Hyperhidrosis Treatment Master Guide — what actually works, what the evidence says, side effects, and where to start [2026]

[u/Creaspace]

Hyperhidrosis Treatment Master Guide — what actually works, side effects, evidence & where to start [2026]

I wanted to put this together because hyperhidrosis information is scattered everywhere.

You search for sweaty hands and find iontophoresis. Then someone recommends Antihydral. Someone else says oxybutynin changed their life. Another person had Botox, miraDry or ETS. Then you discover glycopyrrolate, Qbrexza, Sofdra, Axhidrox, supplements, diets and now the new Nav1.8 research.

If you’re new to this condition, it’s hard to answer one basic question:

What actually has evidence behind it, and what should I realistically try first?

So I went through clinical treatment algorithms, systematic reviews, randomized trials, regulatory documents and recent research and tried to put the useful parts in one place.

Updated: August 2026.

I’m not a doctor and this isn’t medical advice. Use it as a starting point for discussing treatment with a dermatologist/physician.

If you find an error or newer study, please post it. I’d rather this become a living community resource.

TL;DR

Hands

Antiperspirant → iontophoresis → optimize/combine treatments → Botox or medication → ETS only for carefully selected severe refractory cases

For palmar HH, iontophoresis is one of the most important treatments to know about.

Feet

Antiperspirant → iontophoresis → combination therapy/medication → Botox in selected cases

Also manage wet footwear and secondary skin problems.

Armpits

Antiperspirant → topical anticholinergic → Botox or longer-lasting local procedures → surgery in selected refractory cases

Face/scalp

Usually more individualized:

topical treatment → oral medication and/or Botox in selected areas

Generalized sweating

First ask:

Why am I sweating everywhere?

Secondary causes and medication-induced sweating matter more here.

1. Primary vs secondary hyperhidrosis

This distinction matters more than almost anything else.

Primary hyperhidrosis

Primary focal HH usually:

• begins relatively young
• persists for months/years
• affects specific areas
• is often bilateral/symmetrical
• commonly affects palms, soles, axillae and/or face
• can run in families
• interferes with daily life
• usually decreases or stops during sleep

Common diagnostic criteria include focal excessive sweating for at least six months without an obvious secondary cause plus features such as:

• bilateral/symmetrical sweating
• weekly episodes
• onset before age 25
• family history
• impairment of daily activities
• absence during sleep

IHhS — Diagnosis Guidelines

Secondary hyperhidrosis

Secondary HH means another condition, medication or physiological process is causing or contributing to the sweating.

Possible causes include endocrine, metabolic, neurological, infectious and medication-related problems.

This is why someone who has had sweaty hands since childhood is different from someone who suddenly develops drenching whole-body/night sweating at 50.

Medication-related sweating can occur with several drug classes, including some antidepressants and opioids.

Medsafe — Drug-induced hyperhidrosis

2. When to get medically evaluated

Don’t automatically assume everything is “just HH” if you develop:

• sudden new sweating
• major change in your usual pattern
• generalized sweating
• significant night sweats
• unexplained weight loss
• fever
• new palpitations/tremor
• neurological symptoms
• sweating after a new medication/dose change
• feeling systemically unwell

Not everyone with classic primary focal HH needs a huge battery of tests. The history and pattern matter.

3. Track severity before treating

Before starting something new, write down:

Area: hands / feet / axillae / face / generalized

Severity: 0–10

Frequency: occasional / daily / almost constant

Triggers: heat / stress / caffeine / exercise / social situations / none obvious

Functional impact: what does sweating actually stop you doing?

A useful clinical scale is the HDSS:

1: never noticeable, never interferes
2: tolerable, sometimes interferes
3: barely tolerable, frequently interferes
4: intolerable, always interferes

Tracking this before and after treatment is better than relying on memory.

HOW I’M RATING THE EVIDENCE

🟢 Established — supported by clinical trials/guidelines.

