Diseases of the Apocrine sweat

glands
 The apocrine sweat glands belong to the hair-
sebaceous gland unit. They are localised in the
axillae, over the sternum, in the area of the
nipple, in the periumbilical region, on the mons
pubis, and in the anogenital area.
 Increases in size and function occur at puberty
under the influence of hormonal factors.
Diseases of the Apocrine sweat
glands
 The mechanism by which the apocrine sweat
glands are stimulaed has not been finally
established. Cholinesterase-positive and
catecholamine-bearing nerve fibers can be
detected around the apocrine sweat glands.
 Fox-Fordyce Disease
 Acne Inversa
 Bromhidrosis
 Chromhidrosis
Fox –Fordyce Disease:

 Chronic pruritic papular disease occuring usually in young women

in areas rich in apocrine sweat glands, especially in the axillae.
 Occurence: rare, approximately 90% of cases are women
between the ages of 20 and 40 years.
 Clinical findings: small, flat or conical, firm, skin – colored or
yellowish-whitish papules. The axilla hair is scanty; many hairs are
broken off. Quite often, there are disturbances in menstruations or
signs of virilization.
 Course: spontaneous healing after menopause
 Treatment: systemic : hormonal treatment with contraceptives
 Topical: steroids as cream or lotion, tretinoin, antiperspirants
Acne inversa

 This disease was previously assigned to

disorders of the apocrine sweat glands,
but more recently has been assigned to
the follicular or acne diseases. Changes
of hidradenitis suppurativa type occur in
acne inversa.
Bromhidrosis
 Penetrating odor due to bacterial decomposition of
apocrine sweat, mainly in the axillae. In itself, apocrine
sweat is odorless but is decomposed by the
coryneform cocci on the skin surface.
 Course : The involution of the apocrine sweat glands in
advanced age causes the bromhidrosis to vanish.The
condition is favored by poor hygieneand is then quite
often associated with erythrasma.
 Treatment: Intensive body hygiene, use of antimicrobial
deodorants that inhibit the bacteria.
Chromhidrosis

 It occurs only in circumscribed skin

areas. The sweat may be colored yellow,
blue, green, or black.In young women,
chromhidrosis may occur on the face due
to aberrant apocrine sweat glands areas.
Following psychogenic stimulation, small
dark droplets are produced in the follicle
openings.
Acne vulgaris
 One of the most common diseases in
dermatology
 It occurs at puberty in almost everyone,
although to different extents, and
regresses in early adulthood
 Only occasionally acne vanish before the
age of 20 and sometimes it persists zup
to 30 or lifelong
Acne

 It is a polyetiological disease of the skin

areas rich in sebaceous follicles, it is
characterized by seborrhea, disturbed
keratinization in the follicles with
comedones and subsequent
inflammatory papules, pustules and
nodular abscesses and scars.
Acne

 Pathogenesis: Numerous pathogenic

factors control acne, such inheritance,
sebum, hormones, bacteria, follicular
keratinization, and follicular
responsiveness, e.g. Reaction to
mechanical forces or inflammation.
Immunological prosesses probably play
only an indirect part.
Primary and secondary
acne lesions
 Primary noninflamatory lesions:
 Normal sebaceous follicle
 Follucular filament in sebaceous follicle
 Microcomedo
 Closed comedo
 Open comedo
Acne

 Secondary inflammatory lesions

 Papule
 Pustule
 Persistent nodule
 Nodular abscess
 Draining sinus
Acne
 Postinflammatory lesions
 Fistulated comedo
 Cyst
 Ice-pick-type-scar
 Milium-type scar
 Closed comedo- type scar
 Nodular scar
 Keloidal scar
 Atrophic scar
Acne

 The clinical forms of acne differ in

expression and severity. They vary from
a few comedones in acne comedonica up
to severe skin changes with a feeling of
illness, ulceration, abscesses, and
fistulas in acne fulminans or acne
inversa.
Acne
 Special forms:
 Acne inversa-synonyms : intertriginous acne, acne
triad, acne tetrad, hidradenitis suppurativa.
 This syndrome is almost seen excusively in males.
Acne conglobata occurs with an inverse picture. The
usually affected parts such as the face, chest and back
are hardly, rarely, or not at all affected, whereas there
is notable involvement of the intertriginous areas such
as the inguinal region, mons pubis, axullae, and in
addition the nape o the neck and the scalp.
Acne
 Acne fulminans:
 Acute febrile ulcerating acne conglobata with
polyarthralgia and leukemoid reaction. This is a rare,
but serius disease of unknown cause beginning
acutely, which is found almost only in young males,
aged 13-16 years, with acne conglobata. It is
characterized by very suddenly occuring hemorrhagic
necroses, particularly on the face, neck, chest and
back, which can lead to bleeding over larger areas of
the skin. It is accompanied by fever, leukocytosis up to
30000 and joint swelling.
Acne
 Contact acne or acne venenata:
 It occurs mainly in patients with seborrhea,
large facial pores, and acne vulgaris or
previous acne.Contact with numerous
comedogenic compounds is involved. Mild
forms are cosmetic acne and pomade acne.
 The most severe manifestations are oil acne
and chloracne.
 Ex. Oil, tar acne.
Treatment

 1. Cleaning ( detergents)
 2. Antiseborrheic- systemic: isotretinoin
 topical: alcoholic solutions, emulsions
o/w
 3. Comedolytic- systemic: isotretinoin
 Topical : salyciclic acid, benzoyl
peroxide, tretinoin, UV radiation
Acne
 4. Antimicrobial : systemic-TTC, doxycycline,
minocycline, erythromycin
 Topical: clindamycin, erythromycin,
tetracycline, azelaic acid, salicyclic acid
 5. Intiinflammatory: systemic: corticosteroids
( acne fulminans), TTC, minocycline,
erythromycin, isotretinoin
 Topical: lotions, paste (facial masks), CO2
acetone snow, UV radiation