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Dermatology Board Prep > DERM (05) Diseases of Cutaneous Adnexa > Diseases of Eccrine, apocrine and other skin glands > Flashcards

Diseases of Eccrine, apocrine and other skin glands Flashcards

1
Q

What is Frey’s syndrome?

A

Damage to the auriculotemporal branch of CN V –> reinnervation with parasympathetic instead of sympathetic fibers for the sweat glands and blood vessels in the overlying skin –> Parasympathetic nervous system activation during chewing –> hyperhidrosis of ipsilateral cheek during chewing.

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2
Q

When do eccrine glands become functional?

A

Birth

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3
Q

What activates eccrine glands?

A

Thermal stimuli (hypothalamic sweat center) and emotional stimuli

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4
Q

Where are eccrine glands not present?

A

External auditory canal, lips, glans penis, labia minora/clitoris

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5
Q

When do apocrine glands become active?

A

Puberty (lay dormant until then)

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6
Q

Where are apocrine glands located?

A

Axillae, nipples/areolae, umbilical and anogenital region.

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7
Q

What areas have apocrine glands that are not affiliated with the follicular unit?

A

External auditory canal and eyelid margins

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8
Q

What is hyperhidrosis?

A

Excessive production of eccrine sweat

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9
Q

What areas are most common for primary hyperhidrosis?

A

Volar most common, followed by axillary

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10
Q

Does primary hyperhidrosis tend to have a strong family history?

A

Yes, 80% report + family hx

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11
Q

What are the criteria for dx of primary hyperhidrosis?

A
  1. Focal, visible excess sweating
  2. Present for at least 6 months
  3. No apparent secondary causes
  4. At least two of the following -Bilateral and symmetric -Impairs activities of daily life -At least one episode per week -Age of onset <25 years -Positive family history -Stops during sleep
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12
Q

What is compensatory hyperhidrosis?

A

Anhidrosis in one area may increase hyperhidrosis in another area.

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13
Q

What is compensatory hyperhidrosis associated with?

A

Long-standing or recurrent miliaria (non-functional sweat glands) and also diabetes (autonomic dysfunction –> anhidrosis or hypohidrosis of skin

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14
Q

What are some causes of secondary hypothalamic hyperhidrosis?

A

Infections, neoplasms (lymphoma w/ b sx’s and pheochromocytoma), endocrinologic disorders (hypoestrogeniemia of menopause, hyperthyroidism), vasomotor disorders (cold injury, Raynauds’s phenomenon, RSD), neurologic diseases (CNS tumors, CVA [contralateral]), Drugs/toxins (opioid withdrawal, combination of rugs that result in the serotonin syndrome), miscellaneous (compensatory in the setting of a sympathectomy, extensive miliaria or DM)

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15
Q

Tests that can be performed for hyperhidrosis?

A

Starch-iodine test

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16
Q

Primary treatment options for hyperhidrosis?

A

Topical: Antiperspirants aluminum chloride, Drysol 20%

Oral: Oral glycopyrrolate, clonidine or oxybutynin

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17
Q

Non-medication-based treatments for hyperhidrosis?

A

Botox, iontophoresis, thermal ablation w/ Nd:YAG laser or microwave

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18
Q

What are the 3 categories of hypohidrosis/anhidrosis?

A
  1. Central and neuropathic diseases
  2. Peripheral (non-neural)
  3. Idiopathic
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19
Q

What are the central/neuropathic causes of hypo/anhidrosis?

A

Tumors, peripheral neuropathies, SCI, medications –> disrupt stimuli from the hypothalamus to eccrine gland

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20
Q

What are some causes of peripheral (non-neural) hypo/anhidrosis?

A

Ectodermal dysplasias (AED, Rapp-Hodgkin, etc), destruction (via tumors, burns, morphea, etc), or obstruction (miliaria, ichthyosis, psoriasis, etc)

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21
Q

What is bromhidrosis?

A

Foul-smelling sweat

22
Q

What are the two types of bromhidrosis?

A

Eccrine variant and apocrine variant

23
Q

What is the cause of eccrine variant bromhidrosis?

A

Degradation of sweat by resident microflora of the feet m/c (maceration of S. corneum and bacterial degradation of keratin)

24
Q

What is the cause of apocrine variant bromhidrosis?

A

Degradation of odiferous substances (triglycerides) by skin flora

25
Q

Where does apocrine bromhidrosis occur?

