1. DISEASES OF
SEBACEOUS GLANDS
and
SWEAT GLANDS
By: Dr. Faraedon Kaftan
College of Medicine
Sulaimani University
L2
2011 - 2012

2. DISEASES OF SEBACEOUS GLANDS
sebaceous gland: holocrine glands in the skin that secrete sebum
usually through the hair follicles.
1- Sebaceous hyperplasia
2- Adenoma sebaceum (Sebaceous adenoma)
3- Sebaceous cyst (Epidermoid cyst)
4- Acne
5- Sebaceous gland carcinoma
1- Sebaceous hyperplasia
• sebaceous glands enlarge & produce yellow, shiny bumps (papules),
cauliflower -shaped on the face, affects newborns & middle-aged to
elderly adults

3. 2- Adenoma sebaceum (Sebaceous adenoma):
Epiloia (tuberous sclerosis):
• is a noncancerous slow-growing tumor (angiofibroma) of an oil-
producing gland
• Red. pink, flesh-coloured, or Yellow papules or nodules on the face,
scalp, belly, back, or chest.
• It is associated with tuberous sclerosis (Epiloia): is a genetic disorder
that affects the brain/nervous system (Seizures), kidneys, and heart,
and cause tumors to grow.
• (Epiloia): Epi=epilepsy, loi=low intelligence, a=adenoma sebaceum

4. Skin signs in Tuberous sclerosis (Epiloia):
• Adenoma sebaceum: (angiofibroma): Red papules
on the face containing many blood vessels
• Cafe-au-lait spots
• Shagreen spots: Raised patches of skin with an orange-peel texture often
on the back
• Ash leaf spots: White areas of skin that look like an ash leaf

5. 3- Sebaceous cyst (Epidermoid cyst)
• Epidermoid cyst originates in the epidermis and a pilar cyst originates
from hair follicles, but neither type of cyst is strictly a sebaceous cyst
• The fatty, white, semi-solid material in both cysts is not sebum, but keratin,
and under the microscope neither entity contains sebaceous glands.
• "True" sebaceous cysts are known as steatocystomas or, if multiple,
as steatocystoma multiplex.
Steatocystoma multiplex Epidermoid cyst

6. 4- Acne:
• is a chronic inflammatory disease of the
pilosebaceous follicles.
• is rare in children and old age.
• The sites involved are the seborrheic areas
rich in sebaceous glands mainly face, upper
chest , back and the shoulder areas.
• The usual types of acne occur after puberty.
Pilosebaceous follicle

7. Etiology
1- Increase in the activity of sebaceous glands (↑ sebum) and occlusion of
the pilosebaceous orifices are the main factors of acne pathogenesis.
2- Hormones :
• Androgens ↑ the activity of sebaceous gland in both sexes.
• Estrogens antagonize the effect of androgens.
• ACTH ↑s the activity of the sebaceous glands due to its stimulation of
production androgens.
3- Infections: Corynebacterium (Propionibacterium) acnes and staphylococci
are considered important in the pathogenesis of acne.
4- Diet: The effect of diet is variable. Some types of diet such as high
carbohydrate, fatty foodstuffs, chocolate, diets rich in iodides such as
seafood may have some effect on exacerbation and not the pathogenesis
of acne in certain individuals.
5- Drugs: acniform eruption results due to different systemic and topical
medications. Tetracyclines , corticosteroids, certain vitamins with mineral
supplements such as iodides may be accompanied by acniform eruptions.
6- Stress and lack of sleep may have some role.

8. Pathogenesis: formation of acne
1- Increased activity of sebaceous glands with
production of excess sebum plays an important role
2- Occlusion of the pilo sebaceous orifices plays an important
role
2- Hormones : Increased activity of sebaceous glands and
occlusion of the cornfied hypertrophic pilosebaceous
follicles lead to retention of sebum into the follicles, which
dilate and rupture by time.
3- Anaerobes such as Corynebacterium (Propionibacterium)
acne, Pityrosporon ovale and Staphylococci cause split of
the sebum into fatty acids and triglycerides which act as an
important irritating factors & → to the formation of the
different clinical types of acne which varies from papules,
pustules ,cysts and comedones

9. (A) Normal follicle;
(B) open comedo (blackhead);
(C) closed comedo (whitehead);

10. CLINICAL TYPES OF ACNE
1- NEONATAL ACNE
• begins shortly after birth as small papules on the seborrheic
areas mainly on the forehead and cheeks
• There is usually a family history of severe acne .
• The condition resolves spontaneously within few weeks .
• Rx: antiseptic lotions (Clindamycin or Erythrocin topically) .