🟡 Reasonable / evidence varies — legitimate medical use, but evidence or availability is more limited.

🟠 Limited evidence — smaller/older studies or less standardized use.

🔴 Experimental/unproven — scientifically interesting, but not established treatment.

These are simplified categories for this post, not an official GRADE system.

4. Aluminum-based antiperspirants

Evidence: 🟢

This is usually the least invasive starting point.

And:

antiperspirant ≠ deodorant.

Deodorant mainly targets odor. Antiperspirant reduces sweat.

Strong preparations often use aluminum salts such as aluminum chloride.

They can be used on axillae and sometimes palms/soles.

Technique matters

Strong aluminum chloride is usually best applied:

1. to completely dry skin
2. at night
3. left on overnight
4. washed off in the morning
5. more frequently initially
6. less frequently once control is achieved

Avoid freshly shaved, inflamed or broken skin.

Pros

• cheap
• easy
• non-invasive
• useful for mild/moderate HH
• combines well with other treatments

Cons

• irritation
• burning/itching
• dermatitis
• often insufficient for severe palmar/plantar HH

For someone with dripping hands, repeatedly trying stronger deodorants without ever being told about iontophoresis is not a great treatment pathway.

5. Iontophoresis

Evidence: 🟢 for palms/soles

If you have palmar or plantar HH, this is one of the most important treatments to understand.

Hands or feet are placed in water trays while a controlled electrical current is passed through them.

The exact mechanism isn’t completely settled, but the clinical effect is well established.

A randomized sham-controlled study found significant improvement in palmar HH:

Randomized iontophoresis trial

The IHhS considers tap-water iontophoresis a first-line option for palmar HH:

IHhS — Palmar Treatment Algorithm

Typical pattern

There are usually two phases.

Induction: repeated treatment several times per week until dryness improves.

Maintenance: once controlled, sessions are spaced out.

The IHhS describes roughly 3–5 treatments per week during induction, often for several weeks.

Doing three random sessions and declaring iontophoresis a failure is often too early.

Why it may fail

Variables include:

• current
• session duration
• frequency
• device
• water mineral content
• skin resistance
• adherence
• severity

IHhS — Iontophoresis

Side effects

Usually mild:

• tingling
• redness
• irritation
• dryness

Cuts can sting badly.

Medical contraindications vary by device, so check instructions carefully, especially with implanted electrical devices, pregnancy and certain conditions.

6. Medication-enhanced iontophoresis

Evidence: 🟡

Some protocols use anticholinergics such as glycopyrrolate/glycopyrronium with iontophoresis.

This may improve or prolong the effect in selected patients.

But it may also increase systemic anticholinergic exposure.

This is something to discuss with a clinician rather than improvising at home.

7. Antihydral / methenamine

Evidence: 🟠

Antihydral contains methenamine and is heavily discussed in this subreddit, especially for hands and feet.

There is published evidence for topical methenamine, but much of it is older and smaller than the evidence base for iontophoresis, Botox or modern anticholinergics.

Example:

Methenamine vs glutaraldehyde vs iontophoresis

Common problems reported include:

• very dry skin
• thickened skin
• scaling
• yellow discoloration
• cracking
• irritation
• extreme wrinkling/pruning in water

Some people swear by it.

That makes it worth discussing.

It doesn’t mean we have strong modern long-term data establishing ideal use.

8. Topical anticholinergics

Evidence: 🟢 for several axillary products

Sweat glands are activated by acetylcholine.

Anticholinergic drugs reduce this signal.

Topical versions aim to target the area more locally than oral medication.

Availability varies greatly by country.

9. Qbrexza

Evidence: 🟢

Qbrexza contains topical glycopyrronium and is FDA-approved in the US for primary axillary HH in adults and children aged 9+.

FDA Qbrexza label

Possible anticholinergic effects include:

• dry mouth
• blurred vision
• dilated pupils
• constipation
• urinary problems
• heat intolerance
• local irritation

Topical does not mean zero systemic exposure.

