Some patients have experienced cardiac sympathetic denervation, which can result in a 10% decrease in heart rate both at rest and during exercise, resulting in decreased exercise tolerance.Percutaneous sympathectomy is a minimally invasive procedure similar to the botulinum method, in which nerves are blocked by an injection of phenol. The procedure provides temporary relief in most cases. Some physicians advocate trying this more conservative procedure before resorting to surgical sympathectomy, the effects of which are usually not reversible. Prognosis
Hyperhidrosis can have physiological consequences such as cold and clammy hands, dehydration, and skin infections secondary to maceration of the skin. Hyperhidrosis can also have devastating emotional effects on ones individual life.Those with hyperhidrosis may have greater stress levels and more frequent depression.Excessive sweating or focal hyperhidrosis of the hands interferes with many routine activities, such as securely grasping objects. Some people with focal hyperhidrosis sufferers avoid situations where they will come into physical contact with others, such as greeting a person with a handshake. Hiding embarrassing sweat spots under the armpits limits the affected persons arm movements and pose. In severe cases, shirts must be changed several times during the day and require additional showers both to remove sweat and control body odor issues or microbial problems such as acne, dandruff, or athletes foot. Additionally, anxiety caused by self-consciousness to the sweating may aggravate the sweating.
Excessive sweating of the feet makes it harder for patients to wear slide-on or open-toe shoes, as the feet slide around in the shoe because of sweat.Some careers present challenges for people with hyperhidrosis. For example, careers that require the use of a knife may not be safely performed by people with excessive sweating of the hands. The risk of dehydration can limit the ability of some to function in extremely hot (especially if also humid) conditions. Even the playing of musical instruments can be uncomfortable or difficult because of sweaty hands. Epidemiology
It is estimated that the incidence of focal hyperhidrosis may be as high as 2.8% of the population of the United States. It affects men and women equally, and most commonly occurs among people aged 25–64 years, though some may have been affected since early childhood. About 30–50% of people have another family member affected, implying a genetic predisposition.In 2006, researchers at Saga University in Japan reported that primary palmar hyperhidrosis maps to gene locus  14q11.2–q13. References


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