11. 2- JUVENILE ACNE
• mainly males, facial acne at around 3 months - 5 years of age .
Etiology
• Transplacental stimulation of the adrenals.
• Drugs
• Virilizing tumour or congenital adrenal hyperplasia.
Treatment
• Erythromycin 125 mg 3 times daily.
• Topical preparations:
erythromycin or Clinamycin lotion.

12. 3- Acne vulgaris (common): (POST-PUBERTAL ACNE)
• is a common human skin disease, the commonest type of acne & characterized
by areas of skin with Seborrhea (scaly red skin), Comedones [blackheads:
(open) & whiteheads: (closed)], Papules (pinheads), Pustules (pimples),
Nodules (large papules) and possibly scarring
• affects mostly skin with the densest (high density) population of sebaceous
follicles; these areas include the face, the upper part of the chest, and the
back.
• is of 2 types inflammatory (severe) & noninflammatory
• occurs most commonly during adolescence, and often continues into
adulthood, in adolescence usually caused by an increase in testosterone, which
people of both genders accrue (gain) during puberty.
• For most people, acne diminishes over time and tends to disappear or
decrease after one reaches early twenties, there is no way to predict how long
it will take to disappear entirely, and some individuals will carry acne well into
their thirties, forties & beyond.
• main effects are: scarring & psychological (reduced self-esteem & depression
or suicide)

13. 4- NODULAR (CYSTIC) ACNE
• Cysts containing thick , viscid or blood tinged fluid .
• The most common sites involved are the face and the back
• DD: cysts of neurofibromatoses (café au lait macules & the cysts
are more soft)
Cystic , Black dot and Keloidal acne papulo-pustular and scarring acne

14. 5- ACNE CONGLOBATA
• is a severe type of acne that may affect the face and back.
• The lesions are boggy and heal in some cases by scar formation
• more common in girls.
6- SOLAR ACNE (senile comedones)
• in elderly people, especially in the periorbital areas.
• Due to high exposure to UV radiation (solar damage)

15. 7- DETERGENT ACNE
• Uncommon, occurs in patients who wash many times daily
• Certain bacteriostatic soaps contain weak acnegenic compounds
8- ACNE KELOIDALIS
• due to pyogenic infection of the sebaceous glands leading to
more destruction and disfiguration of tissues with formation of
keloids.
Acne keloidalis nuchae:

16. 9- ACNE EXCORIATA
• is common in neurotic patients, who play by picking or
squeezing the lesions.
• may lead to crust and pitted scarring.
10- TROPICAL ACNE
• Hot humid environment leads to excessive sweating.
• Occlusion of the pores of the sweat glands leads to miliaria

17. 11- ACNE ROSACEA
• Erythema of the face usually has the appearance of
butterfly where papules are embedded in the
erythematous patches of the face.

18. 12- ACNIFORM ERUPTIONS
• Red papules mainly (and to lesser extent pustules) simulating
acne vulgaris
• Lesions appear suddenly.
• Lesions are not necessarily located on the seborrheic areas but
may be distributed on the chest ,trunk and extremities.
Drugs & factors may cause acniform eruption are:
• Tetracycline, Minocycline, Doxycycline and Cs.
• Topical corticosteroids especially when occluded.
• Iodides and bromides in vitamins and mineral supplements
• isonicotine hydrazine (INH), ACTH, Chloral hydrates and pro-banthin
• Chemicals: Chloracne, which is due to excess chlorination of swimming pool.
• Chloronaphthalines, cutting oils, crude coal tar, petrol and its derivatives

19. 13- ACNE FRONTALIS (Acne necrotica)
• Follicular papulopustules appear on the forehead which has a
central depressed surface due to central necrosis.
• may heal with pitted scars resembling the late lesions of Variola
(Acne varioliformis)
14- MECHANICAL ACNE
• is due to physical trauma, which may lead to licheinification , occlusion of the
pilo sebaceous orifices and pigmentation.
• Tight caps especially in young babies and children, pressing bands and
headgears.
• Head bands and tight under wears are other causes.
• Continuous friction from turtleneck sweaters
may localize acne to the neck.

20. 15- ACNE SCAR:
• acne is accompanied by severe scarring due to:
- secondary bacterial infection,
- repeated playing in the lesions
- excoriations in neurotic patients.
16- IMMOBILITY ACNE
• Adolescent patients lying in bed for a long time, as in the
orthopedic ward, due to a change in the environment of the
skin, which may enhance bacterial colonization of the duct.

