Society Spotlight: The Efficiency of Antiperspirant Products to Reduce Perspiration of Residual Lower Limbs
December 2012 Issue
As many as 50 percent of individuals with lower-limb amputations have demonstrated skin complications during use of their protheses.1 The socket environment closes the limb in snugly, restricting the airflow and making it nearly impossible to keep the limb cool. Skin problems such as blisters and other macerations resulting from friction and exacerbated by perspiration buildup are cited as common problems. Heat rash is another condition that often results from excessive perspiration. Folliculitis, a bacterial infection of the hair follicle, contact dermatitis, or allergic reactions in the form of a rash or dry, irritated skin are other frequent conditions cited by researchers.1,3,4 All of these conditions related to excessive perspiration not only complicate the prosthetic fit and use but also have the potential to adversely affect multiple aspects of an amputee's life. Because excessive perspiration predisposes them to infection and skin sensitivity, this problem is especially troublesome for patients with diabetes, who account for nearly 80 percent of the lower-limb amputee population.2 Further, compromised residual-limb tissue is often accompanied by increased problems with prosthetic fit and comfort as well as general pain and distress. This functional loss adversely affects the physical, social, psychological, and emotional well-being of the amputee.5,6
Although there has been extensive research conducted to determine the prevalence and pathology of problems related to excessive perspiration, there is an absence of research being conducted to remedy the issue. There are, however, products that are commonly recommended by prosthetists to help improve the socket environment by decreasing limb perspiration. ALPS, St. Petersburg, Florida, produces a special skin care system that includes a spray-on antiperspirant. Additionally, DSE Healthcare Solutions, Edison, New Jersey, manufactures a nonprescription roll-on antiperspirant called Certain Dri®, advertised to provide 72 hours of protection from excessive perspiration. Some prosthetists, such as Tony van der Waarde, CP(c), recommend natural crystal alum to fight perspiration.7 The purpose of this study is to determine which of these three test products is most effective.
Nearly one out of every 400 people with an amputation in the United States has suffered from a skin condition rendering his or her prosthesis useless.1,2 These individuals are prone to skin problems as the reduced surface area of the skin after an amputation results in a less efficient skin cooling system. A compounding complication involves the intimate fit of the socket, which restricts the natural process of perspiration evaporation.8-9 As blisters form more quickly under warm, moist conditions, perspiration buildup that occurs within the socket can have serious skin consequences.10
Excessive perspiration is a major cause of pistoning. Pistoning creates higher peak pressures, especially during the loading response phase of gait, as well as increased shear and friction forces that lead to skin abrasions.8 Moisture within the socket not only subjects the skin to higher pressures but it also encourages bacterial breeding. An increase in skin bacteria, in turn, compromises the skin's normal infection-fighting power.9 Bacterial infections are more prominent in the summer when there is a marked increase in temperature and moisture.3
Jeffery Peery, MS; William Ledoux, PhD; and Glenn Klute, PhD,10 discovered that skin temperature in a transtibial socket depends on both activity and locality after measuring limb temperature while progressively increasing activity level. The increase in activity level resulted in an increase in perspiration suggesting that the more active an amputee is, the more at risk he or she is for formation of skin breakdowns.5
Chris Lake, CPO, and Terry J. Supan, CPO, found that nearly 50 percent of the participants in their study on dermatological conditions associated with silicone suspension sleeves suffered from heat rash and folliculitis.1 Many patients who use silicon suspension sleeves reported increases in perspiration and eruption on the residual limb.1,11 These results solidify the positive relationship between perspiration and skin complications.
Similar to silicon suspension sleeves, the introduction of silicon liners, while providing comfort, increased the frequency of perspiration as discovered by Kenji Hachisuka.11 Factors such as perspiration, itching, and odor were identified as predicted values of hygiene problems. Hachisuka concluded that keeping the residual limb clean is critical to reduce skin problems.11
Alum, a natural crystal found in the earth, is an astringent that is used as an antiperspirant and recommended to reduce perspiration and therefore skin breakdown. van der Waarde7 suggested the effectiveness of alum after conducting a study with five golfers who had amputations. Prior to the study, each subject reported skin problems such as eczema, contact dermatitis, or heat blisters. Four out of five subjects reported significant relief after applying alum to their residual limb, and 75 percent of the subjects stated they would continue to use the product routinely.7
There have been several O&P-specific studies to identify the dermatologic conditions that arise during prosthetic use. The studies have revealed that skin irritations with excessive perspiration are not only prevalent among amputees but have also proven to have significant negative effects. However, the lack of scientific data to support specific antiperspirant recommendations leaves individuals with amputations at risk for the development of skin irritations.
