Table of Contents
Overview of Sebaceous Glands
Sebaceous glands (Lat. glandula sebacea) can be found almost in the entire body. Rich in sebaceous glands are the head, face, also the back and the upper body. The produced tallow, also referred as the sebum, consists of triglycerides, fatty acids and wax esters. The production is stimulated by androgen hormones.
Nevus Sebaceous Glands (Nevus Sebaceous)
The nevus sebaceous gland is also called organoid nevus and consists of the sebaceous glands, ectopic glands and the malformed hair follicles residues. Nevus sebaceous occurs at an early age but usually it is inherited.
Clinic of nevus sebaceous
As a flat, white-yellowish, waxy tumor without hair it most frequently occurs in the hair area; there, it might develop alopecia. Sebaceous glands nevus occurs mostly solitary on the face and the neck.
In old age, the nevus may evolve into a benign and malignant adnexal tumor. The most common (one) is the trichoblastoma.
The therapy of nevus sebaceous
In dermatology cryotherapy is a proven treatment method. Here coldness is usually used locally, to destroy pathological tissue.
Excision of a nevus sebaceous can be performed for cosmetic reasons or even to avoid complications such as the formation of tumors.
Sebostasis means a reduction of sebaceous glands activity. The result is dry skin (xerosis cutis) and brittle hair.
The etiology of sebostasis
Sebostasis is age-related and occurs in 80 % of cases in old age. Mechanical or chemical degreasing such as frequent washing or very dry hair can also cause sebostasis.
Clinic of sebostasis
The clinical symptoms shows a scaly and rough skin and the patient often suffers from itching and an unpleasant tightness of the skin.
The dry skin often leads to barrier disorder. Therefore, secondary inflammation and super infection by bacteria may evolve. Consequently, the skin cracks and forms an eczema craquele, also named drying eczema or asteatotic eczema.
Typical symptoms of sebostasis are Brittle and scrubby hair.
The therapy of sebostasis
A consistent anti-sebostatic cleaning as a prophylactic treatment is recommended. It is necessary to maintain the skin regularly with fatty externa, special fatty acids and urea.
The patient should shower, if possible, only briefly under warm, but not hot water. Alcoholic lotions must be avoided, as they cause the skin to dry out.
Seborrhea means, “tallow flow” and refers to a strongly increased sebum production, which leads to oily skin and greasy lankly hair. Seborrhea is often a predisposition for acne, rosacea and seborrhoeic eczema.
Etiology of Seborrhea
In 80 % of cases seborrhea occurs at adolescence. This suggests that hormonal changes play a decisive role. Responsible for sebum production are an increase of androgen production and a higher density of androgen receptors. Thus, hormonal medicines, such as anabolic steroids or contraceptives, can affect the sebaceous glands.
Clinic of seborrhea
A greasy shine of the face, scalp and hair are the consequence of increased sebum production. Partially large pores are visible.
An increase in lipid secretion favors the conditions for Propionibacterium acnes and yeast fungi (e.g. Malassezia furfur) to propagate.
The therapy of Seborrhea
A prophylactic anti-seborrheic skin care is recommended. For cleaning and care, disinfectants (e.g. benzoyl peroxide) and soap-free synthetic detergents, as well as low-fat externa (lotions and gels) can be used.
Topical and systemic retinoids work anti-inflammatory and against the abnormal keratinization. In severe cases of acne the use of oral retinoids, like Isoretinoid, are proven to be highly effective.
Note: Retinoids are teratogenic and contraindicated in pregnancy! Women can use a systemic anti-androgens against Seborrhea. A topical application of estradiol for men can lead to systemic side effects.
Acne vulgaris is a common chronic inflammatory disease of the sebaceous glands. Acne presents itself, depending on the shape and characteristics, with comedones, pustules or papules. Particularly affected are the areas rich in sebaceous glands such as the face, scalp, as well as back and chest. Frequently, acne vulgaris occurs above the age of 12.
Note: 65 % of young people suffer from acne!