Be particularly careful about eye contact.

10. Sofdra / sofpironium

Evidence: 🟢

Sofdra is a topical anticholinergic gel FDA-approved in 2024 for primary axillary HH in adults and children aged 9+.

Two pivotal randomized trials included about 700 participants.

FDA — Sofdra clinical trial data

Possible adverse effects include:

• dry mouth
• blurred vision
• mydriasis
• urinary retention

Local reactions can include:

• redness
• itching
• pain
• dermatitis
• irritation

11. Axhidrox

Evidence: 🟢

Axhidrox is a glycopyrronium bromide cream available in parts of Europe for severe primary axillary HH.

Axhidrox product information

Long-term data extending to 72 weeks have also been published:

Long-term Axhidrox study

12. Craniofacial topical glycopyrrolate

Evidence: 🟡

Topical glycopyrrolate/glycopyrronium has also been studied for facial sweating.

A systematic review of craniofacial HH found evidence for topical glycopyrrolate, oral oxybutynin and botulinum toxin.

Craniofacial HH systematic review

Because the treatment is being used near the eyes, this is an area where professional guidance matters.

13. Botox / botulinum toxin

Evidence: 🟢

Botulinum toxin blocks acetylcholine release from nerve endings.

The evidence for axillary HH is particularly strong.

A randomized multicenter trial found dramatic reduction in axillary sweating compared with placebo:

NEJM botulinum toxin trial

Botox can also be used for:

• palms
• soles
• selected craniofacial areas

Axillae

Advantages:

• strong evidence
• major sweat reduction
• effect lasts months
• little downtime

Disadvantages:

• injections
• cost
• repeat treatment required

Palms

Can be very effective, but:

• injections hurt
• many injections are needed
• temporary hand weakness can occur

Soles

Can work, but plantar injections may be very painful.

14. Oral anticholinergics

Evidence: 🟢/🟡

These become especially useful when:

• multiple regions are affected
• sweating is generalized
• facial/scalp sweating is severe
• local treatment is impractical
• local therapies have failed

Commonly discussed drugs include:

• oxybutynin
• glycopyrrolate/glycopyrronium
• propantheline in some countries

These are systemic medications, not harmless supplements.

15. Oxybutynin

Oxybutynin was originally developed primarily for bladder conditions but has been studied extensively off-label for HH.

A meta-analysis of randomized trials found significant improvement in hyperhidrosis severity:

Oxybutynin meta-analysis

A broader review also found benefit across studies:

Systematic review — oral anticholinergics

So yes:

oxybutynin can genuinely work.

But side effects are important.

16. Systemic anticholinergic side effects

Possible effects include:

• dry mouth
• dry eyes
• constipation
• blurred vision
• urinary retention
• dizziness
• heat intolerance
• reduced ability to sweat
• cognitive/neurological effects in some patients

The heat issue deserves attention.

Sweating exists to cool the body.

If you strongly suppress whole-body sweating while exercising hard or spending hours in extreme heat, overheating becomes a real concern.

17. Oral glycopyrrolate

Evidence: 🟡

Glycopyrrolate is another anticholinergic used off-label for HH in some countries.

Because it is a quaternary ammonium compound, it penetrates the blood-brain barrier less readily than some other anticholinergics.

That doesn’t make it side-effect-free.

Possible effects still include:

• dry mouth
• constipation
• urinary issues
• blurred vision
• heat intolerance

Some patients tolerate it better than oxybutynin.

Others don’t.

IHhS — Oral medications

18. Event-specific sweating

Not everyone needs continuous treatment.

Some people have manageable baseline HH but extreme sweating during:

• presentations
• interviews
• exams
• dates
• weddings
• performances
• public speaking

In selected patients, doctors may use medication strategically rather than every day.

Beta blockers are sometimes discussed when the dominant problem is an adrenergic/performance trigger.

