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Medical dermatology Dan > Sweat glands Dan > Flashcards

Sweat glands Dan Flashcards

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USMLE® Step 1 flashcards Dermatology Board Prep flashcards
1
Q

which condition are exacerbated by sweating?

A 
Bromhidrosis 
Susceptability to development of contact dermatitis 
Miliaria 
Keratolysis Exfoliativa 
Juvenile Plantar dermatosis 
Transient Acantholytic dermatosis 
Hailey-Hailey disease
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2
Q

Which genoderms can cause hyperhidrosis?

A 
Palmoplantar keratoderma 
Pachyonychia Congenita 
Congenital Icthyosiform Erythroderma (bullous & non-bullous) 
Dyskeratosis Congenita 
Nail Patella syndrome 
EB simplex>junctional
Apert syndrome
Dermatopathia pigmentosa reticularis
Pachydermoperiostosis

NB these are the major cortical causes of secondary hyperhidrosis along with
Hereditary Sensory & autonomic neuropathies

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3
Q

What are the causes of central hypothalamic hyperhidrosis?

A

Infection, febrile illnesses
Malignancies - lymphoma, phaeo, carcinid
Vasomotor - SLE, RA, Raynauds, MI, reflex symp dyst
Neurologic - abscess, tumour, stroke
Drugs - alcohol, opiates, NSAIDs, catecholamines
Others - POEMS syndrome, diabetic neuropathy

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4
Q

Which genoderms can cause hypohidrosis?

A

Ectodermal Dysplasias
Incontinentia Pigmenti
Fabry disease
Bazex

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5
Q

What skin conditions cause obstruction of sweat glands?

A

Ichthyoses
Psoriasis
Eczematous dermatoses
Bullous diseases

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6
Q

T/F

Eccrine glands open directly to skin surface

A

True

apocrine glands open into a hair follicle

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7
Q

Where are apoeccrine glands found?

A

In the axilla in adults

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8
Q

Which sites have no eccrine glands?

A

lips, ear canal, clitoris and lab minora

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9
Q

T/F

sweat glands become fully functional about 1 year of age

A

False

age 2

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10
Q

T/F

adrenergic synapses innervate sweat glands

A

False
sympathetic innervation but synapses are muscarinic cholinergic not adrenergic
however ciculating catecholamines also stimulate sweat glands

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11
Q

Which 3 higher centres control sweating centrally?

A
  • hypothalamic (thermal)
  • medullary (gustatory)
  • cortical (mental/emotional)
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12
Q

T/F

Primary hyperhidrosis may be inherited in an autosomal dominant fasion

A

True

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13
Q

What are the diagnostic criteria for primary hyperhidrosis?

A
  1. Focal, visible excessive sweating
  2. Present for 6 months or more
  3. No secondary cause identified
  4. At least 2 of;
    At least one episode per week
    Bilateral and symmetrical
    Onset less than 25 yrs old
    Impairs ADLs
    Stops when sleeping
    Fam Hx
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14
Q

T/F

palpmoplantar hyperhidrosis may start in childhood

A

True
usually childhood or puberty
axillary HH doesnt start until puberty

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15
Q

T/F

axillary hyperhidrosis is more common than volar (palmoplantar)

A

False

slightly less common

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16
Q

T/F

axillary hyperhidrosis is associated with body odour

A

False

excess sweat is eccrine and bromhidrosis is rare

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17
Q

T/F

Craniofacial hyperhidrosis is the same as gustatory sweating

A

False
Is excess sweating of head presenting in middle age
Triggered by heat, exercise, eating

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18
Q

What are the broad causes of secondary hyperhidrosis?

A 
Central (CNS)
-hypothalamic (thermal)
-medullary (gustatory)
-cortical (mental/emotional)
Peripheral nerves
sweat glands
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19
Q

T/F

Frey’s syndrome occurs in the distribution of the maxillary nerve (CNV2)?

A

False
Usually in distribution of auriculotemporal nerve - temple and temporal scalp; branch of CNV3
Chorda tympani syndrome is variant – sweating along jaw and chin

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20
Q

T/F

Frey’s syndrome occurs in 5% of pts undergoing parotid surgery

A

False

40%

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21
Q

Other than parotid surgery what can cause Frey’s syndrome?

A 
syringomyelia
encephalitis
sympathectomy, thyroidectomy
lung cancer
subclavian aneurysm
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22
Q

What spinal cord pathology can cause secodnary hyperphidrosis?

A

SSS for Secondary Spinal Sweating
Spinal injury
Syringomyelia
Syphylis - Tabes dorsalis

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23
Q

T/F
in spinal injuries causing hyperhidrosis there is often loss of thermal sweating in skin below the level of the spinal injury

A

True

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24
Q

What is autonomic dysreflexia?

