agents designed for intact skin to macerated or broken skin—this includes aluminum chloride preparations, which are contraindicated in the presence of skin breakdown 5, 6
• In diabetic patients, maceration is a pre-ulcerative sign requiring urgent professional foot care, not self-treatment with over-the-counter antiperspirants 2, 4

When to Refer

• Consult podiatry or wound care specialist if maceration persists despite proper hygiene and drying measures 2
• Immediate referral is required if maceration progresses to ulceration, shows signs of infection (erythema, warmth, purulent drainage), or occurs in a patient with diabetes and peripheral neuropathy 2, 4, 7