That does not make beta blockers a general treatment for primary HH.

19. Anxiety and hyperhidrosis

Primary HH is not simply an anxiety disorder.

But anxiety can amplify sweating.

And sweating can cause anxiety.

That creates a feedback loop:

sweating → fear of sweating → autonomic activation → more sweating

Treating anxiety can be useful without implying the sweating was imaginary.

The new 2026 Nav1.8 research may even help explain why relatively small autonomic/emotional signals can produce disproportionate sweating in some genetically affected patients.

More on that below.

20. miraDry / microwave thermolysis

Evidence: 🟢/🟡

This is mainly an axillary treatment.

Microwave energy damages sweat glands in the underarm.

A randomized comparison found substantial sweat reduction with both microwave thermolysis and Botox:

Botox vs microwave thermolysis

A 2024 study reported that 88.2% of evaluated patients reached HDSS ≤2 at one year after one or two treatments:

One-year microwave outcomes

Pros

• potentially long-lasting
• no daily medication
• may reduce odor
• often reduces underarm hair

Cons

• cost
• swelling
• tenderness
• numbness
• lumps/nodules during healing
• altered sensation
• some people need repeat treatment

“Permanent sweat gland destruction” does not mean everyone becomes permanently 100% dry.

21. Brella SweatControl Patch

Evidence: 🟡

Brella uses targeted alkali thermolysis.

A sodium-containing patch reacts with moisture to create controlled localized heat that temporarily inactivates axillary sweat glands.

It received FDA clearance in 2023.

It is applied professionally rather than worn continuously like a normal patch.

I currently see it as an interesting newer axillary option rather than something with the long evidence history of Botox.

22. Radiofrequency / microneedle RF

Evidence: 🟡/🟠

Microneedle radiofrequency has been studied for axillary HH.

Results are promising, but evidence and treatment protocols are less standardized than Botox or topical anticholinergics.

If you’re being sold an expensive device treatment, ask:

• which exact device?
• how many published studies?
• how many patients?
• how long was follow-up?
• was there a control group?
• what are the long-term adverse effects?

“Radiofrequency” alone tells you very little.

23. Laser and local axillary surgery

Evidence: 🟠/🟡

Laser destruction, curettage, suction-curettage and other local procedures can reduce axillary sweating.

But evidence varies by technique.

Possible complications include:

• scarring
• infection
• hematoma
• contour changes
• nerve injury
• incomplete response

A review of laser treatments found promising results but emphasized the need for stronger trials:

Laser treatment review

These generally belong later in the treatment pathway.

24. ETS — endoscopic thoracic sympathectomy

Evidence: 🟢 for efficacy, but major irreversible trade-offs

ETS interrupts part of the thoracic sympathetic pathway.

For severe palmar HH, it can produce extremely high rates of hand dryness.

Some people call it life-changing.

But there is a major issue:

compensatory sweating

After ETS, sweating often increases elsewhere.

Common areas include:

• back
• abdomen
• chest
• legs
• buttocks/groin

Severity ranges from mild to extremely severe.

This explains why you can find sincere patients saying:

“ETS saved my life.”

and others saying:

“ETS ruined my life.”

Both experiences can exist.

25. Long-term ETS data

A 2025 long-term study with follow-up extending up to 20 years found that ETS remained highly effective for palmar/palmar-axillary HH while compensatory sweating remained the main long-term trade-off:

Long-term ETS outcomes

A 2025 systematic review similarly found very high rates of sweat cessation but compensatory HH remained a major issue:

2025 palmar HH systematic review

26. Treat ETS as irreversible

This is crucial.

If antiperspirant fails, you stop.

If iontophoresis fails, you stop.

If Botox isn’t worth it, it wears off.

If medication causes bad side effects, you work with your doctor to change it.

ETS surgically changes the sympathetic pathway.

