fordyce spots apocrine eccrine bromhidrosis fox fordyce hidradenitis suppuritiva hyperhidrosis foc fordyce spots bromhydrosis acne vulgaris acne conglobata acne excoreiee fulminans sapho papa resistanct acne acne rosacea ocular rhinophyma fordyce spots basic dermatology revision notes based on lecture notes

1. SWEAT GLAND & SEBACEOUS
GLAND
TONY SCARIA 2010
KMC

2. Sweat gland

3. Sweat gland
• Most abundant in palms and soles
• Absent in lips
• 2 types
• Apocrine
• Eccrine

4. Sweat glands
Apocrine
• Limited sites only
• Axilla and groin ,nipple,genital
area
• During secretion a part of cell is
pinched offopen thru ducts of
sebaceous glandviscous
• Innervated by Adrenergic N
fibres
Eccrine
• Abundant
• No histological changes during
secretionopen directly on
surface of skin watery
secretion
• Cholinergic sympatheic fibres

5. • Open directly in to skin surface
• Open in to hair follicles

6. Disorders of Apocrine
• Bromhidrosis
• Chromohidrosis
• Fox Fordyce disease(d/t
blockage in duct)
• Hidradenitis suppurativa
Eccrine
• Anhidrosis
• Hyperhydrosis
• Miliaria (d/t blockage in
duct)

7. Modified apocrine sweat glands
• Ceruminous glands in EAC
• Glands of moll
• Mammary glands

8. • Disorders of eccrine sweat glands
• Hyperhydrosis
• Anhidrosis
• Miliaria
• Disorders of apocrine
• Hydradenitis suppuriativa (d/s of ducts )
• Chromhidrosis (coloured sweat),
• Bromhidrosis (hyperhidrosis + offensive odour),
• Fox - Fordyce's disease (apocrine miliariA.),

9. Miliaria
• Obstruction of eccrine sweat gland disruption of ductal integrity
secretion of sweat in to layers of epidermis & focal anhidrosis
•
• 3 types
• Miliaria crystallina
• Miliaria rubra
• Miliaria profunda

10. Obstruction @
Crystalline miliaria Stratum corneum
Miliaria rubra Obstruction @ malphigian layer Most common miliaria
Miliaria profunda Obstruction @ DEJ

11. Miliaria crystallina

12. miliaria rubra
• obstruction of the eccrine sweat ducts deeper in the epidermis
results in erythematous grouped papules in the same areas

13. Miliaria pustulosa
• Milia rubra becomes pustular

14. Miliaria profunda
• Rupture of duct at or below dermo-epidermal junction sweat
leaking in to dermis

15. Fox Fordyce disease
• Apocrine miliaria
• Blockage of apocrine sweat gland
• Female
• In 2nd decade
• White pearly paules with pruritus
• in axilla most common
• Rx
• OCP
• Surgical excision
• Electrocautery

16. Bromhidrosis
• Apocrine bromhidrosis is offensive body odour from apocrine gland
secretion + hyperhidrosis
• Associated with ginger intake

17. Chromhydrosis  coloured sweat

18. Hydradenitis suppuritiva
• d/s associated ducts of apocrine sweat glands
• c/c relapsing inflammatory disorder in apocrine sweat glands
• Multiple sinus with intercalating bridge
• Mc site  axilla
• Rx
• Biological drug  adalimumab (TNF α inhibitor)
• Surgical excison

20. Sebaceous glands

21. Sebaceous gland is holocrine (whole cell
disintegrates while secretion )

22. • PILOSEBACEOUSAlong with
hair follicle
• ECTOPIC
• Lips & genitalia (Fordyce spots)
• Areola  Montgomery tubercle
• Glans  Tyson glands
• In eye lids  Meibomian glands / gland of zeis
If alone

23. Obstruction of pilosebaceous glands
• Acne vulgaris
• Sebaceous cyst

24. Acne

25. Acne vulgaris
• Adolescents
• Papulopustolo inflammatory rash
• Etiology
• Obstruction of pilosebaceous glands d/t hypercornification  retention of
sebum
• Androgen dependant
• Overproduction of sebum
• Ductal colonisation by Propionibacterium acnes

26. Etiopathogenesis
Hyperproliferation of
keratinocytes of duct of
sebaceous gland
Blockage  increased
sebum collection 
growth of bacteria in
propionibacterium acne
 produce lipase
(produce FFA 
inflammation

27. • Acne vulgaris  most common
• Neonatal acne  maternal androgens
• Infantile acne d/t increased DHEA
• Acne fulminans  a/w systemic features (like fever)
• Acne excoriee women suffering from OCD
• Mobihan syndrome facial edema
• Acne conglobate  most severe
• Drug induced

