Hiperpotliwość
Zapobieganie i profilaktyka

Hiperpotliwość, zarówno pierwotna (ogniskowa), jak i wtórna, wymaga zindywidualizowanego podejścia profilaktycznego. W przypadku hiperpotliwości pierwotnej, której etiologia może mieć podłoże genetyczne i nie jest całkowicie uleczalna, kluczowe jest stosowanie antyperspirantów zawierających chlorek glinu w stężeniu 10-20%, unikanie czynników wyzwalających (np. pikantne potrawy, kofeina, alkohol), odpowiednia higiena skóry oraz kontrola stresu. W hiperpotliwości wtórnej profilaktyka opiera się na leczeniu choroby podstawowej (np. nadczynność tarczycy, cukrzyca) oraz modyfikacji farmakoterapii, jeśli to możliwe. Warto również zwrócić uwagę na zapobieganie powikłaniom skórnym poprzez stosowanie antybakteryjnych środków myjących, talków oraz unikanie syntetycznych materiałów odzieżowych.

Profilaktyka i zapobieganie hiperpotliwości (Hyperhidrosis Prevention, Prophylaxis)

Hiperpotliwość (hyperhidrosis) jest stanem charakteryzującym się nadmiernym poceniem, które może znacząco wpływać na jakość życia pacjentów, prowadząc do zaburzeń funkcjonowania społecznego, zawodowego oraz emocjonalnego stresu. Zapobieganie hiperpotliwości uzależnione jest od jej typu oraz przyczyn, jednak istnieje szereg metod, które mogą pomóc w kontrolowaniu objawów i zapobieganiu nasilenia dolegliwości.12

Rozróżnienie typów hiperpotliwości w kontekście profilaktyki

W kontekście profilaktyki istotne jest rozróżnienie pomiędzy pierwotną i wtórną hiperpotliwością:12

  • Hiperpotliwość pierwotna (ogniskowa) – nie wszystkie przypadki tego typu hiperpotliwości można zapobiec, ponieważ może mieć podłoże genetyczne. Nie istnieje całkowite wyleczenie tego typu hiperpotliwości, a jedynie metody kontrolowania objawów.12
  • Hiperpotliwość wtórna – najczęstszą przyczyną jest działanie leków lub inne schorzenia ogólnoustrojowe. W przypadku hiperpotliwości wtórnej, profilaktyka polega na leczeniu lub opanowaniu choroby podstawowej oraz modyfikacji stosowanych leków pod nadzorem lekarza.12

Profilaktyka hiperpotliwości pierwotnej

Mimo że hiperpotliwość pierwotna nie ma całkowitego leczenia, istnieje szereg działań, które mogą pomóc w zapobieganiu nasilenia objawów:12

  • Stosowanie antyperspirantów zamiast dezodorantów – antyperspiranty pomagają zmniejszyć pocenie się, podczas gdy dezodoranty jedynie maskują zapach. Najlepiej stosować antyperspiranty zawierające chlorek glinu (aluminium) o stężeniu 10-20%.12
  • Identyfikacja i unikanie czynników wyzwalających – prowadzenie dziennika pocenia się, aby zidentyfikować konkretne czynniki wyzwalające nadmierne pocenie, takie jak spożywanie pikantnych potraw, kofeiny, alkoholu czy glutaminianu sodu.12
  • Odpowiednia odzież – noszenie przewiewnych tkanin, takich jak bawełna, oraz częsta zmiana ubrań. W przypadku pocenia się stóp, ważna jest częsta zmiana butów i skarpetek.12
  • Dbanie o nawodnienie – nadmierne pocenie może prowadzić do odwodnienia, dlatego ważne jest picie odpowiedniej ilości wody.1
  • Kontrola stresu – techniki relaksacyjne, takie jak medytacja czy joga, mogą pomóc w kontrolowaniu objawów, jeśli stres jest czynnikiem wyzwalającym.12

Profilaktyka hiperpotliwości wtórnej

W przypadku hiperpotliwości wtórnej, kluczowe znaczenie ma zidentyfikowanie i leczenie choroby podstawowej oraz modyfikacja leczenia, jeśli przyczyną jest działanie leków:12

  • Leczenie choroby podstawowej – jeśli hiperpotliwość jest spowodowana nadczynnością tarczycy, cukrzycą lub innymi schorzeniami, ich odpowiednie leczenie może zmniejszyć lub wyeliminować nadmierne pocenie.1
  • Odstawienie lub zmiana leków – jeśli hiperpotliwość jest skutkiem ubocznym stosowanych leków, należy skonsultować się z lekarzem w celu zmiany leku na alternatywny lub modyfikacji dawki.1
  • Monitorowanie stanu zdrowia – regularne wizyty kontrolne u lekarza mogą pomóc w monitorowaniu skuteczności leczenia choroby podstawowej i jej wpływu na hiperpotliwość.1

Codzienna pielęgnacja i zapobieganie powikłaniom skórnym

Hiperpotliwość może prowadzić do różnych problemów skórnych, takich jak maceracja skóry, infekcje czy nieprzyjemny zapach. Zapobieganie tym powikłaniom jest istotnym elementem profilaktyki:1

  • Codzienna higiena – regularne mycie z użyciem antybakteryjnych mydeł oraz dokładne osuszanie skóry.1
  • Stosowanie talków i proszków – w przypadku pocących się stóp stosowanie specjalnych proszków może pomóc utrzymać je w suchości.1
  • Stosowanie specjalistycznych produktów – dostępne są specjalne tkaniny i ubrania odprowadzające wilgoć oraz prześcieradła wchłaniające pot, które mogą pomóc w zapobieganiu maceracji skóry.1
  • Unikanie syntetycznych materiałów – wybieranie naturalnych, oddychających tkanin, które minimalizują ryzyko rozwoju infekcji skórnych.1

Postępowanie farmakologiczne w profilaktyce hiperpotliwości

Leki miejscowe

Miejscowe preparaty są pierwszą linią obrony w zapobieganiu objawom hiperpotliwości:12