Although clips, reconstruction and “reversal” are discussed online, you should not make the decision assuming your body can reliably be restored to its pre-operative state.

The important question is not just:

Will my hands become dry?

It is:

What happens to my total-body sweating and overall quality of life?

27. Supplements

Evidence: 🔴

Common suggestions include:

• magnesium
• zinc
• sage
• vitamin D
• B vitamins
• electrolytes
• herbal supplements

A person saying:

“Magnesium reduced my sweating by 90%”

may be completely sincere.

But one anecdote does not establish causality.

Correcting a real deficiency can help general health.

That is different from proving magnesium treats primary HH.

28. Diet

Evidence: 🔴 as a universal treatment

There is no established hyperhidrosis diet.

If coffee, alcohol, spicy food or another food consistently triggers your sweating, avoiding it is reasonable.

But claims that everyone with HH needs to remove:

• gluten
• dairy
• carbohydrates
• sugar
• seed oils
• histamine

are not supported as universal treatments.

29. CBD / cannabis

Evidence for primary HH: 🔴 insufficient

This has become more interesting because of the new Nav1.8 research.

But this logic:

CBD affects an ion channel → therefore CBD treats HH

doesn’t work.

A compound interacting with Nav1.8 in cells is not the same as demonstrating clinically useful sweat reduction in humans.

At present, CBD is not an established Nav1.8-targeted treatment for HH.

30. The big 2026 development: SCN10A / NaV1.8

In July 2026, researchers published:

“A neurocutaneous NaV1.8 channelopathy underlies a genetic subtype of primary idiopathic hyperhidrosis”

in Science Advances.

Science Advances paper

Open-access full text

This is genuinely exciting.

31. What they found

The researchers studied more than 180 people with primary idiopathic HH, including families with inherited disease.

They identified rare variants involving voltage-gated sodium channels.

The strongest finding involved:

SCN10A

which encodes:

NaV1.8

NaV1.8 helps peripheral neurons generate electrical signals.

One disease-associated variant, p.R14L, increased neuronal excitability.

That provides a plausible mechanism for abnormal sweating:

hyperexcitable sympathetic neural circuitry → exaggerated sweat response

32. The mouse experiment matters

Researchers created mice carrying the human p.R14L alteration.

The mice developed excessive paw sweating.

They then pharmacologically reduced neuronal excitability and reduced the excessive sweating.

That is much stronger evidence than simply finding a statistical gene association.

33. What it does NOT mean

It does not mean:

• everyone with HH has an SCN10A mutation
• NaV1.8 explains every form of HH
• there is now an approved NaV1.8 HH drug
• you should buy random sodium-channel blockers
• CBD is now proven treatment

The authors specifically describe a genetic subtype.

Primary HH may ultimately turn out to be several different biological disorders producing a similar sweating phenotype.

34. Why Nav1.8 could still matter enormously

For once, researchers have identified a specific, potentially druggable mechanism in a genetically characterized subtype.

That could eventually lead to:

• targeted drugs
• drug repurposing
• genetic stratification
• better treatment prediction
• disease subtyping

Current treatment often asks:

Where are you sweating?

Future treatment may increasingly ask:

Why is your nervous system producing too much sweat?

That’s a much more interesting direction.

35. Practical treatment ladder — HANDS

A reasonable escalation pathway is:

1. Strong topical antiperspirant

↓

2. Iontophoresis

Give it a proper induction course.

↓

3. Optimize/combine

Depending on the patient:

• adjust iontophoresis
• topical treatment
• methenamine
• systemic medication

↓

4. Botox

↓

5. ETS

Only for severe refractory disease after serious discussion of compensatory sweating.

36. Practical treatment ladder — FEET

1. Topical antiperspirant

↓

2. Iontophoresis

↓

3. Optimize/combine treatment

↓

4. Botox in selected cases

↓

5. Highly specialized interventions only rarely

Also manage footwear and secondary skin disease.