A

Axillae

26
Q

Where does keratogenic bromhidrosis occur?

A

Plantar and intertriginous areas

27
Q

What are some specialized metabolic types of bromhidrosis

A
  • Phenylketonuria (musty/mousy odor)
  • Maple syrup urine disease (sweet odor)
  • Methionine adenosyltransferase deficiency (boiled cabbage odor)
  • Trimethylaminuria (fishy odor)
  • Dimethylglycine dehydrogenase deficiency (fishy odor)
  • Isovaleric acidemia (sweaty feet odor)
28
Q

What are some foods that can cause bromhidrosis?

A

Garlic, asparagus, curry

29
Q

What are some drugs that cause bromhidrosis?

A

Penicillins, bromides

30
Q

What is chromhidrosis?

A

Colored sweat

31
Q

What intrinsic compounds cause chromhidrosis?

A

Lipofuscin content in APOCRINE secretions (yellow, green or black)

32
Q

What extrinsic causes can lead to chromhidrosis?

A

Eccrine sweat staining by clothing or chromogenic bacteria or fungi

33
Q

What are the 3 types of miliaria?

A

Crystallina, Rubra, Profunda

34
Q

What pathology determines which of the 3 types of miliaria a person can have?

A

The location of the obstruction of the eccrine glands

  • Crystallina: stratum corneum
  • Rubra: Med-epidermis
  • Profunda: Dermal-epidermal junction
35
Q

What are the morphologies of the 3 types of miliaria?

A

Crystallina: non-pruritic, clear, fragile, 1 mm vesicles

Rubra: Pruritic, erythematous, 1-3mm papules (can also have pustules)

Profunda: Non-pruritic, white, 1-3mm papules

36
Q

What are the most common locations and age groups for miliaria crystallina?

A

Face and trunk, Neonates <2 weeks of age, children and adults in hot climates

37
Q

What are the most common locations and age groups for miliaria rubra?

A

Neck and upper trunk, Neonates 1-3 weeks of age, children and adults in hot climates

38
Q

What are the most common locations and age groups for miliaria profunda?

A

Trunk and proximal extremities, adults in hot climates; often with multiple bouts of miliaria rubra

39
Q

What is neutrophilic eccrine hidradenitis?

A

Usually occurs following the administration of chemotherapy. Children and adults can be affected

  • Clinically presents with erythematous papules and plaques, classically on the trunk
40
Q

Prognosis of eccrine hidradenitis?

A

Resolves in a few days to weeks

41
Q

What mediation is eccrine hidradenitis most commonly?

A

Cytarabine

42
Q

Pathogenesis of eccrine hidradenitis?

A

Excretion of drugs into eccrine sweat –> toxin insult to sweat gland and duct.

43
Q

What is idiopathic palmoplantar hidradenitis?

A

Occurs in otherwise healthy children, sudden onset of painful nodules on the palms/soles.

44
Q

Prognosis of palmoplantar hidradenitis?

A

Resolves spontaneously within few days to weeks but may be recurrent.

45
Q

After what does idiopathic palmoplantar hidradenitis occur after?

A

Most commonly occurs after vigorous physical activity in healthy children

46
Q

Pathogenesis of idiopathic palmoplantar hidradenitis?

A

Eccrine gland rupture due to thermal and mechanical trauma

47
Q

What is keratolysis exfoliativa?

A

Superficial desquamation of the palms and occasionally the soles

48
Q

Clinical of keratolysis exfoliativa?

A

Presents with multiple annular and semi-annular collarettes of white scale usually <5 mm

Note: there is no inflammation with these lesions and vesicles can precede these lesions.
Can also be associated with hyperhydrosis

49
Q

What is Fox-Fordyce syndrome?

A

Plugging of the apocrine sweat glands

50
Q

Most common locations for Fox-Fordyce syndrome?

A

occlusion then rupture of apocrine sweat gland ducts in axillae >> anogenital or periareolar region >> periumbilical/presternal area

51
Q

Clinical of Fox-Fordyce syndrome?

A

Clinically appear as skin-colored papules that are follicular dome-shaped and are PRURITIC

52
Q

Tx for Fox-Fordyce syndrome?

A

Topical steroids or tacrolimus and OCPs

DERM (05) Diseases of Cutaneous Adnexa (5 decks)

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