Disorders of sebaceous glands Flashcards
T/F the sebaceous gland is apocrine
F holocrine
sebaceous glands occur on the palms and soles
F
there are many sebaceous glands on the dorm hand and feet
F sparse
meibomian glands of the eyelids and tyson’s glands of the prepuce are sebaceous glands
T
what are fordyce spots
free sebaceous glands in the margin of the upper lip often visible as pale-yellow bodies
Human skin surface lipid consists of what
glycerides, FFAs, wax esters, squalene, cholesterol esters
In children the sebum is 95% the surface lipid T/F
F
sebum helps protect against fungal and bacterial infection T/F
T
4 factors in the aetiology of acne
increase in sebum hypercornification of the pilosebaceous duct colonisation of the duct with P Acne inflammation
There is an increased incidence of atopic dermatitis in ppl with acne T/F
F decreased
Indications for an endocrine evaluation in ppl with acne
severe/sudden onset, therapy resistent, rapid relase post isotretinoin, irregular menses, hirsutism, hyperseborrhoea
What is HAIR-AN
hyperandrogenism, insulin resistance and acanthuses nigricans
At what age do you get worried about seeing acne
between 2-7
Hormonal tests for unusual acne
days 2-5 of menstrual cycle: Total & free T, SHBG, DHEA, androstenedione, prolactin, FSH, LH, FSH, LH, TFTs, lipids, glucose. Cortisol and 17 alpha hydroxyprogesterone USS ovaries
Poor prognostic factors for acne
early onset, family hx, more severe sebum, early onset relative to menarche, truncal, scarring, persistent
Topical treatment for back acne
avoid heat, oily environment, check meds/steroids/supplements. IL steroids 5% glycol acid, 10% propylene glycol in ethanol
Topical treatment for acne
BPO retinoids clindamycin 1%, erythromycin 2%, dapsone 5% azalea acid 15%, nicotinamide 4% 2% salicylic acid
associations with acne fulminans
osteolytic bone lesions fever, arthralgias, myalgias, hepatosplenomegaly. SAPHO EN
who gets acne fulminans
boys 13-16
What lab abnormalities might you expect with acne fulminans
elevated ESR, proteinuria, leukocytosis and anaemia lytic lesios on xray, increased uptake on technetium scintillography
P acnes are gram negative non motile rods T/F
F Gram +ve
P acnes fluoresce with the wood’s lamp
T
Management of acne fulminans
pred, reduce over 6 weeks isotretinoin at 4 weeks: 0.25mg/kg iniitally, then increase to achieve complete clearance. infliximab may be helpful dapsone may help - especially if associated EN
Clinical features of acne fulminans
abrupt, inflammatory and ulcerated nodular acne on chest and back which is painful bleeding crusts over ulcers fever painful joints including sacroiliac, ankles, shoulders malaise loss of appetite and weight loss enlarged liver and spleen
What is acne conglobatat
severe nodulocystic acne where there are interconnecting abscesses and sinuses. (part of the follicular occlusion triad)
acne mechanica occurs when
repeated friction and mechanical obstruction of pilosebaceous unit e.g. chin straps, collars, violin players
Drug induced acne - signs
abrupt, monomorphic eruption of inflammatory papules and pustules
Examples of drugs which may cause acne
steroids, bromides, iodides, isoniazid, lithium, phenytoin, progesterone, sertraline, risperidone, cetuximab, cyclosporin
What is apert’s syndrome
craniosyntosis , early epiphyseal closure, hypertelorism, prone to development of severe pustular acne
What syndromes may predispose to acne
cushings, HAIR-AN, PCOS, SAHA, late onset congenital adrenogenital syndrome, apert’s syndrome
comedogenicity is tested how
via a rabbit’s ear test - placing the ingredients in the external ear canal of rabbits and check the amt of hyperkeratosis
What is chloracne due to
exposure to aromatic hydrocarbons.
