a) ALUMINUM CHLORIDE: In water, aluminum chloride produces aluminum hydroxide plus hydrochloric acid, making a strongly acidic solution. 15% is the maximum concentration allowed for an over-the-counter product. Aluminum chloride is irritating to skin, may damage clothes, but has the best efficacy (Shelley & Hurley, 1980).
b) ALUMINUM CHLOROHYDRATES: There are several formulas with different concentrations of aluminum and chloride. The two most commonly used are Al2(OH)4Cl2(2/3 basic aluminum chloride) and Al2 (OH)5 Cl (which is 5/6 basic aluminum chloride). Aluminum chloride is also available in PEG or propylene glycol complexes to increase its solubility. The maximum allowable concentration for over-the-counter products is 25%. These agents have little skin irritation. A 20% solution in water has a pH of 4.4. Most aerosols are aluminum chlorohydrate and are anhydrous (Emery, 1987).
c) ZIRCONIUM SALTS: These were used in over-the-counter products until they were found to produce skin and lung granulomas. Aerosol products have been banned.
d) ALUMINUM-ZIRCONIUM CHLOROHYDRATES: These are safer than zirconium alone, but rabbits injected with aluminum zirconium-glycine compounds did have skin changes. This substance has a pH of approximately 4 in solution. They can be used topically only in the maximum concentration of 20% (Anon, 1977b). They are weaker acids than aluminum chloride, and have lower irritation potential and cause less damage to clothing (Emery, 1987).
e) BUFFERED ALUMINUM SULFATE: This is available as an 8% solution buffered by 8% sodium aluminum lactate. This is an effective agent and virtually nonirritating.
f) GLUTARALDEHYDE: This agent is usually used in a 2% buffered solution, but only on soles and palms, not axillae.

1) MILD TO MODERATE: Skin and eye irritation can occur after topical or eye exposure; contact dermatitis has been reported. GI irritation can occur after ingestion. Respiratory irritation and cough can occur after inhalation of aerosols.
2) SEVERE: Severe toxicity has not been reported.

1) Systemic symptoms are unlikely. Supportive care for mild irritant symptoms is all that is necessary.

1) Acute toxicity is limited; GI decontamination is not indicated. Wash skin and irrigate eyes. Dilution with small amounts of water may help with GI irritant effects.

1) HOME CRITERIA: Patients with minimal irritant symptoms after inadvertent exposure can be managed at home.
2) OBSERVATION CRITERIA: Patients with deliberate self harm exposures or persistent symptoms should be sent to a healthcare facility for evaluation.

1) Acute toxicity is not significant; do not overtreat.

1) There is little absorption after dermal application.

1) Exposure to other irritants.

1) DECONTAMINATION: Remove contaminated clothing and jewelry and place them in plastic bags. Wash exposed areas with soap and water for 10 to 15 minutes with gentle sponging to avoid skin breakdown. A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999).

1) CORNEAL EPITHELIAL DAMAGE: The aluminum chloride salt used in antiperspirants is aluminum chloride hexahydrate which is not as acidic or caustic as anhydrous aluminum chloride. Antiperspirants accidentally contacting the eyes sometimes cause slight transient disturbances of the corneal epithelium, but no serious or persistent injury has been reported.

1) Inhalation of aerosol antiperspirants may cause temporary cough, but no serious sequelae are expected.

1) Although the antiperspirant aluminum salts are not expected to produce neurologic symptoms, additives, such as ethanol or essential oils, may cause CNS depression or stimulation (ie, seizures) if large quantities have been ingested.

1) CASE SERIES: A controlled study of 130 matched pairs of patients found no significant correlation between lifetime use of aluminum-containing antiperspirants and Alzheimer's disease (Graves et al, 1990).

1) WITH POISONING/EXPOSURE

1) Gastrointestinal (GI) reactions vary by the constituents of the antiperspirant. The aluminum salts used are not caustic and will generally cause only mild to moderate GI irritation.

1) Some of the more concentrated aluminum chloride products are in alcoholic solutions. Thus, the alcohol may cause vomiting or mild CNS depression if the amount ingested is significant.

1) Some of the product bases may contain waxes, glycine and glycerol, fatty acids, and oils which may cause diarrhea when taken in large amounts.

1) These products may be irritating to the skin, producing a burning sensation, tingling, or mild rashes or papules. Skin burns are not anticipated, and allergies are infrequent.
2) CASE SERIES: Four of 12 patients treated with an aluminum chloride hexahydrate antiperspirant developed a stinging sensation immediately after application. The symptom disappeared in 3 patients after 1 week despite continuation of treatment (Goh, 1990).
3) When applied to damp skin, aluminum chloride-containing antiperspirants may be particularly irritating due to the formation of hydrochloric acid (Sweetman, 2003).

1) CASE SERIES: In a study of 982 women who regularly used cosmetics, antiperspirants, deodorants, and personal cleanliness products, only 2% tested positive on patch tests for contact allergy to components of these products while 25% complained of irritation (DeGroot et al, 1988).
2) Chlorphenesin is an antifungal used in antiperspirant/deodorant products. One case of positive patch tests and contact dermatitis due to this ingredient has been reported (Goh, 1987).
3) CASE SERIES: A study of 19 male soldiers was conducted to determine the efficacy of antiperspirants in reducing foot sweat accumulation and injuries. Twelve soldiers (38%) developed irritant dermatitis as a result of application of the antiperspirants to the feet. It is speculated that the dermatitis could be due to the aluminum component in the antiperspirant (Darrigrand et al, 1992).

1) CASE REPORT: A 27-year-old female developed an acutely inflamed right axillary mass following several years of aluminum-zirconium complex-containing antiperspirant use. A histologic examination revealed granulomatous inflammation. The granuloma disappeared after discontinuation of the antiperspirant (Skelton et al, 1993).

1) WITH POISONING/EXPOSURE

A) Patients with minimal irritant symptoms after inadvertent exposure can be managed at home.

A) Patients with deliberate self harm exposures or persistent symptoms should be sent to a healthcare facility for evaluation.

1) Systemic symptoms are unlikely. Supportive care for mild irritant symptoms is all that is necessary.

1) No laboratory measures are necessary with these ingestions.

1) DILUTION: If no respiratory compromise is present, administer milk or water as soon as possible after ingestion. Dilution may only be helpful if performed in the first seconds to minutes after ingestion. The ideal amount is unknown; no more than 8 ounces (240 mL) in adults and 4 ounces (120 mL) in children is recommended to minimize the risk of vomiting (Caravati, 2004).

1) DECONTAMINATION: Remove contaminated clothing and wash exposed area thoroughly with soap and water for 10 to 15 minutes. A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999).

1) Skin irritation due to antiperspirant use can usually be controlled by discontinuation of the product.

1) For the treatment of hyperhidrosis, an antiperspirant containing aluminum chloride in a 20% alcoholic solution is applied to dry skin at bedtime and is washed off in the morning before the sweat glands are completely active (Sweetman, 2001).

1) LD50- (ORAL)MOUSE:
2) LD50- (ORAL)RAT: