![[OC] America’s debt is back near its WWII-era high — Federal debt held by the public as % of GDP, 1939–2025](https://preview.redd.it/7e0fglbisdjh1.png?auto=webp&s=64a387b5d982c9aaa8c37d147fab497c19c29f2a)
u/Creaspace
![[OC] America’s debt is back near its WWII-era high — Federal debt held by the public as % of GDP, 1939–2025](https://preview.redd.it/7e0fglbisdjh1.png?auto=webp&s=64a387b5d982c9aaa8c37d147fab497c19c29f2a)
[OC] The world's biggest cities moved East — and South: megacities in 1975 vs. 2025
Where did all the children go? The share of the population under 15, 1960 vs. 2025
The age distribution around the globe has undergone a remarkable transformation since 1960.
Back in 1960, children aged 0–14 accounted for 37.4% of the world's population. Fast forward to 2025, and that share had fallen to 24.4%.
This change has been particularly pronounced in several countries:
- South Korea: 41.3% → 10.2%
- China: 40.3% → 15.4%
- Brazil: 44.2% → 19.4%
- Japan: 29.8% → 11.2%
- United States: 31.3% → 17.1%
In stark contrast, Nigeria shows a very different trajectory: 41.1% → 40.5%.
It's important to note that these figures reflect the share of the population aged 0–14, not the absolute number of children. A country's share can fall even if its absolute number of children does not.
Source: World Bank, World Development Indicators
Indicator: SP.POP.0014.TO.ZS
Original source: UN Population Division, World Population Prospects
Full visualization, data & sources:
https://chartive.org/visualizations/where-did-all-the-children-go-1960-2025
What got more expensive — and what got cheaper in the U.S. since 2000?
From 2000 to 2025, overall consumer prices in the U.S. rose by 87%. But underneath that average, different categories moved in dramatically different directions.
For example:
- Hospital services: +274%
- Motor vehicle insurance: +248%
- College tuition & fees: +188%
- Day care & preschool: +147%
- Rent: +136%
At the other end, some categories became dramatically cheaper according to their price indexes:
- Computers*: −92%
- Televisions*: −98%
*These figures come from BLS Consumer Price Indexes, not simple sticker-price comparisons. BLS accounts for changes in product quality where applicable, which is especially important for rapidly improving technology such as computers and televisions.
Source: U.S. Bureau of Labor Statistics, CPI-U
Annual averages, 2000 vs. 2025.
Full data, sources & methodology:
https://chartive.org/visualizations/what-got-more-expensive-cheaper-since-2000
[OC] The most common path to adulthood among Americans aged 25–34 changed dramatically between 1975 and 2024
[OC] U.S. real GDP per capita rose 142% since 1974. Real median personal income rose 57%.
[OC] U.S. job postings are bouncing back to levels we saw in 2020, but the types of jobs being advertised have shifted significantly.
Hyperhidrosis Treatment Master Guide — what actually works, what the evidence says, side effects, and where to start [2026]
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
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:
- to completely dry skin
- at night
- left on overnight
- washed off in the morning
- more frequently initially
- 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
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+.
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.
Long-term data extending to 72 weeks have also been published:
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:
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:
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.
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:
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:
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:
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.
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:
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.
[OC] 19 years of iPhone software support — how long every iPhone generation gets iOS updates (2007–2026)
Bevor ihr ein neues iPhone kauft: eures bekommt wahrscheinlich noch Jahre Updates – und oft reicht ein Akkutausch
Ich seh hier (und im Bekanntenkreis) oft den Reflex „Handy ist 3–4 Jahre alt, muss was Neues her". Bei iPhones ist das meistens rausgeworfenes Geld, und ich dachte, die Zahlen dazu passen gut hierher.
Warum ihr euer altes iPhone wahrscheinlich behalten könnt:
- Apple liefert grob 6–8 Jahre große iOS-Updates, danach noch 1–2 Jahre Sicherheitsupdates.
- Das aktuelle iOS 26 (und iOS 27 im Herbst) läuft ab dem iPhone 11 von 2019. Sprich: so ziemlich jedes iPhone, das hier noch rumliegt, ist voll versorgt.
- Nur iPhone XR/XS und älter sind bei den großen Updates raus.
Der wichtigste Spar-Punkt: Wenn sich ein iPhone „lahm" anfühlt, ist fast immer der Akku schuld, nicht das Alter. Einmal unter Einstellungen › Batterie › Batteriezustand schauen – liegt die maximale Kapazität unter ~80 %, bringt ein Akkutausch für ~50–70 € meist mehr als ein Neukauf für mehrere Hundert.
Und wenn's doch was „Neues" sein soll: gebraucht ein iPhone 12/13 nehmen, dann habt ihr noch Jahre Update-Ruhe für kleines Geld.
