Flashcards in Pilosebaceous Unit & Apocrine Disorders Deck (27):
4 components of pilosebaceous unit
1) keratinized follicular infundibulum
3) sebaceous gland
4) sebaceous duct, which connects gland w/ infundibulum.
Overgrowth of which flora causes acne vulgarism?
Infundibular hyperkeratosis w/ androgen stimulation of sebum secretion → proliferation / retention of corenocytes. Not clinically apparent.
Accumulation of keratin and sebum plug that is clinically visible. Sebaceous lobule undergoes regression.
Acne Fulminans / Pyoderma Faciale (sxs and population)
Most severe form of cystic acne.
Abrupt onset of deep lesions which may cause scarring. Nodules may coalesce into oozing friable plaques w/ hemorrhagic crusts.
Most common in males age 13-16.
Systemic sxs include fever, arthralgias, myalgias, lymphadenopathy, and hepatosplenomegaly.
Acne Conglobata sxs
Severe eruptive acne w/o systemic sxs. Presents w/ comedones, nodules (may coalesce), abscesses, and draining sinuses.
Acne Mechanica (cause and sxs)
Due to mechanical / frictional obstruction of pilosebaceous unit by things like helmets, chin straps, collars, etc. Linear and geometric distribution.
Acne Excoriee (cause, sxs, population, tx)
Scratching by patient → linear lesions and post-inflammatory scarring.
Common in people w/ anxiety, OCD, or personality disorders.
Antidepressants and psychotherapy may be helpful.
Drug-Induced Acne (onset, sxs, location, cause)
Onset 2-4 weeks after starting drug.
Uniform morphology, as opposed to hetergenous morphology in acne vulgaris.
Favors trunk / extremities.
Most often caused by glucocorticoids, anabolic steroids, and lithium.
Neonatal acne (cause, prevalence, sxs, tx)
Due to maternal hormones.
Occurs in 20% of infants.
Superficial red papules on face.
Usually resolves w/in first 3 months of life.
Infantile acne (timing, cause, tx)
Beyond 3-6 months.
Due to child hormones (not mother). Immature adrenal gland may result in elevated DHEA.
Typically resolves w/in 1-2 years. Check for endocrine tumors if it persists
Topical acne treatments
Topical retinoids such as treninoin and adapalene are cornerstone for acne treatment. Unplug obstructed follicular orifice to release comedones and normalize keratin. Apply to full face.
Topical anti-inflammatories include benzoyl peroxide or topical antibiotics.
Systemic acne treatments
Oral antibiotics, oral contraceptives, oral spironolactone, oral isotretinoin
Oral antibiotics (use, general side effects, individual drugs)
Used for inflammatory acne that affects whole face or in people w/ acne that is not hormonally related. Best used for short time.
All 3 have risk for nausea, pseudotumor cerebri, dizziness, and teeth staining.
Tetracycline – must take on empty stomach → severe nausea. Photosensitivity. Primary oral tx for inflammatory acne.
Doxycycline – photosensitivity
Minocycline – NO photosensitivity. May cause blue/gray pigmentation on skin, lupus-like syndrome, and muscle / joint pain.
Oral spironolactone (mechanism and use)
Inhibits testosterone receptor. Used for jaw line acne and hirsuitism.
Oral contraceptive use
Use if acne is caused by hormones, which is common in women. Jaw line acne or hirsuitism.
Oral isotretinoin (mechanism, use, side effects)
Reduces keratin plug, reduces inflammation, and reduces oil gland. Best for severe nodulocystic and scarring acne.
Does NOT cause nausea, dizziness, or teeth staining.
Side effects: Photosensitive, pseudotumor cerebri, teratogenic, hyperlipidemia, muscle / joint pain, mood changes, eczematous rash, and hepatotoxicity
Rosacea (sxs, location, triggers, population, tx)
Inflammatory papules, but also fixed background redness, blushing, telengectasias. Absence of comedones (distinguishes from acne). No scarring.
Cheeks and nose are common sites.
May be triggered by sun, wind, heat, stress, hot liquids, spice foods, alcohol, or demodex mites. Always ask about blushing, acne, and ocular problems.
More common in fair-skinned individuals.
Tx w/ topical or systemic antibiotics to reduce erythema and inflammation. Laser surgery treats telangiectasias (cosmetic), but does not prevent future flares. Do NOT do laser surgery if active acne / flushing is present as it will return. Retinoids not useful as comedones are not present.
Subtype of rosacea. Overgrowth of sebaceous tissue on nose w/ redness. May be permanent.
Ocular Rosacea (sxs and prevalence)
Dry or gritty discomfort (foreign body sensation). Occurs in 50% of patients.
Perioral / Periorificial Dermatitis (associated disease, hallmark, trigger)
Subtype of rosacea.
Orificial = eyes / nose
Spares vermillion border.
Worsens w/ topical steroids and cinnamon / mint flavorings.
Pyoderma Faciale / Rosacea Fulminans sxs
Acute eruption of inflamed papules / pustules in centrofacial region.
Where are apocrine sweat glands found?
Axilla, groin, skin folds
Hidradenitis Suppurativa (cause, population, hallmark, sxs, tx)
Blockage of apocrine duct → rupture → chronic inflammation.
3x more common in women.
Hallmark is pain.
Recurrent nodules / boils w/ draining sinus tracts and scarring, often found in axillae.
Medical Tx: weight loss, systemic antibiotics, isotretinoin, prednisone, retinoids, and AlCl
Surgical Tx: Excision, CO2 laser ablation, or liposuction (remove glands). Use intralesion steroid injection for pain management.
Follicular Occlusional Triad / Acne Inversa (underlying cause and 4 diseases)
Underlying cause involves follicular hyperkeratinization.
1) Acne conglobata
2) Dissecting cellulitis of scalp – Inflammatory nodules / papules on scalp w/ scarring. Tend to be boggy / inflamed areas. Evolve into scarring alopecia.
3) Hidradenitis suppurativa
4) Pilonidal cyst – Often found on superior gluteal cleft. Painful and scarring.
Hyperhidrosis (sxs, types, tx)
Excess sweating, most often affects palms, soles, and axillae
Overproduction → maceration → bacterial / fungal growth → eccrine bromhidrosis (foul odor).
Primary – Mental / thermal stimuli w/o underlying disease. Most common.
Secondary – due to underlying disease or metabolic changes.
Tx: AlCl (plugs duct, primary tx), oral anticholinergics (systemic side effects), botox, surgical sympathectomy (divide nerve in neck plexus, used for hands, but may cause compensatory hyperhidrosis), liposuction (axillae).