Sebaceous Gland Diseases + Acne

Sebum composition

50-55% triglycerides + fatty acids; 10-15% squalene; 25-30% wax esters; small cholesterol amount

Regulation of sebum

Androgens increase sebum; estrogens decrease; neurovegetative + emotional influences

Seborrhoea definition

Excessive sebum production in sebaceous-rich areas

Seborrhoea oleosa

Oily shiny skin with greasy surface

Seborrhoea sicca

Dry flaky scaling despite sebaceous activity

Conditions linked to seborrhoea

Acne vulgaris, rosacea, seborrheic dermatitis

Seborrhoea therapy

Vitamin B6, sulfur or selenium shampoos, avoid greasy pads, isotretinoin in severe cases

Sebostasis definition

Reduced sebum production causing dry skin

Sebostasis signs

Pityriasiform desquamation, dryness, itchiness, resembling ichthyosis or neurodermatitis

Sebostasis therapy

Oil emulsions, avoid soaps, strong moisturizers

Seborrheic dermatitis definition

Chronic inflammatory disease of sebaceous-rich areas with greasy scales

Factors in seborrheic dermatitis

Genetics, increased sebum, hormones, Malassezia, stress, Parkinson disease

Seborrheic dermatitis scalp signs

Yellow greasy scales, erythema, corona seborrhoica

Seborrheic dermatitis face signs

Red plaques on nasolabial folds, eyebrows, beard area with greasy scaling

Seborrheic dermatitis intertriginous signs

Moist erythematous plaques with possible Candida infection

Seborrheic dermatitis therapy

1% hydrocortisone, ketoconazole 2%, sulfur/tar shampoos, short steroid courses

Infantile seborrheic dermatitis

Inflammatory oily scaling in first 3 months of life

Causes of infantile seborrheic dermatitis

Transplacental androgens, Candida colonization

Crusta lactea

Yellowish greasy scalp crusts in infants

Infantile seborrhea therapy

Olive oil or salicylic acid 3%, emollients, antifungals if Candida

Erythrodermia seborrhoica

Severe generalized form of infantile seborrheic dermatitis

Erythrodermia seborrhoica cause

Immunodeficiency, complement C5 defect, poor phagocytosis

Erythrodermia seborrhoica symptoms

Diffuse erythema, fatty scaling, fever, diarrhea, vomiting, anemia

Erythrodermia seborrhoica treatment

Rehydration, IV antibiotics, topical corticosteroids, antifungals

Acne vulgaris definition

Chronic inflammatory disease of the pilosebaceous unit

Main pathogenetic factors in acne

Increased sebum, abnormal keratinization, P. acnes overgrowth, inflammation

Role of androgens in acne

Increase sebaceous gland size and activity

Initial acne lesion

Microcomedone from keratin plugging

Closed comedone

Whitehead with small follicular opening

Open comedone

Blackhead with widened opening and oxidized melanin

Propionibacterium acnes role

Produces lipases, proteases, chemotactic factors that drive inflammation

Acne comedonica

Non-inflammatory acne with numerous comedones

Acne papulopustulosa

Inflammatory acne with papules and pustules

Acne nodulocystica

Deep nodules and cysts with scarring

Acne conglobata

Severe acne with nodules, abscesses, draining sinuses, severe scars

Acne fulminans

Acute ulcerative acne with fever, arthralgia, leukocytosis

Acne fulminans therapy

Systemic corticosteroids and dapsone

Acne inversa

Hidradenitis-like acne in intertriginous areas

Acne tetrad

Acne conglobata + hidradenitis suppurativa + scalp perifolliculitis + pilonidal sinus

Drug-induced acne

Caused by steroids, lithium, iodides, bromides, phenytoin; monomorphic lesions

Acne cosmetica

Acne caused by comedogenic cosmetics in women

Topical acne therapy

Retinoids, benzoyl peroxide, erythromycin, clindamycin, azelaic acid

Retinoid effects

Normalize keratinization and comedolysis

Benzoyl peroxide effect

Strong antibacterial and anti-inflammatory activity

Azelaic acid effect

Comedolytic, antibacterial, anti-inflammatory

Systemic antibiotics in acne

Tetracycline, doxycycline, minocycline, erythromycin, dapsone

Antiandrogen therapy for acne

Cyproterone acetate, Dianette, spironolactone

Oral isotretinoin

Decreases sebum by up to 90% and is used for severe acne

Isotretinoin contraindication

Pregnancy due to severe teratogenicity

Isotretinoin interactions

Cannot be combined with tetracyclines due to pseudotumor cerebri risk

Rosacea definition

Chronic facial dermatosis with erythema, papules, pustules, telangiectasias

Rosacea triggers

Heat, cold, UV, alcohol, spicy food, stress, Demodex

Rosacea stages

Episodic flushing, persistent erythema, papulopustules, rhinophyma

Rhinophyma

Phymatous overgrowth of the nose in advanced rosacea

Ocular rosacea signs

Blepharitis, conjunctivitis, episcleritis

Rosacea therapy

Topical metronidazole, ketoconazole, tetracyclines, isotretinoin in severe cases

Perioral dermatitis definition

Inflammatory papules and pustules around the mouth and nasolabial folds

Triggers of perioral dermatitis

Topical steroids, cosmetics, fluoridated toothpaste, hormones

Perioral dermatitis clinical

Red papules, papulovesicles, papulopustules with burning sensation

Perioral dermatitis therapy

Zero therapy, tetracyclines, isotretinoin for severe forms

Difference between acne and rosacea

Rosacea has no comedones

Difference SD vs Psoriasis

SD has greasy yellow scales; psoriasis has silvery dry scales

Malassezia role

Growth of lipophilic yeast drives seborrheic dermatitis

Parkinson disease and SD

Parkinson patients have increased seborrheic dermatitis

Candida in SD

Secondary infection common in intertriginous SD

Comedo extractor use

Used only after retinoids soften comedones; not for papules or pustules

Intralesional steroid use

Used for cysts and nodules; risk of skin atrophy if too much used

Acne scarring types

Atrophic, hypertrophic, keloid scars

Severe acne duration

if untreated approx 7 years with scarring risk