Die komplette Tabelle (jedes Modell + bis wann Updates) hab ich mal aufbereitet – full disclosure, ist meine Seite, verlinke ich nur, weil's als Kommentar zu unübersichtlich wär: wie lange bekommt welches iPhone Updates
Wie lange fahrt ihr eure Handys? Und hat jemand Erfahrungen mit Akkutausch bei Drittanbietern vs. Apple?
The Nav1.8 study may be bigger than it first looks — but there is also a lot of misinformation spreading
I read through the new Nav1.8 hyperhidrosis study because some of the discussion around it is already getting a bit muddled.
First of all: no, researchers have not suddenly found a cure for hyperhidrosis.
But they may have identified something genuinely important: a specific neurological mechanism behind at least one genetic form of primary hyperhidrosis. More importantly, it is a mechanism that could potentially be targeted with medication.
What did the researchers actually find?
The study included more than 180 people with primary idiopathic hyperhidrosis, including several families where excessive sweating appeared to be inherited.
The researchers found an unusually high number of rare mutations affecting voltage-gated sodium channels. The strongest link was to SCN10A, the gene responsible for producing a sodium channel called Nav1.8.
Nav1.8 helps certain peripheral nerves generate and transmit electrical signals.
One of the mutations they identified, called p.R14L, appeared to make the channel overactive. The affected nerve cells became more excitable and reacted much more strongly to cholinergic stimulation.
That is relevant because sweat glands are controlled by cholinergic sympathetic nerves.
Put very simply:
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This could also help explain something many people with hyperhidrosis experience: a very small emotional trigger, social interaction or stressful thought can suddenly cause a completely disproportionate amount of sweating.
That does not mean hyperhidrosis is “caused by anxiety.”
The emotional signal may simply be activating a nervous system that is already unusually excitable.
The mouse experiment is probably the most interesting part
The researchers created mice carrying the same Nav1.8 mutation that they had found in humans.
The mice developed excessive sweating on their paws, which is where mice have functional sweat glands.
When the researchers used sodium-channel-blocking compounds to reduce the abnormal nerve activity, the excessive sweating dropped significantly.
The effect was reversible. Once the medication wore off, the sweating returned.
That is a big deal because it suggests the pathway might be controlled without permanently cutting or destroying sympathetic nerves.
In theory, that could eventually lead to a treatment that targets the underlying nerve dysfunction rather than just blocking sweat or interrupting the entire sympathetic pathway.
But this does not mean Nav1.8 causes everyone’s hyperhidrosis
This is probably the most important limitation.
The researchers describe this as a genetic subtype of primary idiopathic hyperhidrosis. They are not claiming that every person with hyperhidrosis has an SCN10A mutation.
We still do not know:
- How many people with primary hyperhidrosis carry relevant SCN10A/Nav1.8 mutations
- Whether the same mechanism exists in people without a clear family history
- Whether it applies equally to palmar, plantar, axillary, craniofacial and generalized hyperhidrosis
- Whether it has any relevance to secondary hyperhidrosis
- Whether blocking Nav1.8 will reduce sweating safely in humans
The study also suggests that different biological problems may lead to very similar symptoms.
In one patient, for example, the suspected mechanism involved another mutation affecting a water channel inside the sweat gland itself.
So hyperhidrosis may eventually turn out to be less of a single disease and more of an umbrella term for several different disorders that all produce the same end result: excessive sweating.
That could help explain why one person gets amazing results from iontophoresis, glycopyrrolate or oxybutynin, while someone with seemingly identical symptoms gets almost no benefit.
What about Suzetrigine/Journavx?
This is where I think people need to slow down a little.
Suzetrigine is a selective Nav1.8 inhibitor that is already FDA-approved in the US under the brand name Journavx.
However, it is approved for the short-term treatment of moderate-to-severe acute pain. It is not approved for hyperhidrosis.
I have seen comments claiming that Suzetrigine itself completely stopped sweating in the mutant mice. I could not find that specific claim clearly stated in the published paper.
The researchers reported that the excessive sweating could be reversed using clinically used sodium-channel inhibitors and a Nav1.8-preferential compound.
That definitely makes Suzetrigine scientifically interesting. But it does not automatically mean Journavx will work for hyperhidrosis.
Different Nav1.8 inhibitors interact with the channel in different ways. A mutation may also change how well a particular drug binds to or affects that channel.
Most importantly:
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Please do not try to obtain or use it on your own. Journavx is a prescription drug with important dosing restrictions, interactions and limitations, and it has only been studied for short-term acute pain.
What about guanfacine, CBD or THC?
The researchers discussed several existing substances because some of them can influence autonomic signalling, cholinergic activity or sodium-channel function.
