Aerosol Antiperspirants and Axillary Granulomata – A Study

I’ve heard from several customers who tell me of their “allergy” to commercial antiperspirants. They describe swelling bumps under the arms after application. Sometimes I think they are experiencing Axillary Granulomata or Cutaneous Granulomas. I write about more this here: Cutaneous Granulomas caused by Antiperspirants.

A friend of mine was relieved to find a natural deodorant that doesn’t cause this reaction.

When I come across an interesting study or some information about this, I’d like to post it or post a link. I found this report regarding aluminium zirconium applied with a spray, which isn’t the common application method any more. However, those who get bumps from antiperspirants may find it interesting.

1652 BRITISH MEDICAL JOURNAL VOLUME 288 2 JUNE 1984

Department of Rheumatology, Manchester Medical School,
Manchester M13 9PT
SIMON WILLIAMS, medical student
A J FREEMONT, MB, lecturer in osteoarticular pathology
Correspondence to: Mr S Williams.

Preparations containing aluminium or zirconium, such as vaccines, cosmetics, and antiperspirants, produce occasional inflammation and granulomas. Both the patients described here developed chronic axillary granulomas after using an underarm deodorant spray containing aluminium.

Case reports

Axillary Granulomata Case 1; Shaving and Applying Antiperspirant

A 20 year old woman, previously healthy except for well controlled epilepsy, complained of recurrent painful swellings in both axillae. These had been treated with occasional courses of antibiotics, but the response had been unsatisfactory. On examination she had a tender lump about 2 cm in diameter in the left axilla. The diseased skin was widely excised along with extensive underlying granulation tissue. When questioned at follow up the patient confirmed that she was in the habit of shaving her armpits and admitted using the antiperspirant preparation Arid Extra Dry underarm powder spray.

Axillary Granulomata Case2; Aluminium used in Antiperspirant

A healthy 31 year old woman presented with a painful subcutaneous nodule in the right axilla, surmounted by a small pigmented naevus. Thelump was excised. The patient admitted using the same antiperspirant as the first patient, spraying it from close range after shaving her armpits. In both cases light microscopic examination of the lesions showed a granulomatous response within the dermis and subcutaneous tissues. Examination with polarised light showed that giant cells contained doubly refractile crystals. Some of these cells, and others which did not contain crystals, stained positively for aluminium with solachrome azurine at pH 5. When examined by wavelength dispersive electron probe analysis the crystals were shown by their mineral content to be talc. The presence of aluminium in histiocytes and giant cells was confirmed.

Comment

Granuloma formation in these two cases occurred in response to a mixture of talc and aluminium salts. Subcutaneous granuloma formation has been reported after injection of triple vaccine,2 and x ray crystallography has shown that the agent responsible was the aluminium hydroxide adjuvant. Although recent work has refuted the traditional indictment of depilation and deodorants as a cause of hidradenitis suppurativa,3 certain spray preparations may provide ajet injection of aluminium salts, a known cause of granulomas.4 The manufacturers of Arid Extra Dry describe its active constituent as talcum powder coated with aluminium trichloride. The latter hydrolyses to aluminium hydroxide in physiological conditions. Savage has suggested that the presence of elemental aluminium within such lesions could be detected by electron probe analysis,2 and this was possible in both of our cases.

Granulomas of the axillae have been reported in a German patientwho used deodorants containing zirconium but did not shave.” Shaving the axillae is endemic among British women, as is the use of underarm deodorants. Entry of particles from the deodorant is probably facilitated by the mild abrasion of shaving, and the manufacturers of Arid Extra Dry state on the canister that the product should not be applied to broken, irritated, or sensitive skin, and should be discontinued if the skin becomes irritated or a rash develops.

Our cases illustrate the possible consequences of using this type of pressurised powder antiperspirant, particularly if the manufacturer’s instructions are not rigidly followed.

I thank Mr J Magell and Dr C K Heffernan of Blackburn Royal Infirmary for their help.

Erdohazi M, Newman RL. Aluminium hydroxide granuloma. Br Med 7 1971 ;iii:621-3.

2 Savage J. Aluminium hydroxide granuloma. Proc Roy Soc Med 1973;66: 984-5.

3 Morgan WP, Leicester G. The role of depilation and deodorants in hidradenitis suppurativa. Arch Dermatol 1982;118:101-2.

4 Lenz TR. Foreign-body granuloma caused by jet injection of tetanus toxoid. Rocky Mountain Medical Journal 1966;63 :48.

5 Kleinhans D, Knoth W. Granulomas of axillae (zirconium ?). Dermatologica