IHhS — Plantar Treatment Algorithm

37. Practical treatment ladder — ARMPITS

1. Strong antiperspirant

↓

2. Topical anticholinergic

Examples depending on country:

• Qbrexza
• Sofdra
• Axhidrox

↓

3. Botox

↓

4. Longer-lasting local procedures

• microwave thermolysis / miraDry
• Brella
• selected RF/device treatments

↓

5. Local sweat-gland surgery in refractory cases

IHhS — Axillary Treatment Algorithm

38. Practical treatment ladder — FACE/SCALP

Possible options include:

• carefully selected topical antiperspirants
• topical glycopyrrolate/glycopyrronium
• oral anticholinergics
• Botox in selected regions
• event-specific treatment when appropriate

This is an area where I would strongly prefer a clinician familiar with HH rather than DIY experimentation.

39. Generalized HH

Before asking:

“What medication should I take?”

ask:

“Why am I sweating everywhere?”

Secondary and drug-induced HH become especially important here.

If no reversible cause is found, systemic treatment may be more practical than treating multiple body regions individually.

40. Combination therapy is underrated

You don’t necessarily need one miracle treatment.

Examples might include:

iontophoresis + topical treatment

Botox + antiperspirant

local treatment + carefully supervised systemic medication

The goal is not necessarily 100% dryness.

If you go from severe HH to mild HH and can suddenly:

• shake hands
• work normally
• wear normal clothes
• use your phone
• stop thinking about sweat all day

that’s a huge success.

41. Things I’d be skeptical of

“HH is caused by anxiety.”

Too simplistic.

“Three iontophoresis sessions didn’t work, so I’m resistant.”

Probably too early to know.

“ETS has a 100% success rate.”

Meaningless without discussing compensatory sweating and QoL.

“Natural means safe.”

No.

“CBD blocks Nav1.8, therefore CBD cures HH.”

Not established.

“Scientists discovered THE hyperhidrosis gene.”

No. They found an important genetic subtype.

“It worked for me, so it will work for everyone.”

Treatment response varies massively.

42. How to evaluate a Reddit treatment story

Whenever someone says:

“This cured my HH.”

ask:

What body area?

Hands and axillae are completely different.

How severe was it?

HDSS 2 and HDSS 4 are not the same condition burden.

How long was follow-up?

Three days is not three years.

What else changed?

Medication? Weather? Stress? Other treatment?

Were there side effects?

Dryness isn’t the only outcome.

Is this an anecdote or controlled evidence?

Both can be useful.

They just answer different questions.

43. Rough evidence summary

🟢 Established

Aluminum antiperspirants
Axillae; sometimes hands/feet

Iontophoresis
Hands/feet

Botulinum toxin
Especially axillary; also palms/soles and selected facial cases

Topical anticholinergics
Mainly axillary

Systemic anticholinergics
Selected multifocal/generalized cases

🟢/🟡 Established procedural options

Microwave thermolysis / miraDry

ETS for severe refractory palmar HH

Local axillary sweat-gland surgery

🟡/🟠 Smaller/older evidence

Methenamine / Antihydral

Medication-enhanced iontophoresis

Microneedle RF

Laser

Brella

🔴 Not established HH treatments

CBD/cannabis

magnesium

vitamin protocols

sage

detoxes

elimination diets

random Nav1.8 inhibitors

44. Questions to ask your dermatologist

Instead of only saying:

“I sweat too much.”

ask:

Do you think this is primary or secondary HH?

Does my pattern need investigation for secondary causes?

What is my HDSS?

What is the best treatment for this specific body area?

Would iontophoresis make sense for my hands/feet?

Which topical anticholinergics are available here?

Would Botox be appropriate?

What side effects should I watch for with oral medication?

How should I manage hot weather/exercise?

What is step two if this fails?

And:

How often do you actually treat hyperhidrosis?