  • Chlorek glinu – 20% roztwór chlorku glinu (np. Drysol) jest zalecany jako leczenie pierwszego rzutu w większości przypadków pierwotnej hiperpotliwości, niezależnie od nasilenia i lokalizacji. Preparat ten należy nakładać na noc na dotknięte obszary przez 6-8 godzin, dopóki wynik w skali HDSS (Hyperhidrosis Disease Severity Scale) nie ulegnie zmniejszeniu, po czym można wydłużyć odstępy między aplikacjami.12
  • Miejscowe leki antycholinergiczne – takie jak roztwór glikopironiny 0,5-2,0%, mogą być stosowane jako alternatywa, szczególnie w przypadku pocenia twarzy i głowy.12

Leki doustne

Leki doustne są zalecane, gdy leczenie miejscowe jest nieskuteczne lub objawy są bardziej uogólnione:12

  • Leki antycholinergiczne – takie jak oksybutynina (5-10 mg dziennie) lub glikopironina, które zmniejszają aktywność gruczołów potowych poprzez blokowanie przekaźnictwa nerwowego. Najczęściej stosowanymi doustnymi lekami antycholinergicznymi są oksybutynina i glikopironina.12
  • Beta-blokery – takie jak propranolol, mogą być pomocne w kontrolowaniu pocenia związanego z sytuacjami stresowymi, np. przed wystąpieniami publicznymi.12
  • Leki przeciwdepresyjne – szczególnie selektywne inhibitory wychwytu zwrotnego serotoniny (SSRI), mogą pomóc w kontrolowaniu lęku, który może nasilać pocenie.1

Należy jednak pamiętać, że stosowanie doustnych leków antycholinergicznych wymaga ostrożności, szczególnie u pacjentów w podeszłym wieku (powyżej 65 lat), ze względu na potencjalne ryzyko rozwoju demencji i zaniku mózgu przy długotrwałym stosowaniu wysokich dawek.12

Interwencje zabiegowe w profilaktyce hiperpotliwości

Jonoforeza

Jonoforeza jest nieinwazyjną metodą, która wykorzystuje słaby prąd elektryczny do blokowania gruczołów potowych:12

  • Zalecana 2-3 razy w tygodniu, szczególnie skuteczna w leczeniu hiperpotliwości dłoni i stóp.1
  • Lekarz może zalecić dodanie leków do wody, co może zwiększyć skuteczność terapii.1
  • Metoda ta może być stosowana jako pierwsza lub druga linia leczenia hiperpotliwości dłoni i stóp.1

Toksyna botulinowa (Botox)

Iniekcje toksyny botulinowej typu A (Botox) są skuteczną metodą tymczasowego blokowania nerwów odpowiedzialnych za nadmierne pocenie:12

  • Mogą być stosowane jako pierwsza lub druga linia leczenia hiperpotliwości pachowej, dłoniowej, podeszwowej lub twarzo-czaszkowej.1
  • Efekty utrzymują się przez 4-6 miesięcy, po czym leczenie wymaga powtórzenia.1
  • Według International Hyperhidrosis Society, pacjenci, którzy otrzymują iniekcje Botox, odnotowują zmniejszenie nadmiernego pocenia o ponad 85%.1

Metody termiczne

Metody wykorzystujące energię termiczną do niszczenia gruczołów potowych są nowszymi opcjami leczenia hiperpotliwości pachowej:12

  • MiraDry – nieinwazyjna metoda wykorzystująca technologię elektromagnetyczną do niszczenia gruczołów potowych w okolicach pach bez konieczności operacji.12
  • Laseroterapia – koncentruje wąską wiązkę energii na gruczołach potowych pod pachami, aby je zniszczyć.1

Metody chirurgiczne

Interwencje chirurgiczne są zwykle rozważane w ciężkich przypadkach hiperpotliwości, które nie reagują na inne metody leczenia:12

  • Endoskopowa sympatektomia piersiowa (ETS) – procedura, w której przecina się lub usuwa fragment głównego łańcucha współczulnego w klatce piersiowej, czyli nerwu kontrolującego gruczoły potowe. Jest to najbardziej skuteczna metoda leczenia hiperpotliwości, szczególnie dla pacjentów z nasiloną hiperpotliwością dłoni.12
  • Usunięcie gruczołów potowych – chirurgiczne usunięcie gruczołów potowych w obszarach szczególnie dotkniętych hiperpotliwością, zwłaszcza pod pachami.1

Powikłaniem sympatektomii może być kompensacyjne pocenie, czyli zwiększona potliwość innych części ciała. Większość pacjentów twierdzi jednak, że kompensacyjne pocenie jest bardziej tolerowalne niż pierwotny problem.12

Podejście stopniowe do profilaktyki hiperpotliwości

Eksperci zalecają stopniowe podejście do leczenia i profilaktyki hiperpotliwości, rozpoczynając od metod najmniej inwazyjnych:12

  1. Leczenie miejscowe – antyperspiranty zawierające chlorek glinu jako pierwsza linia obrony.1
  2. Jonoforeza – szczególnie w przypadku hiperpotliwości dłoni i stóp.1
  3. Iniekcje toksyny botulinowej – gdy metody miejscowe są nieskuteczne.1
  4. Leki doustne – antycholinergiczne, gdy inne metody zawiodą.1
  5. Zabiegi chirurgiczne – rozważane w ciężkich przypadkach, które nie reagują na inne metody leczenia.1

Monitorowanie i opieka długoterminowa

Kluczowym elementem profilaktyki hiperpotliwości jest regularne monitorowanie stanu pacjenta i dostosowywanie planu leczenia:12

  • Regularne wizyty kontrolne – umożliwiają ocenę skuteczności stosowanych metod i wprowadzenie niezbędnych modyfikacji.1
  • Ocena psychologiczna – hiperpotliwość może mieć znaczący wpływ na jakość życia i zdrowie psychiczne, dlatego ważna jest również opieka psychologiczna.12
  • Edukacja pacjenta – zwiększanie świadomości pacjenta na temat jego stanu, dostępnych metod leczenia i strategi radzenia sobie z objawami.1

Podsumowanie profilaktyki i zapobiegania hiperpotliwości

Choć całkowite zapobieganie hiperpotliwości, szczególnie pierwotnej, może nie być możliwe, istnieje szereg metod, które mogą pomóc w kontrolowaniu objawów i zapobieganiu nasilenia dolegliwości. Podejście do profilaktyki powinno być zindywidualizowane i uwzględniać typ hiperpotliwości, jej nasilenie, lokalizację oraz preferencje pacjenta.12

