Disorders of sebaceous and apocrine glands

Question 1

What is the most common skin disorder in adolescents?

Answer 1

acne

Question 2

Which gender is more affected by acne?

Answer 2

males

Question 3

What are the common locations for acne?

Answer 3

face, neck, back, chest, upper arms

Question 4

What contributes to the pathogenesis of acne?

Answer 4

• bacteria (part of normal flora but can trigger inflammation) - sebum chemistry (diet affects quality) - sebum quantity (dry vs oily skin, hormone driven, genetic component, diet influenced) - keratinocyte hyper proliferation, shedding, clumping and plugging - terrain

Question 5

What is the western medicine therapeutic goals for acne?

Answer 5

• kill bacteria - inhibit sebum production - stop inflammation - normalize keratinization

Question 6

What is the natural medicine therapeutic goals for acne?

Answer 6

• normalize terrain and encourage healthy bacteria (bacteria are part of normal flora so should not need to be killed) - encourage healthy sebum production (vs stop it in western medicine) - reduce inflammation (vs stop it in western medicine) - normalize pattern of keratinization

Question 7

What are the possible pharmacologic treatments for acne?

Answer 7

• antibacterial (topical - benzoyl peroxide, oral - accutane) - sebum production inhibitors (estrogen, corticosteroids, accutane, spironolactone (antiandrogen) - anti inflammatory (corticosteroids, NSAIDS, antibiotics) - normalize keratinization (tretinoin/Retin-A, Accutane)

Question 8

What are some possible topical treatments for acne?

Answer 8

erythromycin, clindamycin, sulfacetamide, benzoyl peroxide, salicylic acid, tretinoin/retinoids, azelaic acid

Question 9

What are some oral treatment options for acne?

Answer 9

antibiotics, oral contraceptives and oral isotrentinoin (Accutane) will reduce inflammation

Question 10

What is the recommended diet for acne patients?

Answer 10

Low glycemic or Paleo diet: high protein, low carb, no dairy, no chocolate, avoid processed/refined foods

Question 11

How does dairy affect acne?

Answer 11

Dairy raises IGF-1 which induces cell proliferation, inhibits apoptosis, stimulates keratinocytes, sebocytes, adrenals and gonads

Question 12

How can sebum chemistry be influenced?

Answer 12

diet: high protein, low glycemic, low dairy

Question 13

How can sebaceous gland function be inhibited naturally?

Answer 13

• avoid high glycemic foods - omega-3 fatty acid supplement - high dose Zinc (with copper) - High dose Vitamin A

Question 14

What are pharmaceutical options for inhibiting sebaceous gland function?

Answer 14

• estrogens/contraceptives - corticosteroids - isotretinoin (accutane) - anti androgens (spironolactone)

Question 15

How does genetic/heredity affect the terrain in acne patients?

Answer 15

• skin type (dry vs oily) - endocrine imbalances (high estrogen/testosterone) - gender (premenstrual flare, trans puberty)

Question 16

What lifestyle choices can affect acne?

Answer 16

• cigarettes - stress - cosmetics/chemical irritants - harsh scrubbing/mechanical irritation - headbands, chin straps or hair in face - diet (antiinflammatory diet is best, intermittent fasting)

Question 17

What are some additional topical botanicals that can be helpful with acne?

Answer 17

• tea tree oil - azelaic acid - calendula succus - grindelia tincture

Question 18

What are some additional supplements that may be helpful with acne?

Answer 18

• Vit E, Vit C, selenium, chromium, flavonoids

Question 19

What gender is more affected by rosacea?

Answer 19

females by 3x

Question 20

What condition is characterized by central, symmetrical redness?

Answer 20

rosacea

Question 21

List the characteristics of rosacea

Answer 21

• erythema - telangectasia - papulopustules - nodules - NO comedones - rhinophyma (mainly in males)

Question 22

What is this?

Answer 22

telangectasia

Question 23

What is this?

Answer 23

rhynophoma as seen in rosacea

Note: Chronic rosacea of the nose has caused irreversible hypertrophy. More common in men.