21. 17- COSMETIC ACNE
• Due to continuous use of cosmetic creams and powders and kept for a
long time without cleaning and removal.
• Preparations containing lanolin, petrolatum, certain vegetable oils,
butylstearate, lauryl alcohol and oleic acid, are comedogenic.
• Grease that is applied to the scalp may cause acne
Cosmetic acne & contact dermatitis (Clindamycin)
18- ENDOCRINE ACNE
• Endocrine abnormality such as Cushing‘s disease, adrenogenital
syndrome and the polycystic ovarian syndrome are associated with acne
besides the other systemic manifestations.

22. 19- OCCUPATIONAL ACNE
• workers in petrol products as those who wash cars, drivers,
and mechanics may have acniform eruption.
• Cutting oils, industry of chlorine , bromine and swimming
pools maintenars as well.

23. TREATMENT OF ACNE
• Dealing with acne lesion is simple & very difficult at the same time
• Too many preparations (pharmaceutical, cosmetic, herbal, traditional, over
the counter, & body shop preparations are available and the patients are
some times confused and shift from one medication to another by himself ,
according to the advice of others and prescriptions from different centers. In
most cases such patients will loose a lot of time , money and have their
lesions usually exacerbated or accompanied by unwanted complications.
• Playing in lesion and spending a long time looking in mirror and trying to
squeeze the pimples or pustules may lead to hazardous effect complicated by
scars.
• Cosmetics (powders, creams and others used as camouflage ), & sun blocks
especially if left for a long time) lead to occlusion of the pilosebaceous
orifices leading to more complications. Hot humid environment should be
avoided if possible.
• Excessive washing of the affected areas may do harmful effects, especially if
certain detergents are used.
• Facial cleaning and peeling should be done by professionals
• Irritating diet should be avoided.
• sunlight may have a good beneficial effect on acne lesion.

24. Active Treatment: Topical & systemic medications
A- Topical medications
• Washing the area once or twice daily with mild anti seborhea soap
• Erythrocin lotion, Clindamycin lotions (Dalacin lotion) are usually effective in pustular acne.
• Benzyl peroxide is effective medication but there is possibility of irritation.
• Retinoic acid preparations such as (Retin A gel or cream).
B- Systemic Medications
Juvenile acne: Erythrocin suspension can be used .
• systemic medications (used in the adults) are not indicated for children.
Adult acne: Different systemic medications are used in adults.
• The type of medication depends on the severity of the lesion , age and sex.
• The cause of acne should be discussed and the potential success of therapy be
highlighted.
• Mild acne requires only topical therapy.
• moderate or severe acne needs both oral and topical therapy besides other
lines of medical and cosmetic procedures.

25. 1- Oral antibiotics: given for 6 months with topical therapy & they are:
Tetracycline: are bacteriostatic
- 250mg X 4 daily for 10 days and the dose is reduced to twice daily for 20
days then a single daily dose may be given for 1-6 months.
- decreases the split of fats to fatty acids and triglycerides
- inhibits enzyme activities, affects chemotaxis & lymphocyte functions.
- Care should be taken for the side effects of tetracycline.
- tablet should be taken with water (not milk) half an hour before food
Erythromycin: is effective in young age and the childbearing age in females.
Azitromycin is effective medication but more expensive than erythromycin
Doxycycline tablets or capsules (100mg/day) and minocycline (100mg/day) are
effective medications but they are more expensive.
Trimethoprim (400-600 mg/day) is a third-line antibiotic.
Clindamycin: Its risk is pseudomembranous colitis

26. 2- Oral Contraceptives (OCs): Hormonal Therapy:
• are effective in the management of mild & moderate acne
vulgaris, as elevated levels of androgens in acne patients are
underlying pathophysiological factor.
• All low dose OCs reduce serum free testosterone (T) to a
similar extent.
• Anti androgens such as Diane may be effective in controlling
severe acne lesions in young girls.
• Cyproterone acetate (CPA) (2 mg) combined with 50-
microgram ethinyl oestradiol
• Dianette (35 micro g. ethinyl estradiol and 2 mg CPA) appears
to be of value in women with acne resistant to other
therapies.
• Oral spironolactone 100-200 mg for 6 months, is of
considerable benefit in old females.

