Hydrosal, Drysol, and hyperhidrosis

I can now wear tops TWICE and can wear regular shoes. DrySol, you're the best!
--Comment from satisfied user on drugs.com

I had the mixed pleasure of dining at Red Robin recently. Always a pleasure to not cook dinner and not clean up afterwards, but the burger was just so-so. I was briefly alarmed to note as the host seated us that he had enormous sweat rings below his armpits, but then I realized that some misguided RR fashion designer had put darker panels of red material down the sides of the staff's red t-shirts.

Some people, of course, do suffer from axillary hyperhidrosis or excessively sweaty pits. And they suffer terribly, choosing clothing colors less likely to broadcast their problem, keeping their arms close to their bodies. Never raising their hands because they're sure it would be an embarrassing mistake.

Enter Drysol, one of medicine's best kept secrets. Part of the problem, my problem anyway, is the don't ask/don't tell mentality of hyperhidrosis. If I don't ask, patients mostly don't tell me that they suffer from sweaty pits, hair, hands, or feet. Last month, however, I had a patient ask for Drysol by name--he'd heard about it from his nephew. And now he says "It's changed my life."

Those are strong words indeed, praise I most often hear applied to antidepressants, anti-anxiety, and anti-acne medication. Drysol or aluminum chloride hexahydrate is strong stuff. It doesn't always work, and it stings like crazy if applied to wet or newly shaved skin, but when applied with care according to the directions, many hyperhidrotics lose their drip.

Hyperhidrosis is a disorder of sudomotor nerves or those nerves that hook up to and activate sweat glands in response to heat or emotion. While thermoregulation (keeping body temperature in a healthy range) is controlled by the hypothalamus deep and central in the brain, sweaty response to emotion is under the control of the anterior cingulate cortex behind the rational frontal brain and heavily connected to our fear-directing amygdala.

A new preparation of aluminum chloride hexahydrate has been released called Hydrasal which is in a salicyclic acid gel formulation rather than pure alcohol. Small studies recently released at the March meeting of the American Academy of Dermatologists show this product is better tolerated than the Drysol preparation and is also useful in patients who are undergoing Botox injections for hyperhidrosis with incomplete relief of excessive sweating.