Question 24

What are aggravating factors for rosacea?

Answer 24

• hot liquid
• spicy food
• alcohol
• sun
• niacin

Question 25

What comorbidity is 3x more likely in patients with rosacea?

Answer 25

migraine

Question 26

What are some possible ocular complications associated with rosacea?

Answer 26

- iritis/uveitis - scleritis - keratitis - chalazion - blepharoconjunctivitis

Question 27

According to western medicine, what is the cause of rosacea?

Answer 27

unknown

Question 28

According to natural medicine, what is the cause of rosacea?

Answer 28

- terrain - genetics - poor digestion - toxic bowels

Question 29

What are some dietary options for treatment of rosacea?

Answer 29

- antiinflammatory diet - eliminate alcohol, caffeine, spicy food - apple cider vinegar - HCL - bitters - digestive enzymes

Question 30

What are some topical treatments for rosacea?

Answer 30

- azelaic acid - antibiotic (erythromycin, sulfacetamide, metronidazole, benzoyl peroxide, clindamycin) - sulfur solution

Question 31

What are some oral treatments for rosacea?

Answer 31

- B vitamins - antibiotics (tetracycline, erythromycin, metronidazole, doxycycline, minocycline) - accutane - silymarin + methylsulfonilmethane S- MSM

Question 32

Facial dermatosis characterized by papulopustules on erythematous base

Answer 32

perioral dermatitis

Question 33

What does western medicine think causes perioral dermatitis?

Answer 33

aggravation by fluoride and sodium lauryl sulfate

Question 34

What gender is most affected by perioral dermatitis?

Answer 34

women

Question 35

What are the symptoms associated with perioral dermatitis?

Answer 35

- itching - burning - feeling of tightness

Question 36

What does natural medicine think causes perioral dermatitis

Answer 36

disturbances in terrain

Question 37

What is the natural treatment for perioral dermatitis?

Answer 37

- same as acne/rosacea - avoid fluoride and sodium lauryl sulfate

Question 38

What is the Western treatment for perioral dermatitis?

Answer 38

- topical antibiotics (metronidazole, erythromycin) - topical steroids - oral antibiotics (minocycline, doxycycline, tetracycline)

Question 39

Chronic, suppuration, often fibrous tissue disease of the apocrine gland on the skin of axilla and anogenital region that can result in tender lesions, scarring and contractures

Answer 39

hidradenitis suppurativa

Question 40

What are some possible causes/risks of hidradenitis suppurativa?

Answer 40

- obesity - smoking - genetics - mechanical friction

Question 41

What is the pathogenesis of hidradenitis suppurativa?

Answer 41

keratin plug of hair follicle -\> immune dilation of apocrine gland -\> inflammation -\> rupture -\> suppuration -\> ulcer -\> fibrosis \* staph or strep can cause secondary infection

Question 42

What are the early signs of hidradenitis suppurativa?

Answer 42

- erythema - burning - itching - discomfort - hyperhidrosis

Question 43

What are symptoms associated with the mild stage of hidradenitis suppurativa?

Answer 43

- solitary nodule - minimal pain - no abscess

Question 44

What are symptoms associated with the moderate stage of hidradenitis suppurativa?

Answer 44

- multiple recurrent nodules - pain affecting ADLs - discharge/drainage - abscess formation

Question 45

What are symptoms associated with the severe stage of hidradenitis suppurativa?

Answer 45

- diffuse abscess formation - chronic draining sinus tract - chronic inflammation and scarring

Question 46

What is the conservative management of hidradenitis suppurative?

Answer 46

- acne protocol - loose clothing - avoid heat/humidity - avoid shaving/depilation - avoid deodorants - warm/ hot compresses - antibacterial soaps - lowe glycemic diet - avoid brewers yeast and wheat

Question 47

What are the conventional therapies for hidradenitis suppurativa?

Answer 47

- intralesional injections of triamcinolone - incise and drain abscesses - oral and topical antibiotics - prednisone - oral isotretinoin (accutane) - anti-TNF alpha therapy (adalimumab, infiximab)