A

due to spinal injury at or above T6
During attacks there is massive sympathetic discharge causing sweating above the level of cord transaction + hypertension, tachy or brady cardia, flushing, headache, piloerection and paraesthesias
In these pts, direct stimulation of a sympathetic axon can cause sweating in a localised area of skin
Can be triggered by inflammatory mediators from skin conditions inc psoriasis and dermatitis

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25
Q

What are the common causes of compensatory hyperhidrosis

A

Miliaria – recurrent miliaria rubra or profunda leads to non-functioning sweat glands of trunk often followed by comp hyperhidrosis of face

Diabetes – autonomic neuropathy causes hypo or anhidrosis esp of legs. Comp hyperhidrosis can be gustatory on face and neck or thermal on back

Post sympathectomy (including for hyperhidrosis)

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26
Q

what is cold erythema?

A

rare condition where cold causes pain, erythema and central area of hyperhidrosis

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27
Q

which conditions can cause hyperhidrosis due to abnormalities of the eccrine glands?

A 
Eccrine naevi
Palmoplantar keratoderma
Eccrine angiomatous hamartoma
Maffucci syndrome
AV fistula
Klippel-Trenauney syndrome
Glomuvenous malformation
Blue rubber bleb naevus syndrome
Granulosis rubra nasi (see later)
Pretibial myxoedema
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28
Q

What is the grading of volar hyperhidrosis?

A

Mild – moist palm or sole, no visible sweat droplets
Morerate – sweating involving distal fingers
Severe – dripping sweat

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29
Q

What is the grading of axillary hyperhidrosis?

A

Assess Size of sweat stain on clothes;

20cm severe

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30
Q

How is the starch iodine test performed?

A

Apply iodine as 3.5% in alcohol to skin and allow to dry
Brush on starch powder (cornstarch) or paint on starch in castor oil
Mixture turns blue-black at sites of sweating

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31
Q

T/F

primary volar and axillary hyperhidrosis gets worse with age

A

False

often resolve after age 25

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32
Q

what is treatment ladder for hyperhidrosis?

A

Antiperspirants
o 20% aluminium chloride hexahydrate (Driclor)
o Zirconium salts – can help axillae but not volar surfaces
Topical anticholinergics
o 0.5% glycopyrronium bromide cream for gustatory hyprhidrosis
o 2% glycopyrronium aqueous solution for scalp hyperhidrosis
Topical aldehydes
o 1% formalin (formaldehyde) soaks for plantar hyperhidrosis (not for other sites)
o Gulteraldehyde 10% buffered solution pH 7.5 swabbed onto feet 3x per week
Iontophoresis
o Can use tap water or glycopyrollate
Oral anticholinergics
o Propanthelene bromide – 15mg-150mg daily
o Glycopyrrolate – 1-2mg BD
o Oxybutinin – 1.25-5mg
Beta blockers - worsens if used long term
Clonazepam - if anxiety related
BoTox - axillary of volar
MiraDry microwave device
Surgery
o Excision of sweat gland containing axillary skin
o Destruction/removal of glands;curettage, liposuction
o Sympathectomy - VATS procedure
CBT - if anxiety related

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33
Q

T/F

Fabrys disease causes hypohidrosis

A

True
but can also cause secondary hyperhidrosis due to autonomic neuropathy
Sjogren’s also can cause hypohidrosis from direct destruction of glands and secondary hyperhidrosis due to autonomic neuropathy

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34
Q

What are the causes of sweat gland destruction?

A 
Tumour eg. lymphoma
Scleroderma or morphoea
Sjogrens syndrome 
GVHD
Acrodermatitis chronica atrophicans
Deep burns
XRT
Drugs - 5FU, topiramate, topical aldehydes, aluminium slats or zirconium salts
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35
Q

What is Ross’s syndrome?

A

widespread hypohidrosis
w/ patchy hyperhidrosis
+ Holmes-Adie syndrome
(myotonic pupil and loss of deep tendon reflexes)
pupil has irreg outline and sluggish light reflex

36
Q

what conditions cause hypohidrosis by peripheral/autonomic neuropathy?

A 
Many potential causes e.g. DALE
Diabetes
Amyloidosis
Leprosy
Ethanol (alcoholisim)
Also
Fabry's
Sjogren's
37
Q

How is hypohidrosis managed?

A

Treat cause/stop drug if possible
Keep cool – avoid overheating
For disorders of keratinisation with anhidrosis treat aggressively with keratolytics with aim to restore sweating
Spray water can help cooling

38
Q

Regarding Miliaria crystalina;
who gets it?
what body sites?
what is the level of sweat duct obstruction?