Kluczowe elementy profilaktyki hiperpotliwości obejmują:12

  • Regularne stosowanie odpowiednich antyperspirantów
  • Identyfikację i unikanie czynników wyzwalających
  • Odpowiednią pielęgnację skóry i dobór odzieży
  • Stosowanie farmakoterapii pod nadzorem lekarza
  • Rozważenie bardziej zaawansowanych metod, takich jak jonoforeza, iniekcje toksyny botulinowej czy metody chirurgiczne, w przypadku ciężkiej hiperpotliwości
  • Regularne monitorowanie stanu i dostosowywanie planu leczenia
  • Dbanie o zdrowie psychiczne i jakość życia

Należy podkreślić, że pacjenci z hiperpotliwością powinni konsultować się z lekarzem w celu ustalenia najbardziej odpowiedniego planu leczenia i profilaktyki, dostosowanego do ich indywidualnych potrzeb i okoliczności.12

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  1. 10.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Hyperhidrosis: Types, Causes, Symptoms & Treatment
    https://my.clevelandclinic.org/health/diseases/17113-hyperhidrosis
    Not all cases of hyperhidrosis are preventable. For example, you cant prevent focal hyperhidrosis since it may have a genetic cause. If you have generalized hyperhidrosis, managing or treating any underlying health conditions can help. You can also work with your healthcare provider to manage the side effects of medications youre prescribed to reduce the likelihood of hyperhidrosis. […] While hyperhidrosis has no cure, there are a variety of treatment options available to help you manage your symptoms. The condition isnt life-threatening, but it can have a major impact on your life. You may feel embarrassed or sensitive talking about your condition and it might keep you from participating in activities that you regularly enjoy. If hyperhidrosis affects your mental health, talk to a healthcare provider or a mental health professional. They can help you feel better about your body and the effect of overactive sweat glands.
  • #1 Hyperhidrosis – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK459227/
    Hyperhidrosis is classified as primary and secondary, and the management and treatment can significantly differ. The primary disease typically presents earlier in life with more localized symptoms. The secondary disease typically presents due to adverse effects of medications or systemic disorders, particularly neurologic. […] Several treatment options for hyperhidrosis include topical aluminum chloride and oral anticholinergic medications, which are sufficient in patients with mild to moderate disease. Botulinum toxin A injections, sympathectomy, and local excision are also effective but reserved for patients resistant to conservative therapy. […] As more treatment options have become available, treating hyperhidrosis has become easier for clinicians. A stepwise approach is often effective, and many topical and systemic agents are available.
  • #1 Drug-induced hyperhidrosis
    https://dermnetnz.org/topics/drug-induced-hyperhidrosis
    Drug-induced hyperhidrosis is the most common cause of secondary hyperhidrosis. […] It results from the release of acetylcholine by medications that block the action of acetylcholinesterase, an enzyme that breaks down the neurotransmitter. […] A temporal relationship between initiation of a certain medication and onset of symptoms with no other apparent cause of secondary hyperhidrosis is suggestive of drug-induced hyperhidrosis. […] When suspicious of drug-induced hyperhidrosis, the possible culprit medication should be stopped completely as a trial. […] Drug-induced hyperhidrosis resolves when the causative medication is stopped.
  • #1 Hyperhidrosis: 6 tips dermatologists give their patients
    https://www.aad.org/public/diseases/a-z/hyperhidrosis-self-care
    Treating hyperhidrosis is the best way to get relief. To get the best results from treatment, board-certified dermatologists recommend following these tips to help you feel more comfortable: […] Use antiperspirant instead of deodorant to reduce sweating. Antiperspirants help reduce sweating. Deodorants dont. […] Keep a sweat journal to find what triggers your sweating. A trigger is a specific activity or thing that causes you to start sweating heavily. […] Dress for success. Here are tips that dermatologists give their patients: Wear breathable fabrics like cotton. These help you feel more comfortable. […] Care for sweaty feet. When hyperhidrosis affects your feet, dermatologists recommend the following: Change your shoes and socks often. […] Drink plenty of water. Sweating can dehydrate you.
  • #1 Hyperhidrosis: 6 tips dermatologists give their patients
    https://www.aad.org/public/diseases/a-z/hyperhidrosis-self-care
    Take care of your mental health. Does sweating heavily make you feel anxious or depressed? Getting counseling, joining a support group, or learning more about hyperhidrosis may help. […] Dermatologists understand that living with excessive sweating can reduce your quality of life. When you partner with a board-certified dermatologist to treat hyperhidrosis, you can get sweating under control.
  • #1 Hyperhidrosis: Types, Causes, Symptoms & Treatment
    https://my.clevelandclinic.org/health/diseases/17113-hyperhidrosis
    Theres no cure for focal hyperhidrosis. Treatments can help you reduce your symptoms and improve your quality of life. Generalized hyperhidrosis can go away if you and your healthcare provider manage or treat the underlying cause, which could be either a side effect of an underlying condition or a medication you take. Not all cases of generalized hyperhidrosis have a cure.
  • #1 Hyperhidrosis: Diagnosis and treatment
    https://www.aad.org/public/diseases/a-z/hyperhidrosis-treatment
    If you have been diagnosed with secondary hyperhidrosis, which is caused by medication or having another medical condition, your dermatologist may recommend one of the following to prevent excessive sweating: […] Treat the medical condition causing the excessive sweating. […] Patients diagnosed with primary hyperhidrosis (not due to a medication or medical condition) require treatment to control excessive sweating. […] To treat hyperhidrosis, your dermatologist will create an individualized treatment plan based on: The type of hyperhidrosis you have, Your symptoms, Where on your body you sweat heavily, Your preferences for treatment. […] Your treatment plan may include one or more of the following: Treatment you apply to your skin. […] If an antiperspirant is part of your treatment plan, you would apply it to dry skin before bedtime.
  • #1 Hyperhidrosis (Excessive Sweating): Causes, Symptoms & Treatment
    https://www.webmd.com/skin-problems-and-treatments/hyperhidrosis2
    Thoracic sympathectomy is a surgery that cuts certain nerves to reduce sweating. […] There’s no cure for the condition, but treatment, regular doctor visits, and lifestyle changes such as breathable clothes can help keep your symptoms under control. […] While there’s no cure for hyperhidrosis, proper management can improve your quality of life. Regular follow-ups with your doctor are critical for tracking your progress and adjusting your treatment plan.
  • #1 Content – Health Encyclopedia – University of Rochester Medical Center