27. 3- Isotretinoin: (Isotroin: Roacutane: Retane: 13-Cis retenoic acid)
* is more effective than Diane for acne patients, in mild, moderate or severe acne
* precautions, SEs and C/I should be always taken into consideration before its use
* produces a striking benefit & is superior to other treatment
* is teratogenic & (females using the drug should use contraception.
* The precautions and contra-indications especially in adult females should be
strictly considered as fetal abnormalities and other complications may occur.
* pregnancy should be at least after 1 or 2 ms after stopping the drug.
* Pregnancy test should be negative before using isotretinoin.
* dose of is 0.5 -1.0 mg/kg for younger patients & for a period of 4 months.
* influences all the major factors involved in acne in doses of 0.5-2.0mg/kg .
* Each Isotretinoin capsule is 20 mg.
Action of Isotretinoin:
1- Reduces sebum secretion.
2- The populations of of P. acnes fall gradually & ductal cornification.
3- Stimulates the T-helper cells, increase in Igs (IgE) and reduces chemotaxis.
4- Has effect on bacteria, ductal corneocytes & inflammation & comedon formation
5- interfers with endogenous vitamin A metabolism.

28. Treatment of Post Acne Scars
1- Peeling: by fruit acids such as 10% Glycolic acid for
superficial scars and superficial wrinkles .
2- Ultraviolet light is useful in some cases especially in mixed
acne lesions of papules and pustules. PUVA can induce
superficial peeling leading to improvement of skin lesions.
3- Surgical repair or local collagen injection or fat tissue for
deep scars.

29. 4- Laser skin resurfacing by CO2 Laser (recently) to smoothen
and correction of superficial scars.
5- Dermabrasion: a technique, done with a rotating brush
applied on the scars.

30. DISEASES OF THE SWEAT GLANDS
Diseases of Eccrine sweat glands:
1- Hyperhidrosis
2- Anhidrosis
3- Miliaria
Eccrine sweat glands can be seen under usual microscope while
Apocrine sweat glands are seen under electron microscope

31. 1. HYPERHIDROSIS
• is an abnormal increase in the amount of sweat in the eccrine sweat glands.
• Types:
1- Generalised hyperhidrosis: factors affect the eccrine sweat glands and increase
their sweat production:
A- Physiological hyperhidrosis: emotional, hot humid environment, work or exercise.
B- Pathological hyperhidrosis:
• Febrile illnesses.
• Endocrine problems: hyperthyroidism and diabetes.
• Trauma to the brain or inflammatory conditions of the hypothalamus
• Drugs: sympathomimetic drugs and others that can affect the hypothalamus
2- Localized hyperhidrosis: is very common, mainly affects palms, soles and axilla

32. Treatment of Hyperhidrosis
• Reassurance and psychotherapy in the emotional Hyperhidrosis.
• Anticholinergic drugs
• Sedatives: Benadryl or other types of mild sedatives
• Synthetic analogues of atropine such as Banthin and Probanthin
have temporary inhibitory effect of sweat .The side effects as
some patients may not easily accept, are dryness of mouth,
blurring of vision with higher doses.
• Antihistamine: Cyproheptadine or Citrizine.
• Topical preparations: Most antiperspirants contain aluminum
salts
• Astringents: Palm and foot soaks with: Potassium permanganate
1: 2000

33. • Powders: used for dusting of the feet and the interdigital
spaces to minimize sweating in localized hyperhidrosis as :
R/x
• Aluminum chloride 3
• Potassium alum 10
• Salicylic acid 3
• Starch 5
• Talc powder 100
• Botulinum toxins: Botox: for severe palmer hyperhidrosis.
• Aluminum-chloride hexahydrate 25% (driclor) in absolute
ethanol can give effect in axillary hyperhidrosis.
• Iontophoresis: treatments of the hands and feet. No drugs,
no surgery, no needles, Mild electrical current is passed down
high quality cables to the treatment electrodes which are
placed into trays filled with tap water, it slows down secretion
at the gland

34. POMPHOLYX (Dyshidrosis) (dyshidrotic eczema):
is a deep seated vesicular eruption (sago grains) of the palms &
soles (bilateral around the fingers & toes) .
Treatment
• Treatment of the cause: hyperhidrosis or infections.
• Potassium permanganate 1: 8000 soaks are effective for the
hands and feet.
• Topical Cs cream alone or in combination with antibacterials

