Residual Limb Hyperhidrosis in Prosthetic Users: First Prospective Pilot of Topical Antiperspirant Treatment

ABSTRACT Background Residual limb hyperhidrosis (RLH) is a frequent and debilitating condition among lower‐limb prosthetic users. Although aluminium chloride is recommended first‐line for focal hyperhidrosis, its efficacy in RLH has not previously been evaluated in prospective studies. Objectives To assess the effectiveness of 15% aluminium chloride for RLH using standardized clinical and patient‐reported outcomes. Methods This single‐centre, prospective pilot study enroled seven transtibial amputees; six completed the 4‐week intervention (one discontinued due to localized dermatitis). Participants applied 15% aluminium chloride nightly to sweating areas identified by the Minor (iodine–starch) test combined with the Sweating Intensity Visual Scale (SIVS), reducing application frequency once improvement occurred. Outcomes included the Hyperhidrosis Disease Severity Scale (HDSS), Minor/SIVS grading and a 0–100 Numerical Rating Scale (NRS) assessing sweating and functional impact. Pre–post changes were analysed using Wilcoxon tests or paired t ‐tests with Cohen's d effect sizes. Results Five of six completers (83%) achieved a ≥ 1‐point HDSS improvement ( p = 0.034), corresponding to ≥ 50% sweat reduction. SIVS scores decreased from a median of 2.5−1.0 ( p = 0.313). Significant NRS improvements were observed for perceived sweating (mean −32.5, p = 0.031, d = 1.05), functional interference (−46.7, p = 0.031, d = 1.41) and activity level (−33.3, p = 0.043, d = 1.08). Nonsignificant trends were seen for quality of life, gait stability and skin quality. Conclusions This study suggests that topical aluminium chloride may reduce RLH and improve prosthesis comfort and function. Targeted application guided by the Minor test produced clinically meaningful improvement in most participants. Larger controlled trials are needed to confirm efficacy and support evidence‐based RLH management.