    https://www.urmc.rochester.edu/encyclopedia/content?ContentTypeID=85&ContentID=P00284
    Treatment may include antiperspirant, medicine, injections, surgery, or treatments for another health condition. […] You can help prevent this problem by treating your hyperhidrosis and keeping your skin dry as much as possible. […] You may have skin problems in the areas where you sweat. The skin may become moist, pale, swollen, and soft enough to rub away easily. This is known as skin maceration. It can lead to loss of skin, pain, and skin infection. […] Talk with your healthcare provider about: […] Ways to prevent skin maceration. […] If you are bothered by odor, try bathing daily with antibacterial soap and drying yourself completely. […] Consider keeping a sweat journal that identifies specific triggers. Triggers might include certain spices or foods such as caffeine, chocolate, hot sauce, spicy foods, and alcohol. […] If your sweating is triggered by stress, relaxation methods, like yoga, may help.
  • #1 Excessive sweating (hyperhidrosis)
    https://www.nhs.uk/conditions/excessive-sweating-hyperhidrosis/
    Excessive sweating is common and can affect the whole body or just certain areas. Sometimes it gets better with age but there are things you can do and treatments that can help. […] You can see a pharmacist about excessive sweating. You can buy things without a prescription, such as: stronger antiperspirants instead of deodorant, armpit or sweat shields to protect your clothing, foot powders for sweaty feet, soap substitutes that are more gentle on your skin. […] If there’s no obvious cause for your sweating, and nothing seems to be helping, then you may be referred to a specialist (dermatologist). They may recommend other treatments that you can try, such as: taking tablets that reduce sweating, treating the areas with a weak electric current passed through water or on a wet pad (iontophoresis), having botox injections for sweating under the armpits (this may not be available on the NHS), surgery for example, removal of the sweat glands.
  • #1 Don’t Sweat It: An Overview of Hyperhidrosis
    https://www.uspharmacist.com/article/dont-sweat-it-an-overview-of-hyperhidrosis
    For individuals who experience nighttime sweats, Wicked Sheets and Cool-jams offer sheets that can keep the person cool and wick away moisture throughout the night. Other companies, such as Thompson Tee and Sutran Garments, offer sweat-proof clothing designed to block underarm sweat, odor, and staining. Similar to the wicking sheets, these garments will not prevent hyperhidrosis, but they may improve the individuals quality of life and minimize embarrassment over underarm odor and stains. […] It is important to note that these preventive methods will not rid the individual of hyperhidrosis, but they may be beneficial as add-on therapy to the previously discussed treatment options.
  • #1 Hyperhidrosis – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK459227/
    First-line therapy for hyperhidrosis includes over-the-counter aluminum chloride hexahydrate 20% for 3 to 4 nights, then nightly as needed. […] If a patient does not respond to topical treatment or has more generalized symptoms, oral anticholinergic medications should be considered, including oxybutynin 5 mg to 10 mg daily or topical glycopyrrolate 0.5% to 2.0%. […] Iontophoresis 2 to 3 times weekly and botulinum toxin A injections every 3 to 4 weeks are effective if patients fail topical and oral drug therapy. […] More invasive therapeutic measures are available, including sympathectomy or local excision as a last resort. […] If a secondary cause is suspected, treatment of the underlying disorder or discontinuation of the suspected medication is recommended in addition to regular therapy.
  • #1 Hyperhidrosis: Management Options | AAFP
    https://www.aafp.org/pubs/afp/issues/2018/0601/p729.html
    First-line treatment of all primary focal hyperhidrosis, regardless of severity, is topical 20% aluminum chloride (Drysol). This solution is applied nightly to the affected areas for six to eight hours until the HDSS score decreases, at which time the application interval can be lengthened to maintain sweat control. […] Canadian guidelines recommend oral anticholinergics for treating primary hyperhidrosis with an HDSS score of 3 or 4 that does not resolve with topical aluminum chloride, onabotulinumtoxinA, or iontophoresis. The most commonly used oral anticholinergic medications are oxybutynin and glycopyrrolate.
  • #1 Hyperhidrosis Treatment FAQs | Mount Sinai – New York
    https://www.mountsinai.org/care/thoracic-surgery/services/hyperhidrosis/treatment-faqs
    We can treat mild forms of hyperhidrosis without surgery. The most common approaches include use of astringents, talc or starch, sedatives, antihistamine medicines, or beta blockers. […] If these do not work, we can offer surgical treatment. […] The most effective treatment for hyperhidrosis is endoscopic thoracic sympathectomy (ETS), a surgical procedure. […] You should see a dramatic improvement practically from the moment you awaken from the anesthetic. These effects are permanent for almost everyone. […] Although ETS is a minimally invasive surgical procedure, you may feel some pain shortly after the surgery. […] Most patients return to normal activity after about a week. […] When an incision is made, there is a small risk of infection, bleeding, or healing issues at the surgical sites.
  • #1 What can I do for my excessive sweating? – Harvard Health
    https://www.health.harvard.edu/diseases-and-conditions/what-can-i-do-for-my-excessive-sweating
    If your anxiety occurs only in certain situations, your doctor can prescribe a low-dose beta blocker like propranolol beforehand. The drug blocks your sympathetic nervous system and thus helps to reduce sweating. […] For more general social anxiety, your doctor or therapist might prescribe an SSRI (selective serotonin reuptake inhibitor). Examples are sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac). They help you feel less anxious, which, in turn, makes you sweat less.
  • #1 Oral Medications – International Hyperhidrosis Society | Official Site
    https://www.sweathelp.org/hyperhidrosis-treatments/medications.html
    There are a number of oral (taken by mouth) prescription medications that may be used to help manage certain types of excessive sweating, either alone or (more often) in combination with other treatments like antiperspirants, injectables, miraDry, and/or iontophoresis. […] The key, experts say, is that these medications should not be used alone, but combined with other therapies to optimize their benefits and minimize side effects. […] Many hyperhidrosis patients experience success with anticholinergic therapy, especially when it’s used in combination with other sweat management techniques. […] Of course, it is common for medications to be used off-label and a substantial safe history of off-label use of these meds has helped most practitioners to feel confident about them. […] It should be noted that studies (in JAMA Neurology 2016 and JAMA Internal Medicine 2015) have reported a potential link between the development of dementia and/or brain atrophy and long-term, high-dose anticholinergic use by older people.
