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Derm > Diseases of apocrine and eccrine glands > Flashcards

Diseases of apocrine and eccrine glands Flashcards

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1
Q

Harlequin syndrome

A

Unilateral flushing
Hyperhidrosis in association with contralateral anhidrosis
May be due to peripneral or CNS abnormalities

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2
Q

What causes sweating in phaeochromocytoma

A

Episodic release of catecholamines

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3
Q

Overarching causes of hyperhidrosis

A 
Primary
Cortical
Hypothalamus
Medullary
Spinal
Local
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4
Q

Causes of hypothalamic hyperhidrosis

A
  1. Chronic infections
  2. Malignancy - lymphoma
  3. Neurological - CNS tumours, parkinsons, etc
  4. Vasomotor
  5. Toxins - ETOH, ETOH withdrawal
  6. Endocrine/metabolic - diabetes, hyperthyroidism, pregnancy, menopause, PKU, gout
  7. Miscellaneous: compensatory, localized unilateral hyperhidrosis, POEMs
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5
Q

What can cause hyperhidrosis in diabetes

A
  1. Low BSL
  2. Peripheral neuropathy
  3. Gustatory hyperhidrosis
  4. Poorly controlled –> scalp sweating
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6
Q

What temperature does sweating start?

A

When the fever is 39-40 there is no sweating, its only once the temperature goes down does the sweating start –> inhibitory mechanism

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7
Q

How does food induce sweating

A

Reflex arc:
Afferent impulses from taste bud receptors –> travel via the glossopharyngeal nerve to nuclei within the medulla oblongata –> provocation of sweating rather than the usual response of salivation
Sweating occurs to the upper cutaneous lips and cheeks a few minutes after eating
Associated vasodilation –> erythema

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8
Q

Food that induces sweating

A

Spicy or sharp-tasting foods and beverages

Citrus fruits, alcohol, condiments

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9
Q

Three main causes of compensatory hyperhidrosis

A
  1. Miliaria –> anhidrosis to the back results in hyperhidrosis to the face
  2. Diabetes –> peripheral neuropathy results in truncal hyperhidrosis
  3. Post sympathectomy –> cervicothoracic –> thermal hyperhidrosis to the trunk
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10
Q

What is cold erythema

A

Cold induces localized erythema, pain and central hyperhidrosis

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11
Q

How can you assess sweat for axillary and volar

A

Volar:
Mild : moist palm or sole
Moderate: sweating towards fingertips
Severe: Drip sweat

Axillary
Normal: <5 cm
Mild 5-10 cm
Mod 10-20 cm
Severe >20 cm

Starch iodine (3.5% iodine in alcohol, then starch powder brushed onto area) or quinizarin methods –> site that turns blue-black is where the sweating is happening
Gravimetric - weighing filter paper before and after application to the skin
Evaporative: assesses water vapour loss from the skin
Infrared thermography

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12
Q

When to use aluminium antiperspirants

A

At night, because the aluminium occludes sweat ducts, and so you don’t want to be too sweaty
Used 3-5 consecutive nights, then after that 1-2 times a week
Main a/e is irritant contact dermatitis and burning
Aluminium chloride hexahydrate 6.25-20%
Aluminium chloride 12-20%
Aluminium zircuonium may be effective in axillae but not volar surfaces

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13
Q

What can you give with aluminium antiperspirants to stop it being sweated away

A

Anticholinergic drug 1 hour before using

Can also use topical aldehydes - formaldehyde, glutaraldehyde

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14
Q

Who can you use topical towellete treatment with and what does it do

A

Glycopyrronium tosylate via a cloth towelette –> nine years or over

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15
Q

How does iontophoresis work

A

Don’t know, but thought to block the sweat ducts in the stratum corneum
Use 2-3 times a week

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16
Q

What are adverse effects from oral anticholinergics

A 
Dry eyes and mouth
Insomina
Mental status changes - confusions, hallucinations
Palpitations
Seizures
Blurred vision
Bowel disturbances
Urinary retension
Hypertension
17
Q

Risks for sympathectomy

A

Do T2-3 for palmar and lumbar for plantar

Risk: Horner syndrome, hypotension, pneumothorax, compensatory hyperhidrosis, and hyperhidrosis may jsut gradually recur

18
Q

List all possible treatments for primary hyperhidrosis

A 
Primary:
- Topical aluminium anti-perspiratorys
- Topical towellete
Secondary:
- Botox
- Iontophoresis
- Thermal ablation: Nd:Tag laser, microwave
- Anti-cholinergics: oxybutinin, glycopyrrolate
- Alpha 2 agonist: clonidine
- Beta blocker: propanolol
- Anxiolytic: clonazepam
Third line:
- Sympathectomy
- Excision
- Liposuction
19
Q

What is the diagnostic criteria for primary hyperhidrosis

A
  1. Present for at least 6 months
  2. No secondary cause
    At least 2 of the following:
  3. Bilateral and symmetric
  4. Impairs ADL
  5. Once a week
  6. Age of onset <25 years
  7. FHx
  8. Stops during sleep
20
Q