35. 2. ANHIDROSIS
means absence of sweating in the eccrine sweat glands due to
defect in production or conduction of sweat to the skin surface
Types of anhidrosis:
1- Generalised anhidrosis: occurs in: Miliaria, Congenital
ectodermal defects, Orthostatic hypotension, Diabetic neuropathy,
Multiple myeloma, Thyrotoxicosis, Myxedema & Pemphigus
2- Segmented type of anhidrosis:
Treatm: General measures: Avoid vigorous exercise, Avoid
exposure to hot environment & Air-condition and humidifiers

36. 3. MILIARIA (SWEAT RETENTION):
• in children and older age groups is due to interference in free
delivery of sweat to the skin surface.
• Occlusion of the sweat ducts pores by keratin in response to
epidermal injury may lead to rupture of the sweat glands
• 4 types
A. Miliaria crystallina:
B. Miliaria rubra or prickly heat:
C. Miliaria pustulosa:
D. Miliaria profunda:

37. Types of miliaria:
A. Miliaria crystallina: is due to occlusion of the sweat
orifices and escape of sweat in the stratum corneum,
• superficial & mildest type
• numerous discrete vesicles with clear fluid, which ruptures
easily.
• little burning or stinging sensation in hot humid environment.

38. B. Miliaria rubra or prickly heat:
• is the most common, especially in hot humid climates
appearing on the back, chest, side of the abdomen,
antecubital, popliteal fossa and in areas exposed to friction.
• Erythematous papulovesicular rash causing itching and
burning sensation due to leakage of sweat into the
epidermis, where the severity depends on the heat load.

39. C. Miliaria pustulosa:
• pruritic, discrete, superficial erythematous pustules with a dark
punctum at the center corresponding to the hyperkeratotic plug
occluding the sweat orifice.
• The common sites: intertriginous areas and the flexural
surfaces of the extremities.
• The contents of the pustules are sterile and it is formed due to
intraepidermal sweat retention

40. D. Miliaria profunda: is due to deep poral occlusion and
rupture of sweat ducts and escape of sweat into the epidermis
at the dermo-epidermal junction.
• Deep & severest type
• non-inflammatory, non-pruritic and flesh colored papules where
the severity of the lesion depends on the degree of sweating.
• may be accompanied by systemic manifestations such as
irritability, easily fatigue ; headache, anorexia, drowsiness and
inability to concentrate due to heat intolerance.
• Miliaria improves by cooling of the skin and the symptoms may
disappear after a short time.

41. Diseases of Apocrine sweat glands:
A- Bromhidrosis
B- Chromhidrosis
C- Hidradenitis suppurativa
D- Fox-fordyce disease

42. A- BROMOHIDROSIS: Malodorous sweat may occur in the axilla & feet
Causes: Hyperhidrosis, Apocrine glands Dysfunction, Bacterial and fungal
infections, Fatty acids decomposition producing distinctive odor, Certain
foodstuffs such as garlic, onion and excessive protein ingestion & Heavy
metals: arsenic.
Treatment:
• General cleaning of the body & frequent bathing.
• Changing of socks and under wears repeatedly and using light clothes.
• Avoid excess sweating.
• Avoid certain types of food such as excess proteins, garlic, and spices.
• Aeration of the area .
• Dusting powders especially for the feet before dressing the socks.
• Soaks for the feet such as potassium permanganate 1: 2000
• Deodorants:
• Antibacterial antiseptic soap (Cidal soap)

43. B- CHROMOHIDROSIS:
• is colored sweat due to dysfunction of the apocrine glands.
• The commonest site is the face, where the color of sweat may be black,
green, blue or yellow.
• The crural areas: a rusty stain may appear on the underwear.
C- HIDRADENITIS SUPPURATIVA:
• is chronic & recurrent infection of the apocrine sweat glands of the axilla
& the inguinal areas.
• Tender reddish nodule appears, firm that may cause an abscess with
multiple openings on the skin surface and discharging pus.
• Scarring may accompany severe cases.
Treatment
• Local compresses with potassium permanganate for oozing
• topical antibiotics.
• High doses of systemic antibiotics.
• Incision and drainage of the abscess.
• Cs: Chronic persisting localized cases may improve with steroid injections.

44. D- FOX-FORDYCE DISEASE
• is a rare disease occurs mainly in young girls
• Intense pruritic, small, flesh colored papules occur mainly on
the axilla, mamma, umbilicus, perineum, labia
• The papules may increase in size forming nodules with an empty
follicular center.
Treatment
• is not always successful.
• Estrogens and contraceptive pills may give improvement to
itching and involution to the lesions.