Pilosebaceous Unit

Question 1

pilosebaceous unti segments

Answer 1

1. keratinized follicular infundibulum
2. hair
3. sebaceous gland
4. sebaceous duct (connects gland w/ infund)

Question 2

what does sebum contain?

Answer 2

free FA
wax
sterol esters
TGs
squalene

Question 3

acne vulgaris

Answer 3

patho: 1) abnorm keratinization-inc corneocytes –> microdomes
2) microcomedone expands, sebac lobule regresses –> raised comedone created by accum of sebum and keratinocytes
3) comedones rupture –> inflam; pustules, papules, nodules, cysts may form

clin: non inflam: open and closed comedones
inflam: usually start w/ comedome formation

treat: topical retinoids (comedones, prevent), topical anti-inflam and anti-bio, oral antibiotics (reduce inflam), hormonal agents, incise and drain, chemical peels, steroid injection, laser and light treatment

Question 4

acne fulminans

Answer 4

severe cystic acne
men 13-16 years
systemic manifestations: fever, malaise, arthralgias, myalgias, hepatosplenomegaly

Question 5

acne conglobata

Answer 5

eruptive acne w/o systemic manifestations

follicular occlusion tetrad

Question 6

acne mechanica

Answer 6

acne from mechanical and frictional obstruction of pilosebaceous unit
linear and geometric distribution

Question 7

acne excorice

Answer 7

acne as a result of excoriation or manipulation

may treat w/ antidepressants and psychotherapy in addition to acne treatment

Question 8

drug induced acne

Answer 8

common offenders: anabolic steroids, corticosteroids, lithium, phenytoin, isoniazid, iodides, bromides

abrupt, monomorphous eruption of inflam papules

Question 9

infantile acne

Answer 9

acne persists beyond 3 months
mild hormonal imbalance (poss. inc. DHEA)
deep cystic lesions and pustules may be seen

Question 10

rosacea

Answer 10

patho: history often includes easy blushing, inflam acneiform papules of cheeks/nose
- triggers: food, meds –> vasodilation, UV, wind, cold weather, humidity, emotional stress, heat, alcohol, spicy food

clin: flushing, erythema, telangiectasias, papules/pustules, no comedones
2* features: burning, stinging, xerosis on central face, edema, ocular issues, rhinophyma

treat: topical or oral antibiotics, laser and lights

Question 11

periorificial dermatitis

Answer 11

• variant of rosacea
• small erythematous papillose in perioral or periocular region, spares vermillion border
• exacerbated by topical corticosteroids, cinnamon, mint

Question 12

pyoderma faciale (rosacea fulminans)

Answer 12

acute eruption of inflamed papillose and pustules in centrofacial region

Question 13

steroid rosacea

Answer 13

use of topical or systemic corticosteriods exacerbated rosacea
controlled by systemic antibiotics to topical calcineurin inhib

Question 14

apocrine sweat glands

Answer 14

axillary, anogenital

olfactory communication

Question 15

Hidradenitis suppurativa (HS)

Answer 15

epi: more common in women, poss genetic

patho: results from occlusion of apocrine glands (foll. infund. occlusion followed by rupture of follicles)
follicular occlusion tetrad

clin: tender nodules and papules at first, recurrent boils, and draining sinus tracts –> scarring, drainage, odor, pain

treat: weight reduction
topical: antibiotics, absorbing powder, antiseptic soap, aluminum Cl
systemic: prednisone, retinoids, antibiotics
surgery: intralesional steroid injection, incise and drain, laser

Question 16

follicular occlusion tetrad

Answer 16

aka: acne inversa
patho: related to follicular hyperkeratinization

acne conglobata
HS (hidradenitic supperativa)
dissecting cellulitis of scalp
pilonidal cyst

lead to permanent scarring

Question 17

dissecting cellulitis

Answer 17

perofollicular pustules, nodules, abscesses, ans sinuses that evolve into hair loss (scarring alopecia)

Question 18

pilonidal cyst

Answer 18

cyst or bases near or on the natal cleft of the butt

Question 19

eccrine gland

Answer 19

palms, soles, axillae

activated by emotional and thermal stimuli, activity controlled by sweat center in hypothal (ACh)

thermoregulation, electrolyte balance, moisten st. corn., drug delivery

Question 20

hyperhidrosis treatments

Answer 20

Alum Cl - plug

oral anti cholinergics - reduce sim of sweat glands as part of sym. nerve response, e.g. glycopyrrolate

botulinum toxin (botox) - prevent ACh release at NMJ

surgical sympathectomy - only for palms, cut sym fibers