Diseases of Eccrine, apocrine and other skin glands Flashcards
What is Frey’s syndrome?
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.
When do eccrine glands become functional?
Birth
What activates eccrine glands?
Thermal stimuli (hypothalamic sweat center) and emotional stimuli
Where are eccrine glands not present?
External auditory canal, lips, glans penis, labia minora/clitoris
When do apocrine glands become active?
Puberty (lay dormant until then)
Where are apocrine glands located?
Axillae, nipples/areolae, umbilical and anogenital region.
What areas have apocrine glands that are not affiliated with the follicular unit?
External auditory canal and eyelid margins
What is hyperhidrosis?
Excessive production of eccrine sweat
What areas are most common for primary hyperhidrosis?
Volar most common, followed by axillary
Does primary hyperhidrosis tend to have a strong family history?
Yes, 80% report + family hx
What are the criteria for dx of primary hyperhidrosis?
- Focal, visible excess sweating
- Present for at least 6 months
- No apparent secondary causes
- 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
What is compensatory hyperhidrosis?
Anhidrosis in one area may increase hyperhidrosis in another area.
What is compensatory hyperhidrosis associated with?
Long-standing or recurrent miliaria (non-functional sweat glands) and also diabetes (autonomic dysfunction –> anhidrosis or hypohidrosis of skin
What are some causes of secondary hypothalamic hyperhidrosis?
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)
Tests that can be performed for hyperhidrosis?
Starch-iodine test
Primary treatment options for hyperhidrosis?
Topical: Antiperspirants aluminum chloride, Drysol 20%
Oral: Oral glycopyrrolate, clonidine or oxybutynin
Non-medication-based treatments for hyperhidrosis?
Botox, iontophoresis, thermal ablation w/ Nd:YAG laser or microwave
What are the 3 categories of hypohidrosis/anhidrosis?
- Central and neuropathic diseases
- Peripheral (non-neural)
- Idiopathic
What are the central/neuropathic causes of hypo/anhidrosis?
Tumors, peripheral neuropathies, SCI, medications –> disrupt stimuli from the hypothalamus to eccrine gland
What are some causes of peripheral (non-neural) hypo/anhidrosis?
Ectodermal dysplasias (AED, Rapp-Hodgkin, etc), destruction (via tumors, burns, morphea, etc), or obstruction (miliaria, ichthyosis, psoriasis, etc)
What is bromhidrosis?
Foul-smelling sweat
What are the two types of bromhidrosis?
Eccrine variant and apocrine variant
What is the cause of eccrine variant bromhidrosis?
Degradation of sweat by resident microflora of the feet m/c (maceration of S. corneum and bacterial degradation of keratin)
What is the cause of apocrine variant bromhidrosis?
Degradation of odiferous substances (triglycerides) by skin flora
Where does apocrine bromhidrosis occur?
Axillae
Where does keratogenic bromhidrosis occur?
Plantar and intertriginous areas
What are some specialized metabolic types of bromhidrosis
- 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)
What are some foods that can cause bromhidrosis?
Garlic, asparagus, curry
What are some drugs that cause bromhidrosis?
Penicillins, bromides
What is chromhidrosis?
Colored sweat
What intrinsic compounds cause chromhidrosis?
Lipofuscin content in APOCRINE secretions (yellow, green or black)
What extrinsic causes can lead to chromhidrosis?
Eccrine sweat staining by clothing or chromogenic bacteria or fungi
What are the 3 types of miliaria?
Crystallina, Rubra, Profunda
What pathology determines which of the 3 types of miliaria a person can have?
The location of the obstruction of the eccrine glands
- Crystallina: stratum corneum
- Rubra: Med-epidermis
- Profunda: Dermal-epidermal junction
What are the morphologies of the 3 types of miliaria?
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
What are the most common locations and age groups for miliaria crystallina?
Face and trunk, Neonates <2 weeks of age, children and adults in hot climates
What are the most common locations and age groups for miliaria rubra?
Neck and upper trunk, Neonates 1-3 weeks of age, children and adults in hot climates
What are the most common locations and age groups for miliaria profunda?
Trunk and proximal extremities, adults in hot climates; often with multiple bouts of miliaria rubra
What is neutrophilic eccrine hidradenitis?
Usually occurs following the administration of chemotherapy. Children and adults can be affected
- Clinically presents with erythematous papules and plaques, classically on the trunk
Prognosis of eccrine hidradenitis?
Resolves in a few days to weeks
What mediation is eccrine hidradenitis most commonly?
Cytarabine
Pathogenesis of eccrine hidradenitis?
Excretion of drugs into eccrine sweat –> toxin insult to sweat gland and duct.
What is idiopathic palmoplantar hidradenitis?
Occurs in otherwise healthy children, sudden onset of painful nodules on the palms/soles.
Prognosis of palmoplantar hidradenitis?
Resolves spontaneously within few days to weeks but may be recurrent.
After what does idiopathic palmoplantar hidradenitis occur after?
Most commonly occurs after vigorous physical activity in healthy children
Pathogenesis of idiopathic palmoplantar hidradenitis?
Eccrine gland rupture due to thermal and mechanical trauma
What is keratolysis exfoliativa?
Superficial desquamation of the palms and occasionally the soles
Clinical of keratolysis exfoliativa?
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
What is Fox-Fordyce syndrome?
Plugging of the apocrine sweat glands
Most common locations for Fox-Fordyce syndrome?
occlusion then rupture of apocrine sweat gland ducts in axillae >> anogenital or periareolar region >> periumbilical/presternal area
Clinical of Fox-Fordyce syndrome?
Clinically appear as skin-colored papules that are follicular dome-shaped and are PRURITIC
Tx for Fox-Fordyce syndrome?
Topical steroids or tacrolimus and OCPs