Detergent acne due to
alkaline soap washing. Some soaps contain weak acnegenic compounds eg hexachlorophene
% of newborns who get neonatal acne
>20%
Neonatal acne usually involves comedones on the cheek and nasal bridge
F typically NOT comedones
Treatment for neonatal acne
ketoconazole cream, azaleas acid cream, tretinoin, BP 2.5%
Comedones occur in infantile acne T/F
T
Isotretinoin is effective for the treatment of chloracne
F - doesn’t work as sebaceous gland as already undergone atrophy - use topical retinoid, gentle cautery
treatment of a comedo naevus
Keratin filled pits in a grouped or linear arrangement
T/F pyogenic granulomas often appear post isotretinion
T
What conditions are associated with seborrhoea
acromegaly, parkinsonism Reduced by isotretinoin, spironolactone
What may happen to osteoma cutis (which may occur as a complication of acne) if the patient is treatment with minocycline
Becomes pigmented.
Types of acne scars
icepick, box, rolling/atrophic, keloid
Gram negative folliculitis presentation
sudden eruption of multiple small pustules or nodular lesions, usually premolar or prenatal post long term oral or topical ab treatment.
Tx of gram negative folliculitis
stop ab trimethoprim 600mg daily or ampicillin 250mg aid or oral isotretinoin
Associations with pyoderma faciale
crohns, high dose Vit B
SAPHO
synovitis, acne, pustulosis, hyperostosis and osteitis
Treatment of fordyce spots
CO2 laser, oral isotretinoin
Histo features of steatocystoma multiplex
a true sebaceous cyst eosinophilic cuticle lack of granula layer sebaceous lobules in wall, may have vellum hair
Treatment options for sebaceous hyperplasia
hyfrecate, CO2, TCA, cryo, vascular laser, isotretinoin, topical retinoids
The comedone is formed in the isthmus of the follicle
F infundibulum
Early non specific inflammation in acne results in less scarring than does a delayed, specific inflammatory response
T
The number of P acnes in acne lesions is associated with increased severity T/F
F
The principle androgen mediating sebum production is Testosterone T/F
F DHT
Infants have increased levels of DHEAS T/F
T
Skim milk is positively associated with acne prevalence and severity
T
What conditions are associated with the FGFR2 gene and acne
apert syndrome, acneiform/comedonal acne
The transverse nasal crease separates what
the alar cartilage and the triangular cartilage
Pseudo acne of the transverse nasal crease is a hormonal form of acne T/F
F
What is an idiopathic facial aseptic granuloma
chronic, painless, solitary nodule with an acneiform appearance on the cheek s of young children. FB type giant cells on H&E. Resolve spontaneously after 11 months without treatment
What is this? Management plan
Acne fulminans
Oral pred 0.5-1mg/day, oral isotretinoin low dose introduced slowy after 3-4 weeks
emollient oil, potent topical steroid for 2-3 weeks to crusts
What is this?
Aeitology?
Treatment
Fordyce spots - heterotopic sebaceous glands
Tx: nothing, CO2 laser, oral isotretinoin, PDT, micropunch excision
What is this?
What gene?
PAPA syndrome - pyogenic arthritis, PG, acne
PSTPIP1 (CD2 antigen binding protein)
What is this?
Pseudoacne of the transverse nasal crease
cultures usually neg, H&E shows FB giant cells
Idiopathic facial aseptic granuloma
Resolves sponanteously after 11 months
8 yo axilla
Childhood flexural comedones
average age of Dx is 6
no association with HS, Acne vulgaris or precocious puberty
New onset pustules in patient with known acne on doxy for 12/12
Gram negative folliculitis
swab
treat with amoxil/trimethoprim depending on culture
isotretinoin may be helpful
A pustular flare often occurs 3-4 weeks into topical retinoid treatment T/F
T
Minocycline may be more effective than doxy in acne because…
more lipophilic, greater penetration into the sebaceous follicle
Chloracne from dioxin poisoning
What is this? - onset was gradual non painful
Morbihan’s disease
erythematous, firm, non pitting swelling of upper face. Peau d’orange appearance
considered to be endpoint of rosacea or allergic contact.
prolonged low dose isotretinoin may be helpful
Types of eosinophilic folliculitis
Classic type – this occurs most commonly in Japan (Ofuji)
Eosinophilic folliculitis associated with advanced Human Immunodeficiency Virus (HIV) infection
Infantile eosinophilic folliculitis
Cancer-associated eosinophilic folliculitis
Medication-associated eosinophilic folliculitis
What is this?