  • #1 Hyperhidrosis: Diagnosis and treatment
    https://www.aad.org/public/diseases/a-z/hyperhidrosis-treatment
    You will continue to use the antiperspirant at bedtime until the excessive sweating is under control. […] If you accidentally get the medication from the cloth on your face or in an eye, you can develop side effects like irritated skin or blurry vision. […] If one of these is right for you, you would either receive treatment in your dermatologist’s office or perform the treatment at home. […] Your dermatologist may recommend adding a medication to the water that can further help prevent excessive sweating. […] If other treatments fail to bring relief, surgery may be considered. […] Surgery can permanently stop excessive sweating in the treated area. […] When surgery is an option, your dermatologist will refer you to a surgeon. […] A possible side effect of surgery is compensatory sweating. […] Sweat gland removal has possible side effects, which include scarring, pain, bleeding, and infection. […] With a dermatologist’s help, you don’t need to live with excessive sweating. Your dermatologist knows how to create a treatment plan that can reduce hyperhidrosis.
  • #1 Hyperhidrosis: Management Options | AAFP
    https://www.aafp.org/pubs/afp/issues/2018/0601/p729.html
    The Hyperhidrosis Disease Severity Scale should be used to gauge severity of primary hyperhidrosis and predict response to treatment. Topical 20% aluminum chloride (Drysol) should be used as first-line treatment in most cases of primary hyperhidrosis, regardless of severity and location. Iontophoresis may be effective as first- or second-line treatment for primary hyperhidrosis of the palms or soles. Intradermal onabotulinumtoxinA (Botox) injections may be considered first- or second-line treatments for many cases of primary hyperhidrosis involving the axillae, palms, soles, or face. Oral anticholinergics are recommended if treatment with topical aluminum chloride, onabotulinumtoxinA injection, and iontophoresis is ineffective. Local surgery and endoscopic thoracic sympathectomy should be considered only after topical and medical treatments have failed.
  • #1 Hyperhidrosis | Conditions | UCSF Health
    https://www.ucsfhealth.org/conditions/hyperhidrosis
    Hyperhidrosis is characterized by abnormal, excessive sweating that can occur in the hands, armpits and feet. […] UCSF offers effective, long-lasting treatments for hyperhidrosis. These include Botox injections and a minimally invasive surgery called endoscopic thoracic sympathectomy (ETS), which blocks the excessive nerve activity leading to severe sweating. […] Many patients with hyperhidrosis try topical medications or herbal remedies to ease their condition, but these have only temporary or no benefit. Fortunately, effective treatments are available. […] UCSF dermatologists use botulinum toxin (Botox) injections to treat hyperhidrosis. The injections temporarily block a chemical in the body that stimulates the sweat glands, and will reduce sweating for about four to six months. […] Surgical interruption of the sympathetic nerve chain offers proven, long-term results.
  • #1 Botox injections one way to treat hyperhidrosis sweating | UCLA Health
    https://www.uclahealth.org/news/article/botox-injections-one-way-treat-hyperhidrosis-sweating
    Hyperhidrosis is a disorder in which the sweat glands become overactive. The result is excessive perspiration that is not associated with exercise, temperature or any other typical triggers. […] When it comes to managing the disorder, the antiperspirant your internist recommended is a common first-line approach. So are medications known as anticholinergics, which interfere with the electrical signals the body uses to activate the sweat glands. […] Nerve impulses associated with sweating can also be muted with the use of Botox. […] Botox injections have come to be widely used in managing primary hyperhidrosis when topical treatments have failed. The treatment works by blocking the nerve signals that instruct the sweat glands to become active. […] According to the International Hyperhidrosis Society, people who receive Botox injections have found excessive sweating decreases by more than 85%. […] With the failure of the antiperspirant to bring you relief, your internist can advise you on whether oral medications, Botox injections or surgery may be an appropriate next step.
  • #1 Hyperhidrosis (Excessive Sweating): Causes, Symptoms & Treatment
    https://www.webmd.com/skin-problems-and-treatments/hyperhidrosis2
    Hyperhidrosis is a condition that causes excessive sweating. If left untreated, these problems may continue throughout your life. […] But there are treatments to help with hyperhidrosis. […] The first treatment for excessive sweating usually involves daily creams that dry out the skin. […] Your doctor may prescribe medication that blocks the nerves that trigger sweat glands or an antidepressant. […] Most people use Botox, a nerve toxin that can temporarily paralyze muscle, as a cosmetic treatment for wrinkles. But doctors also use it for excessive underarm sweating. […] This is a noninvasive treatment that uses electromagnetic energy to direct heat on sweat glands, destroying them. […] Lasers focus a narrow beam on underarm sweat glands to destroy them. […] People with excessive sweating of the hands and feet have used iontophoresis for more than 50 years.
  • #1 How to Stop Excessive Sweating (Hyperhidrosis)? – Scripps Health
    https://www.scripps.org/news_items/4490-what-can-i-do-to-help-control-my-sweaty-palms-or-underarms
    Reducing stress can also make a difference. […] Finding ways to relax is a good approach to breaking the excessive sweating cycle. Techniques for relaxation may include mediation and breathing exercises, Dr. Ross explains. […] Conventional treatment for excessive sweating dates back many decades. Over-the-counter and prescribed antiperspirants and topical medications are part of this treatment option. […] Medical and technological advances have led to more treatment options for hyperhidrosis using devices and other products. […] MiraDry, for example, is a medical device that uses electromagnetic technology to eliminate excessive armpit sweating without surgery. […] New topical medications include Qbrexza, a prescription cloth or wipe that is used to reduce excessive underarm sweating. […] Surgery may be an option for people with severe hyperhidrosis that has not responded to other treatments.
  • #1 Hyperhidrosis Treatment FAQs | Mount Sinai – New York
    https://www.mountsinai.org/care/thoracic-surgery/services/hyperhidrosis/treatment-faqs
    The most bothersome side effect is excessive sweating on the back, abdomen, thighs, or lower legs. We call this compensatory sweating. […] Most patients who develop mild to moderate compensatory sweating say that they are not troubled by this extra perspiration. […] Patients who do develop severe compensatory sweating may have difficulty during hot humid weather or anxious situations.