How do you test for anhidrosis

A
  • Hot environment or exercise, but try not to overheat
  • Colorimetric or gravimetric  diminished or absent sweating
  • Local intradermal injection of cholinergic drug to stimulate sweat, but risk of side effects precludes a large area
  • If suspicious of peripheral nueropahy: text for axon reflex sweating with intradermal nicotine sulfate or picrate
  • Biopsy: sweat gland abnormalities
21
Q

What is the diagnostic test for CF and what is the rationale for it

A

Sweat test
Have a CFTR gene mutation –> decreased electrolyte reabsorption by the eccrine duct –> loss of sodium, chloride and potassium in sweat. Increased Cl concentration in the sweat is seen - >60 mEq/L on 2 separate occasions

22
Q

What is the difference between eccrine and apocrine bromhidrosis

A

Eccrine: maceration of SC with bacterial degradation of keratin
Apocrine: bacterial degradation of apocrine sweat into ammonia and short-chain fatty acids

23
Q

Causes of chromhidrosis

A

Eccrine: exogenous contamination - paint,. dye, microorganisms such as Cornyebacteria, copper salts (blue-grey)
Sunless tanning products - brown sweat
Red sweat - clofazimine and rifampin
Apocrine: intrinsic - lipofuscin in large amounts, alkaptonuria (can be first sign)

24
Q

Complications of miliaria

A

Crystallina - none
Rubra –> can develop miliaria pustulosa, can get secondary infection, and rubra can cause hyperpyrexia
Profundus: when a large number get occluded, can result in compensatory hyperhidrosis, thermoregulatory problems, axillary and inguinal lymphadenopathy

25
Q

Associations of neutrophilic eccrine hidradenitis

A

Believed to be cytotoxic process directed at sweat glands
Medications:
- chemotherapy: bleomycin, cyclophosphamide - comes up 7-14 days after chemotherapy
- G-CSF
- carbamazepine
- zidovudine (HIV)
Malignancy:
- AML
Infectious:
- Immunocompromised with pathogenic organisms: Serratia, Enterobacter, S aureus, Nocardia
Idiopathic - healthy people

26
Q

What is idiopathic palmoplantar hidradenitis?

A

Disease of children, preceded by vigorous physical activity
Eccrine gland rupture due to mechanical and thermal trauma
Multiple, tender erythematous nodules on the soles and less often on the palms
Have neutrophilic infiltration of secretory and ductal components of the coiled portion of the sweat glands
If nodular - may have neutrophilic abscess
Ddx: pseudomonas hot foot, panniculitis, pernio, vasculitis

27
Q

Granulosis rubra nasi - what is it?

A

Rare, inherited condition that peaks in childhood, and possibly AD, resolves at puberty usually
Have hyperhidrosis of the nasal tip, then develop erythema, can extend to cheeks, chin, upper lip, excessive sweating
Associated with palmoplantar hyperhidrosis, and [poor peripheral circulation
Histo: dilation of dermal blood and lymphatic vessels, with perivascular lymphocytic infiltration
Ddx: acne, lupus pernio, perioroficial dermatitis,
Rx: tricky, botox, topical tacrolimus, reassurance

28
Q

What causes keratolysis exfoliativa?

A

Likely low grade damage to the thick stratum corneum on the volar skin
Irregular annular or circinate pattern of scaling
No vesicles or papules
Treatment is tricky - humectants, keratolytic topical products, sal acid

29
Q

Fox-Fordyce epi

A
  • Women, 15-35 years

- remits after menopause

30
Q

Fox-Fordyce pathogenesis

A
  • ?don’t know
  • hormonal facotrs
  • physical and emotional
  • has occurred following trauma of laser hair removal
31
Q

Fox-Fordyce clinical

A
  • Dome-shaped, skin coloured, discrete perifollicular papules within the axilla, anogenital and periareolar skin
  • Less common: medial thighs, periumbilical area and sternal region
  • Loss of hair
  • ++ pruritic
  • Pregnancy and contraception may help
  • Heat and emotional stress aggravate
32
Q

Fox-Fordyce histo

A
  • Keratin plug in follicular infundibulum which obstructs the entrance of the apocrine duct
  • Results in sweat retention and rupture of the duct at the level of the epidermis
  • Epidermal spongiosis and vesiculation
  • +/- perifollicular and periadnexal inflammatory infiltrate - lymphocytes, with occasional histiocytes and eosinophils
33
Q

Fox-Fordyce treatment

A
  • Difficult to treat
  • Topical and intralesional steroids are first line but risk of cutaneous atrophy
  • Topical calcineurin inhibitors
  • Topical tretinoin - reduces pruritus
  • Twice daily clindamycin
  • Oral contraceptives, oral isotretinoin
  • Physical: phototherapy, electrocautery, excision of periareolar skin

Derm (57 decks)

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