BG - explosive crop, some annular plaques with central clearing, intense pruritis
eosinophilic folliculitis -
often peirpheral blood eosinophiia
Tx: open wet dressings
oral indomethacin 50mg/day
UVB, oral minocycline, oral dapsone
T/F HIV associated eosinophilic follicluitis occurs in HIV infected patient whose CD4 count is <600
F <300
Disseminate and recurrent infundibulofolliculitis is aka
Hitch and Lund disease
Disseminate and recurrent infundibular folliculitis aka Hitch and Lund syndrome
improvement with oral vitamin-A, isotretinoin, and PUVA. Some patients may find relief with cooling and soothing emollients.
It generally resolves by itself after some years.
What is this?
acne agminata or lupus miliaris disseminatus faciei
Clinical features and Dx
Erythromelanosis follicularis faciei et colli
multiple pin point follicular papules superimposed on a red brown patch
associated with KP of upper arms
In type 1 skin, may not have melanosis therefore overlap with keratosis pilaris rubra
Tx: Urea, tretinoin, alapalene. sal acid peels and glycoloic acid peels. Photoprotection
Types of KP atrophican
KP atrophicans faciei(ulerythema ophryogenes)= AD
Atrophderma vermuiculatum
Keratosis follicularis spinulosa decalvans = XR
Folliculitis spinulosa decalvans
Keratosis pilaris atrophicans faciei (ulerythma ophryogenes)
Erythematous follicular papules with central keratotic plug, eventually follicular atrophy
scarring alopecia of lateral eyebrows
Associations with Keratosis pilaris atrophican faciei (ulerythema ophryogenes)
Noonan syndrome
cardio facio cutaneous syndrome
cornelia de lange syndrome and woolly hair.
What is this
Atrophoderma vermiculatum
Dx and course
lichen spinulosa
texture likened to that of a nutmeg grater
usually asymptomatic, arises suddenly, enlarges over a week.
Most often in chidlren, favours neck, arms, abdomen and buttocks
can persist indefinately
How is lichen spinulosa different to KP
KP has perifollicular erythema and lacks discrete clusters
DDx of lichen spinulosis
KP
PRP (Juvenile)
keratosis circumscripta
LPP
Phrynoderma
which nutritional deficiency is this?
vit A deficiency - usually favours extensor sites, face is last site to be invovled and hands and feet are spared
What is this and treatment
Acne keloidalis nuchae
Swab
Education - avoid tight shaves, tight collars
Topical antimicrobial cleaners/shampoos such as gentle foaming benzoyl peroxide washes or chlorhexidine can help prevent secondary infection.
Tar shampoos may provide an effective alternative. In addition, mild keratolytic agents containing alpha-hydroxy acids or topical retinoids may help soften the coarse hairs. Patients should discontinue hair greases.
potent or superpotent topical steroids with or without the use of topical retinoids.
Topical abs eg clindamycin, oral abs eg doxy
IL CS
Cryotherapy
In acne there is increased corneocyte adhesion and proliferation T/F
T
P acnes secretesl lipases which cleaves lipids into FFA which activates TLR1
F TLR2
The inflammation in acne is released via IL2, IL8, TNFalpha through TLR1 pathway
F IL1 and TLR2 pathway
T/F topical retinoids down regulate TLR2
T
In a patient with acne, if DHEA and 17OH is elevated where are the androgens coming from?
The adrenal gland
Where do pustules in gram negative folliculitis generally occur
centrofacial, especially perinasal
what is this? and tx
Fox fordyce
Topical retinoids
Topical steroids
Oral antibiotics
Clindamycin solution
Antiandrogenic hormonal therapy
