1. Disease Of Skin Appendages
General hospital of Tianjin medical university
Suju Luo

2. Normal skin
skin appendages
★sebaceous
★hair
★sweat gland

6. Disease Of Skin Appendages
1 Disorders of sebaceous glands(acne vulgaris ; rosacea; seborrheic dermatitis)
2 Disorders of sweat glands(hyperhidrosis, hypohidrosis, miliaria)
3 Disorders of hair (alopecia areata, alopecia androgenitica, hypercrichosis and hirsutism)

7. acne vulgaris

8. Acne Vulgaris
Acne vulgaris is a follicular disorder, a disease of the pilosebaceous unit.
Characterized by comedones (whitehead or blackhead), papules, pustules ,cysts, nodules, and scars.
Sites of predilection are face, neck, and upper trunk

9. Acne Vulgaris Pathogenesis:
★follicular epidermal hyperproliferation, obstruction of the pilosebaceous canal
★excessive sebaceous gland secretion
★ inflammation ( arising as a result of leakage of contents of the pilosebaceous follicle into the surrounding dermis)
★the presence of Propionibacterium acnes

10. The process of inflammatory acne formation
excessive production of sebum and keratin obstruction of the pilosebaceous canal rupture of the follicular wall, releasing the contents into the dermis and initiating an inflammatory response
papules, pustules ,cysts

11. Acne Vulgaris the comedones, open or closed

12. Inflammatory acne

13. upper trunk.

15. Treatment topical treatment is needed for mild acne
 benzoyl peroxide-containing preparations
topical antibiotics-erythromycin and tetracycline
topical vitamin A acid-tretinoin
④antiseptics and keratolytics

16. Treatment
systemic treatment is needed for moderate acne and severe acne
antibiotics---minocycline or erythromycin
hormones---Dianette
retinoids and isotretinoin for severe or persistent cases

17. Treatment Stepped care ★for mild acne topical preparations only
★for moderate acne
topical preparations + systemic antibiotics
★for severe acne
topical preparations + systemic antibiotics /or isotretinoin
if necessary use hormones(Dianette)
for female case

19. Rosacea

20. Rosacea Introduction: relatively common woman more than man
man more severe and complications such as keratitis and rhinophyma

21. two cardinal clinical components of the disease: ★(1)Vascular change consisting of persistent erythema and flush. ★(2)acneiform eruption presents as papules, pustules, nodules, cyst and sebaceous hyperplasia

22. Rosacea Clinical features: (1)30-50 years old people affected
(2)mainly on the area of the nose, cheeks, chin and forehead
(3)flushing and erythema first persistent erythema, telangiectasia，papules and pustules, nodules and cysts rhinophyma
no comedones and seborrhoea
(4)ocular complications

23. erythema , papules and pustules , telangiectasia

24. on the butterfly area of the face,
flushing, erythema ,papules and pustules

25. severe Rosacea ,on the butterfly area of face
flushing and erythema , papules and pustules, rhinophyma.

26. Treatment Topical treatment Systemic treatment
0.75% metronidazole, 5%benzoyl peroxide et al.
Systemic treatment
antibiotics---minocycline or erythromycin or metronidazole
isotretinoin
Laser surgery or electrocoagulation
Surgery

27. 1 Disorders of sebaceous glands
★ seborrheic dermatitis
★ acne vulgaris
★ rosacea

28. Seborrheic dermatitis

29. Seborrheic dermatitis
Clinical features:
characterized by erythematic, yellowish, greasy scales with pruritus, burning and dryness
distributed over the sebaceous sites (the scalp, the faces, the nasolabial folds, eyebrows, ears, upper trunk and flexures.

30. Pathogenesis: linked with yeast Malassezia, immunologic abnormalities, sebaceous activity and patient susceptibility Variants: Infantile seborrheic dermatitis Seborrheic dermatitis of adolescents and adults

31. Infantile seborrheic dermatitis due to the transplacental transfer of maternal androgens to the newborn which stimulate the sebaceous glands marked by erythematous, adherent, waxy scaling of the scalp may also develop circumscribed, yellow red, scaly plaques over the trunk, diaper area and flexural folds

32. Seborrheic dermatitis of adolescents and adults non inflammatory, greasy desquamation over the scalp→scaling and inflammation occur in other seborrheic areas: eyebrows, base of eyelashes, nasolabial folds, external ear canals, posterior auricular fold and presternal area

33. Treatment ＊topical steroids
＊respond to tar shampoos, 2.5 percent selenium sulfide
＊Systemic ketoconazole

35. Disorders of sweat glands
eccrine glands
sweat glands
apocrine glands

36. Disease Of eccrine sweat glands
most numerours eccrine sweat glands on the palms, soles and in the axillae
important role in manitaining homeostatic balance and temperature control

37. Disease Of eccrine sweat glands (1)Hyperhidrosis excessive production of eccrine sweat in response to heat or emotional stimuli caused by enhanced perspiration from the eccrine glands generalized (caused by heat) localized (caused by emotional stimuli)

38. (2)Hypohidrosis and anhidrosis presents as dry and coarse skin with scaling, mild itching or fever Heat stroke--severe case Treatment-- cool bath, air conditioning, light clothing

39. Disorders of eccrine sweat glands
(3) Miliaria
Miliaria crystallina: small crystal clear vesicle-- the level of block of the sweat duct is within the stratum corneum

40. Disorders of hair
alopecia areata
male pattern baldness

41. Alopecia Areata General character: ＊ atopy and autoimmune mechanism
＊ offen affect children and young adults
★ one or more well-demarcated bald areas
★the affected scalp is normal
★ self-limited disease （hair regrowth）

42. Alopecia areata Treatment:
topical minoxidil (stimulates the hair follicles, 2%-5%)
topical steroids

43. Alopecia androgenetica / Male pattern baldness/ female baldness

44. Male pattern baldness
＊the main area of loss in men is the crown,with some frontal recession
＊commonly in men, occasionally in postmenopausal women
＊ increase with age
＊an androgen dependent inherited disorder

45. Excessive growth of hair
hirsutism
hypertrichosis

46. Hirsutism
＊an excessive growth of body hair in women or children in an androgen induced hair pattern (upper lip, chin, sideburn areas, neck, chest, et al)

47. Hypertrichosis
a generalized or localized pattern of non-androgen-dependant excessive hair growth in a male or female without evidence of masculinism or menstrual abnormality

48. Question What are the main four factors which contribute to development of the Acne ?