  • #1 7 Self-Care Tips for People With Hyperhidrosis
    https://www.everydayhealth.com/hyperhidrosis/self-care-tips-people-with-hyperhidrosis/
    Hyperhidrosis can be socially stigmatizing. […] If you have hyperhidrosis and its making you so distraught that it interferes with your ability to work, build relationships, or take part in joyful activities, your dermatologist or primary care physician may consider referring you to a mental health professional, says Wechsler. […] Nearly half of people dealing with excessive sweating havent talked to a healthcare professional about it, research has shown. […] However, the biggest message I have for people is that you should talk to your doctor. There are treatments that work. There is hope. Youre not alone.
  • #2 Hyperhidrosis: Management Options | AAFP
    https://www.aafp.org/pubs/afp/issues/2018/0601/p729.html
    Hyperhidrosis is excessive sweating that affects patients’ quality of life, resulting in social and work impairment and emotional distress. Primary hyperhidrosis is bilaterally symmetric, focal, excessive sweating of the axillae, palms, soles, or craniofacial region not caused by other underlying conditions. […] Topical aluminum chloride solution is the initial treatment in most cases of primary focal hyperhidrosis. Topical glycopyrrolate is first-line treatment for craniofacial sweating. Botulinum toxin injection (onabotulinumtoxinA) is considered first- or second-line treatment for axillary, palmar, plantar, or craniofacial hyperhidrosis. Iontophoresis should be considered for treating hyperhidrosis of the palms and soles. Oral anticholinergics are useful adjuncts in severe cases of hyperhidrosis when other treatments fail. Local microwave therapy is a newer treatment option for axillary hyperhidrosis. Local surgery and endoscopic thoracic sympathectomy should be considered in severe cases of hyperhidrosis that have not responded to topical or medical therapies.
  • #2 Drug-induced hyperhidrosis
    https://dermnetnz.org/topics/drug-induced-hyperhidrosis
    Drug-induced hyperhidrosis is the most common cause of secondary hyperhidrosis. […] It results from the release of acetylcholine by medications that block the action of acetylcholinesterase, an enzyme that breaks down the neurotransmitter. […] A temporal relationship between initiation of a certain medication and onset of symptoms with no other apparent cause of secondary hyperhidrosis is suggestive of drug-induced hyperhidrosis. […] When suspicious of drug-induced hyperhidrosis, the possible culprit medication should be stopped completely as a trial. […] Drug-induced hyperhidrosis resolves when the causative medication is stopped.
  • #2 Hyperhidrosis: Types, Causes, Symptoms & Treatment
    https://my.clevelandclinic.org/health/diseases/17113-hyperhidrosis
    Theres no cure for focal hyperhidrosis. Treatments can help you reduce your symptoms and improve your quality of life. Generalized hyperhidrosis can go away if you and your healthcare provider manage or treat the underlying cause, which could be either a side effect of an underlying condition or a medication you take. Not all cases of generalized hyperhidrosis have a cure.
  • #2 Hyperhidrosis: Symptoms, Causes, Treatment
    https://www.health.com/condition/hyperhidrosis-overview
    Prevention […] Unfortunately, it’s not possible to prevent primary hyperhidrosis. If you are diagnosed with secondary hyperhidrosis, you may be able to decrease sweating by changing medication or properly managing the medical condition causing it. […] Otherwise, it may be possible to help prevent or diminish the symptoms of excessive sweating with: […] Trigger avoidance or management, such as controlling stress or avoiding certain foods […] Lifestyle changes, like wearing lightweight, loose-fitting clothing or applying antiperspirants to sweaty areas.
  • #2 Hyperhidrosis: 6 tips dermatologists give their patients
    https://www.aad.org/public/diseases/a-z/hyperhidrosis-self-care
    Treating hyperhidrosis is the best way to get relief. To get the best results from treatment, board-certified dermatologists recommend following these tips to help you feel more comfortable: […] Use antiperspirant instead of deodorant to reduce sweating. Antiperspirants help reduce sweating. Deodorants dont. […] Keep a sweat journal to find what triggers your sweating. A trigger is a specific activity or thing that causes you to start sweating heavily. […] Dress for success. Here are tips that dermatologists give their patients: Wear breathable fabrics like cotton. These help you feel more comfortable. […] Care for sweaty feet. When hyperhidrosis affects your feet, dermatologists recommend the following: Change your shoes and socks often. […] Drink plenty of water. Sweating can dehydrate you.
  • #2 Hyperhidrosis – UF Health
    https://ufhealth.org/conditions-and-treatments/hyperhidrosis
    A wide range of common treatments for hyperhidrosis includes: […] Antiperspirants — Excessive sweating may be controlled with strong antiperspirants, which plug the sweat ducts. Products containing 10% to 20% aluminum chloride hexahydrate are the first line of treatment for underarm sweating. Some people may be prescribed a product containing a higher dose of aluminum chloride, which is applied nightly onto the affected areas. Antiperspirants can cause skin irritation, and large doses of aluminum chloride can damage clothing. Note: Deodorants do not prevent sweating but are helpful in reducing body odor. […] Medicines — Use of some medicines may prevent stimulation of sweat glands. These are prescribed for certain types of hyperhidrosis such as excessive sweating of the face. Medicines can have side effects and are not right for everyone. […] Iontophoresis — This procedure uses electricity to temporarily turn off the sweat gland. It is most
  • #2 Don’t Sweat It: An Overview of Hyperhidrosis
    https://www.uspharmacist.com/article/dont-sweat-it-an-overview-of-hyperhidrosis
    The key to preventing hyperhidrosis is the avoidance of sweat triggers. Triggers include excessive heat, spicy foods, stress, alcohol, caffeine, tobacco, monosodium glutamate (occurring naturally in foods such as tomatoes and cheese), exercise, and medications. Minimizing the consumption of trigger foods and beverages decreases the incidence of overproduction of sweat. […] Although stress can be a trigger for hyperhidrosis, relaxation techniques, such as meditation and yoga, have minimal to no effect on prevention. Given that certain medications and medical conditions are common causes of secondary hyperhidrosis, it is important to request a list of the patients current medications and review it for drugs that could potentiate hyperhidrosis as an adverse effect. Patients who are unwilling to seek pharmacologic interventions may benefit from a discussion of the use of an antiperspirant rather than a deodorant.
  • #2 How to stop sweating: Sweat-reduction tips
    https://www.medicalnewstoday.com/articles/326441