A

Neonates under 2 wks
- Others in hot climates
Face and trunk
stratum corneum

39
Q

Regarding Miliaria rubra;
who gets it?
what body sites?
what is the level of sweat duct obstruction?

A

Neonates, children, adults esp in hot climates
Neck and upper trunk
Mid epidermis

40
Q

Regarding Miliaria profunda;
who gets it?
what body sites?
what is the level of sweat duct obstruction?

A

Adults in hot climates on exertion only
- Often follows several episodes of Miliaria rubra
Trunk and prox limbs
DEJ

41
Q

T/F

Miliaria crystalina is the most common type of miliaria

A

False
Rubra is
AKA ‘prickly heat’

42
Q

T/F

Periporitis is a complication of any type of Miliaria

A

True in theory

But most often complicates miliaria rubra

43
Q

T/F

Miliaria pustulosa is an infective complication of miliaria rubra

A

False

pustular but sterile

44
Q

T/F

Miliaria rubra can cause hyperpyrexia if extensive

A

True

so can miliaria profunda

45
Q

T/F

Compensatory hyperhidrosis is seen in Miliaria rubra

A

False

seen on face in miliaria profunda

46
Q

T/F

Miliaria profunda is the most short lived form of miliaria

A

True
Regresses within hrs of ceasing exercise/cooling
– differentiates it form other causes of papules which are usually more persistent

47
Q

T/F

sweat gland abscesses are cold abscesses

A

True

not fluctuant, dont point

48
Q

T/F

sweat gland abscesses are sterile

A

False
usually due to staph
= Periporitis staphylogenes

49
Q

T/F

sweat gland abscesses are associated with innune deficiency

A

False

not particularly

50
Q

T/F

Pts w/ widespread idiopathic calcinosis cutis excrete calcium in sweat

A

True

51
Q

What is ‘ureamic frost’ on the skin?

A

CRF pts with uraemia excrete urea in sweat causing a ‘ureamic frost’
NB ureamic pts often alos have reduced size of sweat glands on histo

52
Q

T/F
Body odour is caused by bacterial degradation of apocrine sweat yielding ammonia and short chain fatty acids which cause smell

A

True

53
Q

What is Bromhidrosis

A

Bromhidrosis is smelly sweat of any cause

Most often its ‘keratogenic’ due to maceration of the SC and bacterial colonization which produces the odou

54
Q

T/F

Apocrine bromhidrosis can occur at any aporcrine site

A

False

Apocrine bromhidrosis only affects the axillary region – other apocrine sites don’t produce odour

55
Q

T/F

Bromhidrosis is only caused by aprocrine sweat

A

False

can be apocrine or eccrine

56
Q

T/F

Pts with apocrine bromhidrosis often have more and larger axillary apocrine glands than normal

A

True

57
Q

T/F

Pts with apocrine bromhidrosis have altered local flora with reduced corynebacteria

A

False

altered local flora including increased corynebacteria

58
Q

What are the aetiologies of eccrine bromhidrosis?

A

Keratogenic
Metabolic (syndromes)
Exogenous

59
Q

Which sites are most commonly affected by keratogenic eccrine bromhidrosis?

A

Intertriginous sites

plantar region

60
Q

Which syndrome gives a musty or mousy smell to the sweat?

A

PKU

61
Q

What is the cause of fish odour syndrome?

A

Trimethylaminuria
deficiency of flavin-containing monooxygenase3 (FOM3)
so cannot fully metabolise trimethylamines, choline or lecithin (marine fish, kidney, eggs, liver)
get fishy odour when they eat these things due to excretion triemthylamines in the sweat

62
Q

T/F

Methionine malabsorption syndrome results in boiled cabbage odour of the sweat

A

False
causes oasthouse syndrome - smells like drying hops
Boiled cabbage odour is caused by Methionine adenosyltransferase deficiency

63
Q

Which metabolic syndrome causes a sweet smell of the sweat and urine?

A

Maple syrup urine disease

64
Q

T/F

Pts with Trimethylaminuria get eccrine bromhidrosis with a sweaty feet smell

A

False
Sweaty feet odour typical of Isovaleric acidaemia
Trimethylaminuria causes fish odour syndrome

65
Q

Which foods and drugs can cause eccrine bromhidrosis?

A

Foods – garlic, asparagus, curry
Drugs – penicillins, bromides
Chemicals - DMSO

66
Q

what is management of bromhidrosis?

A

Ascertain if pathological or not
Encourage good hygiene
Avoid garlic, asparagus, curry
Acidic deodorant can help reduce bacteria
Ablation of axillary sweat glands can be offered if troublesome – laser, liposuction, ultrasound ablation, MiraDry, surgery

67
Q

What is the classification of chromhidrosis?