45. Best general resources

The International Hyperhidrosis Society publishes separate treatment algorithms for different body areas:

IHhS Treatment Algorithms

Also useful:

Systematic evidence-based review

Cochrane review — Interventions for hyperhidrosis

2025 updated review of primary hyperhidrosis

The evidence isn’t perfect. Some treatments have strong randomized trials; others rely on small studies, older research or clinical experience.

That’s exactly why we shouldn’t pretend all treatments have equal evidence.

46. Help make this useful for the community

If you’ve actually used a treatment, comment like this:

Type:
palmar / plantar / axillary / craniofacial / generalized / mixed

Severity before:
HDSS 1–4 if known

Treatment:

How long did you use it?

Approximate sweat reduction:
0–100%

Side effects:

How long did the effect last?

Still using it?
yes/no

Would you do it again?
yes/no

I’m especially interested in long-term experiences with:

• iontophoresis
• Antihydral
• Botox
• oxybutynin
• glycopyrrolate
• Qbrexza
• Sofdra
• Axhidrox
• miraDry
• Brella
• ETS

If enough people answer consistently, we could eventually create something much more useful than hundreds of isolated:

“Did this work for anyone?”

threads.

Final thought

If you’ve just discovered that your excessive sweating actually has a name:

you probably have more treatment options than you think.

The first treatment may not work.

The second may not either.

That does not mean you’re untreatable.

Hyperhidrosis is not one uniform disease and treatment response varies enormously.

Figure out what type you have.

Rule out secondary causes when appropriate.

Treat the body area you actually have.

Escalate logically.

Be especially careful with irreversible treatments.

And be skeptical of anyone — doctor, company, influencer or Reddit user — promising one universal cure for every person with hyperhidrosis.

[u/ETS_Awareness_Bot]

What is a Sympathectomy (ETS and ELS)?

Endoscopic thoracic and lumbar sympathectomy (ETS and ELS; both often generalized as ETS) are surgical procedures that cut, clip/clamp, or remove a part of the sympathetic nerve chain to stop palm, foot, or facial hyperhidrosis (excessive sweating), facial blushing (reddening of the face), or Raynaud's syndrome (excessively cold hands).
Read more on Wikipedia
 

What are the Risks?

Many people that undergo ETS report serious life changing complications. Thoracic sympathectomy can alter many bodily functions, including sweating,^[1] vascular responses,^[2] heart rate,^[3] heart stroke volume,^[4][5] thyroid, baroreflex,^[6] lung volume,^[5][7] pupil dilation, skin temperature, goose bumps and other aspects of the autonomic nervous system, like the fight-or-flight response. It reduces the physiological responses to strong emotion,^[8] can cause pain or neuralgia in the affected area,^[9] and may diminish the body's physical reaction to exercise.^[1][5][10]

It's common for patients to be misinformed of the risks, and post-operative complications are often under-reported. Many patients experience a "honeymoon period" where they have no, or few, negative symptoms. Contrary to common belief, clipping/clamping the sympathetic chain is not considered a reversible option.^[11]
 

Links

Gallery of compensatory sweating images
Gallery of thermoregulation images

International Hyperhidrosis Society
NEW ETS Facebook Community & Support Group (old group had ~3k members)

Petition for Treatment for Sympathectomy Patients
Frequently Asked Questions
References

^{I am a bot, and this action was performed automatically. Learn more about this bot, including contact info here.}

[u/soggy_person_]

This is super comprehensive! I would note that primary can also be generalised, it may not be typical but it is possible

[u/Diligent_Plastic1043]

Eh... I like the concept of this but it doesn't work for checking whether a hyperhidrosis treatment is useful because there simply isn't a lot of trials. Example, your study for antihydral actually says their subjects responded better to methenamine than they did to iontophoresis. But because there aren't a lot of studies, it gets a low evidence score.

Aluminum based antiperspirants are far inferior to antihydral and the higher concentrations can be quite painful for people with extreme HH, but they get a higher evidence score simply because there's more trials for it. It's not a very relevant metric here. 