28. Neonatal acne  maternal androgens

29. Acne congoblata  most severe

30. Acne excoriee d/t frequent picking of acne
 excoriation

31. Drug induced acne  acneiform eruptions
monomorphic
Monomorfic

32. Drugs aggravating acne
• Steroids  MC agent
• OCP
• Androgens
• Lithium
• Isoniazid, rifampicin (anti TB) mc cause in India
• Iodine
• Halogens
• Phenytoin
• Phenobarbitone

33. Acne vulgaris
• Pleomorphic lesions
• Comedones most characteristic
• Whitehead  closed
• Blackhead  Open
• Papule
• Pustules
• Nodules
• Cyst
• most commonly in face mid chest
back,upper arms

35. Comednes
• Comedones
• Earliest lesion and hallmark of acne
Comedolytic 
retinoids,adapalene

37. Acne vulgaris
• Healing by scarring
• Rx
• Comedonal acne  topical retinids
• Adapalene, tretinoin, tazorotene (photoreactive , best applied at bed time)
• Pustular /inflammatory ( oral minocycline,doxi,azithro)
• Nodulocystic acne  oral retinoids(isotretinoin)doc for grade IV acne
• 2mg/kg/day Once daily for 5 months
• Total cumulative dose = 150mg/kg
• Hormonal / PCOD acne
• OCP + cyproterone acetate (drug of choice in PCOD acne)
• Cosmetic improvement by laser dermabrasion

38. Oral retionoids
• DOC in acne vulgaris , comedonal acne
,Nodulocystic acne
• 2mg/kg/day Once daily for 5 months
• Total cumulative dose = 150mg/kg
• S/E
• Skin rash*** /
• Dry skin/
• cheilitis/
• hypertriglyceridemia/depression/
• Avoid in Sx  increased chance of keloid
• teratogenic
• Hepatotoxic
• Pseudotumour cerebri
• Pseudotumour cerebri
• Tetracycline
• Vitamin A

39. Minocycline
• Resistant cases of inflammatory acne
• S/E
• Dark brown pigmentation of skin

40. azelaic acid
• Hyperpigmenting skin disorders (melisma and post inflammatory
hyperpigmentation)
• Topically for acne

41. Chemical peeling
• Pyruvic acid
• Glycolic acid
• Malic acid
• Citric acid
• Trichloro acetic acid
• Mandelic acid
• Tartaric acid
• Lactic acid
• Salicylic acid
• Jessners solution
• Lactic acid + salicylic acid + resorcinol

42. Acne conglobata
• Severe acne with oozing pus
• MC in boys of tropical climate
• Rx
• Oral isoretinoin

43. Acne fulminans
• Nodulocystic acne
• Systemic complaints+
• Fever joint pain

44. acne excoriee des jeunes filles
• Young girls with mild acne
• But obsessed in picking  scar

45. SAPHO
• Synovitis
• Acne
• Pustulosis
• Hyperostosis
• Osteitis

47. PAPA
• Autosomal dominant
• Pyogenic Arthritis Pyoderma gangrenosum Acne

48. Resistant acne
• PCOD
• XYY syndrome
• Androgen secreting tumour
• CAH
• Aperts syndrome

49. Acne rosacea
• Erythema + papules,pustules+ telengectasia no
• In adults >30 years
• F>>M
• Men are severely affected
• Neurovascular component + erythema and a tendency to flush easily
• Erythema may be initiated by alcohol ,hot drinks,emotions
• Affects central face
• In a cruciate pattern
• Cheeks forehead nose

51. Types of acne rosacea
• Rhinophyma (sebaceous gland hyperplasia)
• Granulomatous rosacea (apple jelly pattern on discopy)
• Papulopustular
• Ocular

52. Rhinophyma/potato nose
• Long standing rosaceaHyperplasia of cutaneous sebaceous gland
• type of acne rosacea

53. Ocular roacea
• a/w
• Keratitis with pannus
• Blepharitis
• Iritis
• Recurrent chalazion

54. Granulomatous rosacea
• Acne agminata
• Lupus miliaris dissematus facei
• Not a/w with TB
• Annular

55. Rx of acne rosacea
• Oral tetracycline
• Topical metronidazole
• Avoid fluorinated topical glucocorticoids
• Actually elicit rosacea

56. Fordyce spots
• Present in 80 % of individuals
• Ectopic sebaceous glands /hamartomas
• montgomerys tubercle, Fordyce spots