- To discover a simple, inexpensive, and readily available product to decrease residual-limb skin perspiration.
- To determine the effectiveness of ALPS' Prosthetic Antiperspirant, natural crystal alum, and CertainDri.
Twelve subjects were randomly chosen. They all receive prosthetic care at Hanger Clinic, Waterbury, Connecticut. To be eligible for the study subjects had to meet the following criteria:
- Have a lower-limb amputation; be of any gender, age, or race; and report history of problems with excessive perspiration.
- Have normal cognition.
- Wear a total surface bearing (TSB) socket that utilizes some type of gel liner donned directly against the skin.
- Wear the prosthesis for at least six hours per day.
- Have at least a K3 functional classification.
Three subjects were placed in a control group that did not use any type of product on their residual limb. Nine subjects were randomly placed into the experimental group, broken into ALPS' antiperspirant users, natural crystal alum users, or Certain Dri users. These nine subjects were then provided with one of the three products and instructed to use the specific product every day for the duration of the one-week testing period. After the completion of the experiment, the subjects completed a questionnaire that addressed their satisfaction with the product in question.
A negative relationship was found between the use of the antiperspirant products and degree of perspiration in 77.7 percent of subjects. Only two out of the nine experimental subjects reported no change in degree of perspiration after the use of their assigned product. However, subjects who used Certain Dri reported the greatest degree of effectiveness, followed by ALPS' antiperspirant, then natural crystal alum.
The study subjects found Certain Dri antiperspirant to be the most effective in reducing excessive perspiration, however all three products were effective to some extent. It is possible that the unique application of the product contributed to its usefulness, as Certain Dri, unlike the other product tested, is to be applied to the skin at night. The subjects who reported no improvement after use of an antiperspirant could be a consequence of factors such as temperature, weather, or non-compliance, which are limiting factors within this type of experiment that cannot be fully controlled.
The results of this study provide support for the recommendation of Certain Dri antiperspirant for the use of excessive perspiration experienced by lower-limb amputees. The data indicates that use of Certain Dri can increase prosthetic fit comfort, improve self-esteem, and reduce the risk for developing skin conditions and irritations that can interfere with prosthesis use. Through further research and investigation into these and other readily available products, it may be possible to improve the prosthetic wearing experience for nearly all lowerlimb amputees.
Abbey Downing, CPO, practices at Hanger Clinic, Torrington, Connecticut. She completed a bachelor's degree in movement science at the University of Michigan, Ann Arbor, and received her prosthetics and orthotics certificate at the Newington Certificate Program, Connecticut.
Society Spotlight is a presentation of clinical content by the Societies of the American Academy of Orthotists and Prosthetists in partnership with The O&P EDGE.
The O&P EDGE does not endorse any particular product or service. The information in this article is for reader information only.
- Lake, C. and T. J. Supan. 1997. The incidence of dermatological problems in the silicone suspension sleeve user. Journal of Prosthetics and Orthotics 9(3):97-106.
- Below Knee Prosthetics. 1988. Prosthetics-Orthotics Program: University of Texas Southwestern Medical Center, Dallas, Prosthetics-Orthotics Program.
- Levy, S.W. 1999. Skin care determines prosthetic comfort. BioMechanics (April):45-54.
- Lyon, C. C., J. Kulkarni, E. Zimerson, E. Van Ross, and M. Beck. 2000. Skin disorders in amputees. Journal of the American Academy of Dermatology 42(3): 501-7.
- Dudek, N. L., M. B. Marks, S. C. Marshall, and J. P. Chardon. 2005. Dermatological conditions associated with use of a lower-extremity prosthesis. Archives of Physical Medicine and Rehabilitation 86(4):659-63.
- Levy, S. W. 1995. Amputees: skin problems and prostheses. Cutis 55(5):297-301.
- van der Waarde, T. Don't sweat it! Prosthetist's Column, inMotion, December 1996.
- Backus, B. 2005. Problems in lower limb socket fit and present clinical solutions. The Academy TODAY 1(2).
- National Amputee Center. Skin care & stump hygiene. www.waramps.cafnac/skin.html (accessed October 2, 2005).
- Peery, J. T., W. R. Ledoux, and G. K. Klute. 2005, Residual-limb skin temperature in transtibial sockets. Journal of Rehabilitation Research & Development 42(2):147-54.
- Hachisuka, K., T. Nakamura, S. Ohmine, H. Shitama, and K. Shinkoda. 2001. Hygiene problems of residual limb and silicone liners in transtibial amputees wearing the total surface bearing socket. Archives of Physical Medicine and Rehabilitation 82(9):1286-90.