How to Prescribe Drysol (Aluminum Chloride)
Drysol (aluminum chloride hexahydrate 20% in alcohol) should be prescribed for hyperhidrosis with nightly application to completely dry skin at bedtime, covered with plastic wrap or occlusion if needed, then washed off in the morning, with frequency reduced to 1-3 times weekly once sweating is controlled.
Initial Prescription Protocol
Patient Selection and Indication
- Prescribe Drysol for primary hyperhidrosis affecting palms, soles, or axillae 1, 2, 3
- Document baseline sweating severity using objective measures or patient-reported scales 3, 4
- Screen for contraindications including broken or irritated skin, known hypersensitivity to aluminum compounds 5
Dosing Instructions
Initial Phase (Weeks 1-2):
- Apply 20% aluminum chloride hexahydrate solution nightly to completely dry skin 2, 3
- Application must be to bone-dry skin; patients should wait 20-30 minutes after bathing before application 3
- Cover treated area with plastic wrap or occlusive dressing overnight if tolerated 2
- Wash off thoroughly in the morning 3
Maintenance Phase (After Week 2):
- Reduce frequency to 1-3 times weekly once adequate control is achieved 3, 4
- Most patients respond within 48 hours of initial application 3
- Effects typically last 48 hours after each application 3
Expected Response Timeline
- Initial response occurs within 48 hours in most patients 3
- Significant reduction in sweating by week 1-2 3, 4
- Maximum benefit typically achieved by week 4 3, 4
- Effects persist for at least 2 weeks after cessation of regular use 4
Critical Prescribing Pitfalls to Avoid
Application Errors
- Never apply to wet or damp skin - this dramatically increases irritation risk and reduces efficacy 3
- Do not apply immediately after bathing - wait minimum 20-30 minutes for complete drying 3
- Avoid application to broken, inflamed, or recently shaved skin 2, 3
Adverse Effects Management
- Skin irritation occurs in approximately 25-33% of patients 3
- Most irritation resolves within 1 week of continued use 3
- If severe irritation develops, discontinue temporarily and restart at reduced frequency 3
- Miliaria (heat rash) can develop with exertion - this is a limiting factor requiring dose adjustment or discontinuation 2
- One study reported only 5% adverse event rate (mild itching) with proper use 4
Monitoring and Follow-up
- Reassess at 2 weeks to evaluate response and tolerability 3, 4
- Adjust frequency based on clinical response - most patients can reduce to 1-3 times weekly maintenance 3, 4
- Counsel patients that sweating returns to baseline within 1 week of stopping treatment 3