That gives researchers reasonable candidates to investigate.
It does not prove that these substances treat Nav1.8-related hyperhidrosis in humans.
Personal experiences are still worth discussing, especially now that there may be a biological mechanism behind some of them. But an anecdote cannot tell us:
- Whether the person actually carries a relevant mutation
- Whether the improvement was caused by Nav1.8 inhibition
- What dose would be needed
- Whether the effect would remain safe and effective long term
CBD in particular should not suddenly be treated as a Nav1.8 cure.
A substance affecting an ion channel in isolated cells does not necessarily mean the same effect can be achieved safely or consistently in the human body.
Why I still think this is a major development
Most current hyperhidrosis treatments act fairly late in the sweating process:
- Antiperspirants block the sweat ducts
- Anticholinergics reduce sweat-gland signalling throughout the body
- Botox interrupts local nerve transmission
- Iontophoresis temporarily reduces sweating through a mechanism that is still not fully understood
- ETS permanently interrupts part of the sympathetic pathway
This study looks much further upstream.
It gives researchers:
- A specific gene to investigate
- A measurable ion-channel dysfunction
- A mouse model that reproduces the excessive sweating
- A biological target that can be blocked with medication
- Existing drug classes that might potentially be repurposed
That is not just another vague theory about an “overactive sympathetic nervous system.”
It is an actual roadmap for developing a treatment based on the underlying mechanism.
The best outcome may not be one universal cure for everyone with hyperhidrosis.
It may be genetic or functional testing that divides patients into different subgroups, followed by treatments designed for the specific mechanism causing each person’s sweating.
What needs to happen next?
The most useful next steps would probably be:
- Replicating the genetic findings in a much larger and more diverse group of patients
- Finding out how common Nav1.8-related hyperhidrosis actually is
- Testing approved and experimental Nav1.8 inhibitors against the exact mutations found in patients
- Running a small and carefully monitored human proof-of-concept trial
- Investigating whether a topical Nav1.8 inhibitor could work locally while avoiding systemic side effects
- Creating a patient registry for people with severe or clearly hereditary primary hyperhidrosis
So no, this is not a cure announcement.
But after decades of being told that hyperhidrosis is simply caused by an “overactive sympathetic nervous system,” without anyone being able to explain why, we may finally have a concrete answer for at least some patients.
And unlike a vague explanation, this mechanism appears to be both testable and potentially treatable.
That is why I think the study deserves attention, as long as we do not exaggerate what it has already proven.
Does hyperhidrosis clearly run in your family?
And has anyone here ever taken guanfacine or a sodium-channel medication for another condition and noticed a real change in their sweating?
Study: A neurocutaneous NaV1.8 channelopathy underlies a genetic subtype of primary idiopathic hyperhidrosis
Journal: Science Advances (2026)
DOI: 10.1126/sciadv.aed3221
Fuse Infinity – combine two elements to discover a third, with worlds, rarity, and a daily puzzle
I really enjoyed Infinite Craft, but I ended up quitting once I crafted everything, so I decided to create the version I actually wanted to keep playing.
Game Title: Fuse Infinity
Playable Link: https://fuseinfinity.com
Platform: Web browser (desktop + mobile, no install)
Description:
I really enjoyed Infinite Craft, but I ended up quitting once I'd crafted everything, so I decided to build the version I actually wanted to keep playing. A few months back I dove deep into it and got totally hooked — there's just something satisfying about dragging two items together to make something silly. But after a few hundred items it started to feel a bit flat: no real reason to jump back in the next day, and since anything mixes with anything, nothing ever felt rare or special.
So I built my own take on it, and that's how Fuse Infinity was born. It keeps the same core loop (drag two items together, an AI generates a third), but with the stuff I kept wishing it had:
- Different worlds (kitchen, magic, lab, cosmos) that each start with their own elements. Mix items from different worlds and you get a "collision", which is usually something delightfully cursed.
- A rarity system, so finding something almost no one else has discovered feels like a real achievement.
- A daily puzzle: reach a target element in as few moves as possible. That's the "come back tomorrow" hook I was missing — basically Wordle for crafting.
It's free, runs right in your browser, no signup, and works on mobile too.
Free to Play Status:
- Free to play
- Demo/Key available
- Paid (Allowed only on Tuesdays with [TT] in the title)
Involvement: Solo developer — I designed and built the whole thing myself, front to back (the gameplay, the worlds/rarity/daily systems, and the backend). It's entirely my project.
A few things I'm genuinely unsure about and would love feedback on:
- Does the daily puzzle actually make you want to come back, or does it feel like a gimmick?
- On mobile, is the drag-to-combine comfortable or a bit clunky?
- In the first 30 seconds, is it clear what to do, or confusing?
Totally open to honest feedback — bring it on!