    The following strategies can help people manage: Tracking the symptoms in a journal. This can help a person identify, and when possible avoid, situations that trigger excessive sweating. […] A person may then reduce the use to once or twice a week. […] To control excessive sweating and increase comfort, especially in hot weather, a person might try: wearing loose clothing made from lightweight fabrics. […] Hyperhidrosis is excessive sweating, and there are two types: primary and secondary. […] A range of treatments can help, including antiperspirants, aluminum chloride creams, and anticholinergic medications. […] Hyperhidrosis that is particularly severe or resistant to other treatments may require iontophoresis, Botox injections, or a surgical intervention.
  • #2 How to Stop Excessive Sweating (Hyperhidrosis)? – Scripps Health
    https://www.scripps.org/news_items/4490-what-can-i-do-to-help-control-my-sweaty-palms-or-underarms
    Reducing stress can also make a difference. […] Finding ways to relax is a good approach to breaking the excessive sweating cycle. Techniques for relaxation may include mediation and breathing exercises, Dr. Ross explains. […] Conventional treatment for excessive sweating dates back many decades. Over-the-counter and prescribed antiperspirants and topical medications are part of this treatment option. […] Medical and technological advances have led to more treatment options for hyperhidrosis using devices and other products. […] MiraDry, for example, is a medical device that uses electromagnetic technology to eliminate excessive armpit sweating without surgery. […] New topical medications include Qbrexza, a prescription cloth or wipe that is used to reduce excessive underarm sweating. […] Surgery may be an option for people with severe hyperhidrosis that has not responded to other treatments.
  • #2 Hyperhidrosis: Management Options | AAFP
    https://www.aafp.org/pubs/afp/issues/2018/0601/p729.html
    First-line treatment of all primary focal hyperhidrosis, regardless of severity, is topical 20% aluminum chloride (Drysol). This solution is applied nightly to the affected areas for six to eight hours until the HDSS score decreases, at which time the application interval can be lengthened to maintain sweat control. […] Canadian guidelines recommend oral anticholinergics for treating primary hyperhidrosis with an HDSS score of 3 or 4 that does not resolve with topical aluminum chloride, onabotulinumtoxinA, or iontophoresis. The most commonly used oral anticholinergic medications are oxybutynin and glycopyrrolate.
  • #2 Treatment of Hyperhidrosis
    https://www.southcarolinablues.com/web/public/brands/medicalpolicyhb/external-policies/treatment-of-hyperhidrosis/
    Treatment of hyperhidrosis is considered NOT MEDICALLY NECESSARY in the absence of functional impairment or any of the above medical conditions. […] The following treatments may be considered MEDICALLY NECESSARY for the treatment of severe secondary gustatory hyperhidrosis: Aluminum chloride 20% solution, Surgical options (i.e., tympanic neurectomy) if conservative treatment has failed. […] A variety of therapies have been investigated for primary hyperhidrosis, including topical therapy with aluminum chloride, topical anticholinergic medications, oral anticholinergic medications, iontophoresis, intradermal injections of botulinum toxin, endoscopic transthoracic sympathectomy, and surgical excision of axillary sweat glands. […] The evidence has shown that excision is highly effective, and this treatment is considered standard of care for this indication.
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  • #2 What can I do for my excessive sweating? – Harvard Health
    https://www.health.harvard.edu/diseases-and-conditions/what-can-i-do-for-my-excessive-sweating
    If your anxiety occurs only in certain situations, your doctor can prescribe a low-dose beta blocker like propranolol beforehand. The drug blocks your sympathetic nervous system and thus helps to reduce sweating. […] For more general social anxiety, your doctor or therapist might prescribe an SSRI (selective serotonin reuptake inhibitor). Examples are sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac). They help you feel less anxious, which, in turn, makes you sweat less.
  • #2 Oral Medications – International Hyperhidrosis Society | Official Site
    https://www.sweathelp.org/hyperhidrosis-treatments/medications.html
    Patients over (or near) the age of 65 may want to discuss these studies (JAMA Neurology 2016, JAMA Internal Medicine 2015) with their healthcare providers before embarking on or continuing anticholinergic therapy for excessive sweating. […] Therefore, athletes, people who participate in sports, people who work outdoors, and anyone who may potentially cause themselves injury by becoming overheated must use extra care when considering these treatments. […] If you are interested in learning more about using oral medications to treat excessive sweating or as an adjunct/addition to other treatments, find a healthcare provider who is well-versed in hyperhidrosis care and oral medications in the IHhSs Clinician Finder database. […] If you’re considering an oral medication to treat excessive sweating, please know that experts in the field recommend that you try antiperspirants, Botox injections, or iontophoresis, too (or a combination of these).
  • #2 Excessive sweating (hyperhidrosis)
    https://www.nhs.uk/conditions/excessive-sweating-hyperhidrosis/
    Excessive sweating is common and can affect the whole body or just certain areas. Sometimes it gets better with age but there are things you can do and treatments that can help. […] You can see a pharmacist about excessive sweating. You can buy things without a prescription, such as: stronger antiperspirants instead of deodorant, armpit or sweat shields to protect your clothing, foot powders for sweaty feet, soap substitutes that are more gentle on your skin. […] If there’s no obvious cause for your sweating, and nothing seems to be helping, then you may be referred to a specialist (dermatologist). They may recommend other treatments that you can try, such as: taking tablets that reduce sweating, treating the areas with a weak electric current passed through water or on a wet pad (iontophoresis), having botox injections for sweating under the armpits (this may not be available on the NHS), surgery for example, removal of the sweat glands.
  • #2  Cardiovascular and Thoracic Surgery
    https://www.utmbhealth.com/services/cardiovascular-thoracic-surgery/procedures-conditions/hyperhidrosis
    Excessive sweating, also called hyperhidrosis, can affect the entire body, but usually occurs in the palms, soles, armpits, and/or groin area. […] Hyperhidrosis can lead to significant distress socially and in the workplace. […] There are a number of non-surgical treatments for hyperhidrosis, including, but not limited to: prescription-strength topical antiperspirants, orally administered anticholinergic medications, which may partially block the transmission of nerve impulses that have become problematic, and iontophoresis, which uses water and a very mild electrical current to microscopically thicken the outer layer of the skin. […] However, these treatments are successful in only a small fraction of patients, and none are without side effects. […] Surgeons have known for many years that dividing the sympathetic chain in the upper chest can provide a long-term cure for hyperhidrosis.