A

Apocrine chromhidrosis

(true) Eccrine chromhidrosis
(eccrine) pseudochromhidrosis

68
Q

What are physiopathological causes of eccrine chromhidrosis?

A

hyperbilirubinaemia (green)

alkaptonuria (black) (ochronosis)

69
Q

Where is Apocrine chromhidrosis apparent? What causes it?

A

Face, axillae, areolae
Black/brown/green/blue/yellow
Due to excess secretion of lipofuscins from the sweat gland

70
Q

What are investigations for chromhidrosis?

A 
FBC, ELFT w/ split bilirubin
skin swabs for smear and microscopy
skin biopsy
urinary homogentisic acid
\+/- spectrophotometry tests
71
Q

What are the causes of pseudochromhidrosis?

A

Sweat is normal but gets coloured at the skin surface by a pigment e.g.
chromogenic bacteria (corynebacteria, piedraia, pseudomonas)
clothing dye
copper deposits

72
Q

What is granulosis rubra nasi?

A 
Rare AD disease
hyperhidrosis of nose tip onset in childhood followed later by erythema and sometimes papules and vesicles
No associations
No good Rx
often resolves at puberty
73
Q

T/F

Neutrophilic eccrine hidradenitis is a cytotoxic side effect of chemo drugs on the eccrine glands

A

True

74
Q

which drugs cause Neutrophilic eccrine hidradenitis?

A

Cytarabine for AML is most typical
– onset 1-2 weeks after chemo
Also MTX, cyclophosphamide, anthracyclines, 5FU, bleomycin, vinca alkaloids, imatinib
Can occur locally at sites of bleomycin injection
Has been triggered by paracetamol
Can be post G-CSF in HIV pts

75
Q

What are non-drug causes of Neutrophilic eccrine hidradenitis?

A

infections

– strep, staph, gram neg bacilli, HIV

76
Q

T/F

Neutrophilic eccrine hidradenitis can be papules, plaques, linear, targetoid or polymorphic erythematous lesions

A

True
can also be purpuric and pustular
Typically face and extremeties

77
Q

T/F

pts with neutrophilic eccrine hidradenitis are often febrile

A

True

due to infection or drug AE

78
Q

What is the histopathology of neutrophilic eccrine hidradenitis?

A

vacuolar degeneration of eccrine glands sparing hair follicle
neutrophilic infiltrate (may be lymphocytic if pt neutropenic)
eccrine squamous syringometaplasia
(squamous metaplasia of cuboidal epithelial cells of eccrine ducts)

79
Q

T/F

Idiopathic palmoplantar hidradenitis is a rare condtion mainly seen in children esp after intense physicial activity

A

True

80
Q

T/F
Idiopathic palmoplantar hidradenitis is characterised by sudden onset of multiple tender erythematous nodules on the palms most often and sometimes also on the soles

A

False

soles mainly, sometimes also palms

81
Q

What is the histo of Idiopathic palmoplantar hidradenitis?

A

Neutrophilic infiltration of the eccrine glands and ducts

Infiltrate is nodular and may be abscesses

82
Q

T/F

Idiopathic palmoplantar hidradenitis resolves in days to weeks with rest but may be recurrent in up to 50%

A

True

83
Q

What are DDs of Idiopathic palmoplantar hidradenitis?

A

Pseudomonas hot foot syndrome
Erythema nodosum or other panniculitis
Perniosis
Vasculitis esp PAN

84
Q

What is Fox-Fordyce disease?

A

AKA Apocrine miliaria
V itchy condition of unknown cause
Mainly women age 15-35
Dome-shaped skin-coloured perifollicular papules in axilla + periareolar and anogenitial skin
Can be seen on medial thighs, periumbilical area and sternum
Often hair is lost from affected sites

85
Q

What are exacerbating factors in Fox-Fordyce disease?

A

Worse by heat, excercise, emotional stress

Often better in pregnancy or with OCP

86
Q

What is histo Fox-Fordyce disease?

A

keratin plug in the follicular infundibulum obstructing the apocrine duct
rupture of duct and inflammation
spongiosis and Perifollicular and periadnexal infiltrate of lymphocytes

87
Q

What is treatment ladder of Fox-Fordyce disease?

A 
TCS 1st line (caution due to flexural sites)
ILCS 1st line (caution risk of atrophy)
Topical calcineurin inhibitors
Topical tretinoin can help pruritus
Clindamycin lotion BD can reduce symptoms
OCP helps some women
Isotretinoin has been used
Phototherapy
Electrocautery
Excision of periareolar skin

Medical dermatology Dan (41 decks)

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