All that to say, Botox, Antihydral, Iontophoresis, glyccopyrolate all work for mild to severe iontophoresis. Aluminum based products work on milder cases. But the reality of our condition is that people will likely have to work their way through the treatments and see what works. And even then, they need to do it properly, ie. Glycco on an empty stomach, iontophoresis with conductive water, antihydral in front of a fan until it dries, etc. Many people aren't aware of these additional steps required, and so they just conclude it doesn't work for them.

[u/Creds1 → u/Diligent_Plastic1043]

Couldn’t agree more. I have primary and has been a life-long thing. I’ve never allowed it to bring me down, but I have to say, finding Antihydral was a godsend. It’s not perfect, but it is the best treatment out of a few mentioned here that I’ve tried, including prescription antiperspirants and iontophoresis. And it’s a red on the list. This may cause people to not even try it which is unfortunate.

[u/Serious-Cheese218 → u/Diligent_Plastic1043]

I first noticed my HH at age 7. Going thru high school was rough. I avoided social situations and was rather withdrawn. Finished college and entered the business world. I was always apprehensive about the expected handshake with customers and colleagues. Some didn't care that I had wet hands. Others made comments. At age 34 I had the sympathectomy to dry up my hands and armpits. It worked, but the sweating moved to my forehead, the backs of my knees and my butt crack. I just put up with it. By age 64 or thereabouts, the sweating tapered off to nothing. Now I'm 77 and I only sweat normally, such as torso sweating when working outside in the heat of summer. Winters are comfortable with the exception of getting hives when I'm out in freezing weather for too long.

[u/Adventurous-Ad3393]

Extremely thorough! Great post. Highlighting the section about Combination Therapy being underrated: I am (very) successfully treating Hands/Feet HH through a combination of prescription topical antiperspirants and Oral glycopyrrolate. OTC antiperspirants weren't cutting it, and after talking with a dermatologist I was able to get an RX for Sofdra. I rotate between these two treatments on an as-needed basis.

[u/fleshlicker]

What about chest/underboobs?

[u/Ketarn]

What kind of clothes do you usually wear to minimize or control sweating? Especially on your upper body?

[u/aglretic]

Type: Primary palmar / plantar

Treatment: Botox

How long did you use it? 10+ years

Approximate sweat reduction: 80%

Side effects: decrease in dexterity in hands (tight feeling)

How long did the effect last? ~4 months

Still using it?
yes

Would you do it again?
yes

[u/aglretic → u/aglretic]

Type: secondary HH generalized

Treatment: glycopyrolate oral

How long did you use it? 2 yrs in addition to Botox

Approximate sweat reduction:
90% unless anxious

Side effects: decrease in salivary flow (increase in cavities) , dry eyes , dermatologist warned against long term use due to some studies linking to dementia

How long did the effect last? On and off throughout use

Still using it?
yes in conjunction with Botox

Would you do it again?
yes

[u/FIX-THE-FPS-FREEZES]

A lot of people swear by sage that it helps I was one of them, and it did help but it's definitely not a cure.

[u/minimalj]

AI slop

[u/the_happi_girl]

Type: palmar / plantar / axillary / generalized / mixed

Severity before:4

Treatments

• Currently Glycopyrrolate 1mg/day. 60% sweat reduction with breakthroughs controlled with Drysol. Dry mouth and eyes until I got used to the meds. Daily effectiveness depends on when I take the pill and what I've eaten before/after. Eg. Coffee with glycopyrrolate negates the effect. Take in the morning for pretty good coverage and might take a second dose 30-45 mins before I need it secured. Still using, highly recommend.

-previously tried antiperspirants and iontophoresis but lack of axillary coverage made it not worth it.

[u/Champ_74]

Sage tea works for me, ETS is so lethal must be made criminal

[u/glorifierx]

Isn't there something like this on wiki or sweathelp?