  • #2 Diagnosis and treatment for pediatric hyperhidrosi
    https://care.choc.org/diagnosis-and-treatment-for-pediatric-hyperhidrosis/
    Glycopyrronim, which is a glycoprotein, has just been approved by the FDA for treating underarm and palm sweating. […] Iontophoresis is a rather unique, ingenious therapy of using an electrical current to depolarize the sweat glands and reduce the production of sweat in the axilla, hands or feet, says Dr. Reyna. […] miraDry is a new treatment for axillary hyperhidrosis. It destroys the sweat glands with thermal radiation like a microwave. […] Endoscopic thoracic sympathectomy (ETS) is a surgical treatment for palmar hyperhidrosis; this treatment is the last resort for pediatric patients when other methods have failed or noxious side effects of medical management are present. […] “Dermatologists will refer patients to me that don’t have success with topical treatments,” says Dr. Reyna. […] The main side effect of this surgery is compensatory sweating. Unfortunately, when you restrict certain sympathetic flow, such as to the hands, there can be increased flow to other areas of the body. However, compensatory sweating is much more tolerable for many patients.
  • #2 Hyperhidrosis Treatment FAQs | Mount Sinai – New York
    https://www.mountsinai.org/care/thoracic-surgery/services/hyperhidrosis/treatment-faqs
    We can treat mild forms of hyperhidrosis without surgery. The most common approaches include use of astringents, talc or starch, sedatives, antihistamine medicines, or beta blockers. […] If these do not work, we can offer surgical treatment. […] The most effective treatment for hyperhidrosis is endoscopic thoracic sympathectomy (ETS), a surgical procedure. […] You should see a dramatic improvement practically from the moment you awaken from the anesthetic. These effects are permanent for almost everyone. […] Although ETS is a minimally invasive surgical procedure, you may feel some pain shortly after the surgery. […] Most patients return to normal activity after about a week. […] When an incision is made, there is a small risk of infection, bleeding, or healing issues at the surgical sites.
  • #2 Hyperhidrosis | Conditions | UCSF Health
    https://www.ucsfhealth.org/conditions/hyperhidrosis
    A minimally invasive procedure called endoscopic thoracic sympathectomy (ETS) was developed to treat hyperhidrosis. […] The ETS procedure may be done on an outpatient basis with quicker recovery and less scarring than open surgery. The procedure is highly effective in eliminating excessive sweating of the hands in more than 98 percent of patients. […] UCSF surgeons have significant experience in treating hyperhidrosis using ETS.
  • #2 Hyperhidrosis: Management Options | AAFP
    https://www.aafp.org/pubs/afp/issues/2018/0601/p729.html
    The Hyperhidrosis Disease Severity Scale should be used to gauge severity of primary hyperhidrosis and predict response to treatment. Topical 20% aluminum chloride (Drysol) should be used as first-line treatment in most cases of primary hyperhidrosis, regardless of severity and location. Iontophoresis may be effective as first- or second-line treatment for primary hyperhidrosis of the palms or soles. Intradermal onabotulinumtoxinA (Botox) injections may be considered first- or second-line treatments for many cases of primary hyperhidrosis involving the axillae, palms, soles, or face. Oral anticholinergics are recommended if treatment with topical aluminum chloride, onabotulinumtoxinA injection, and iontophoresis is ineffective. Local surgery and endoscopic thoracic sympathectomy should be considered only after topical and medical treatments have failed.
  • #2 7 Self-Care Tips for People With Hyperhidrosis
    https://www.everydayhealth.com/hyperhidrosis/self-care-tips-people-with-hyperhidrosis/
    Hyperhidrosis can be socially stigmatizing. […] If you have hyperhidrosis and its making you so distraught that it interferes with your ability to work, build relationships, or take part in joyful activities, your dermatologist or primary care physician may consider referring you to a mental health professional, says Wechsler. […] Nearly half of people dealing with excessive sweating havent talked to a healthcare professional about it, research has shown. […] However, the biggest message I have for people is that you should talk to your doctor. There are treatments that work. There is hope. Youre not alone.
  • #2 Hyperhidrosis: 6 tips dermatologists give their patients
    https://www.aad.org/public/diseases/a-z/hyperhidrosis-self-care
    Take care of your mental health. Does sweating heavily make you feel anxious or depressed? Getting counseling, joining a support group, or learning more about hyperhidrosis may help. […] Dermatologists understand that living with excessive sweating can reduce your quality of life. When you partner with a board-certified dermatologist to treat hyperhidrosis, you can get sweating under control.
  • #2 Hyperhidrosis: Diagnosis and treatment
    https://www.aad.org/public/diseases/a-z/hyperhidrosis-treatment
    If you have been diagnosed with secondary hyperhidrosis, which is caused by medication or having another medical condition, your dermatologist may recommend one of the following to prevent excessive sweating: […] Treat the medical condition causing the excessive sweating. […] Patients diagnosed with primary hyperhidrosis (not due to a medication or medical condition) require treatment to control excessive sweating. […] To treat hyperhidrosis, your dermatologist will create an individualized treatment plan based on: The type of hyperhidrosis you have, Your symptoms, Where on your body you sweat heavily, Your preferences for treatment. […] Your treatment plan may include one or more of the following: Treatment you apply to your skin. […] If an antiperspirant is part of your treatment plan, you would apply it to dry skin before bedtime.
  • #2 Hyperhidrosis Treatment: Solutions for a Common Problem | RoRoRo
    https://ro.co/hyperhidrosis/hyperhidrosis-treatment/
    If you have hyperhidrosis in your hands or feet (or both), iontophoresis may improve your symptoms. […] Another treatment option is oral prescription anticholinergic medication, like oxybutynin and glycopyrrolate; because these are oral medications, they treat overall sweating and cannot target specific areas. […] Because it is the most invasive option, surgery is often the treatment of last resort. […] In addition to the treatments listed, you can also try to reduce sweating by: bathing daily to decrease the bacteria on your skin and drying yourself off thoroughly, wearing shoes and socks made of natural materials that allow your feet to breathe, changing your socks often if you have sweaty feet, airing out your feet when you can, wearing clothes made of natural or moisture-wicking fabrics. […] If you have hyperhidrosis, you are not alone. Fortunately, a variety of treatments exist for the full range of severity of excessive sweating.