The etiology of acne vulgaris
In most cases acne vulgaris appears with the beginning of puberty. By the end of the third life decade the skin disease usually ends by itself. Boys and girls are affected to the same extent. Typical for girls is deterioration before and during the menstruation.
Note: For young people the disease can be, psychologically, very stressful. Acne often leads to a feeling of distortion! The typical comedones (“blackheads”) are the result of a faulty tallow drain in the closure of the follicle excretory ducts.
Androgens enlarge the sebaceous glands and increase their activity. This may, as already described above, lead to Seborrhea.
The raise of sebum production and thus, an increase of bacteria such as Propionibacterium acnes, result in a bacterial super infection. The bacteria split the fat into free fatty acids, which induce the secretion of pro-inflammatory mediators and release an inflammatory response.
Nicotine abuse leads to a phospholipase-induced inflammation.
Clinic of acne vulgaris
The clinical picture of acne vulgaris shows in particular comedones, papules, and pustules and in severe forms of acne also scars formation.
Acne vulgaris can be divided in 3 stages
- Non-flammable stage
Here we find acne comedonica, which appears centrofacial and is characterized by open (black head) and closed (white head) comedones.
- Flammable stage
The clinical picture of acne papulopustulosa includes pustules and papules. Often affected is the face, back and also décolleté. Acne nodosa forms up to 1 cm large knots and decline very slowly. The next stage is either acne conglobata or a transition to the defect stage. Acne conglobata is the most severe form of inflammatory acne and appears as deep, inflammatory nodes in the face, chest and back. This form is especially common under young men.
- Defect stage
Acne comedonica and papulopustulosa heal usually without scarring. Typical for the defect stage are scars, cysts and abscessed fistula gears.
Treatment of acne vulgaris
To prevent an exacerbation of the chronic and scar formation a stage-related treatment of Acne vulgaris is necessary. The following forms of therapy are to be considered:
- Topical therapy: is applied in cases of papulopustulosa or acne comedonica, Benzoyl peroxide (BPO) 5 – 10 % can be used as a washing suspension to clean the skin.
Effective are topical retinoids, such as adapalene and Isotretinoin. However, retinoids work strongly teratogenic. Therefore, a special clarification for women in the childbearing age has to take place. Oral contraception – one month before the treatment and up to one month after the treatment – plus additional contraceptive methods (condoms) are necessary. Clindamycin or in combination with benzoyl peroxide, as well as topical antibiotics, can be used.
- Systemic therapy: are used against pustulosa or acne conglobata. Considered as systemic treatment methods are tetracyclines, hormones (contraceptives with anti-androgenic effect) and retinoids.
- Peelings etc.: e.g. peelings with fruit acids can have supportive effects. Also a treatment with dermabrasion or hyaluronic acid injection can reduce acne scars.
Special forms of acne
- Acne neonatorum: is already present at birth or occurs in the first weeks of life. The sebaceous glands are stimulated by maternal androgens.
- Acne infantum: is typical in the 3rd – 6th Month of life by testosterone influence
- Acne exocrine: is a surface ulceration caused through constant manipulation and excoriation mild acne papulopustulosa
- Acne tarda: acne, which occurs after puberty through androgen effects. Hormonal disorders must be excluded
- Acne venenata: might develop through the contact with tar, oils, halogens (chlorine) or cosmetics
Acne aestivalis (Mallorca acne): arise in warm, humid climate and the combination of used oily sun creams
Rosacea is a chronic inflammatory, non-infectious disease of the sebaceous glands and the connective tissues. It has a relapsing course in the central facial area. In contrast to acne – rosacea forms no comedones.
Etiology of rosacea
So far the etiology of this disease is largely unexplained. But there are certain factors known which seem to deteriorate rosacea. UV exposure, hot drinks, alcohol and spicy food, as well as hormonal influences or temperature changes can affect the disease activity.
Clinic of rosacea
- Stage I: Typical for rosacea is a flat redness of the face – the flush. In addition there are telangiectasia and persistent erythema present.
- Stage II: facial pustules and papules, partially exceeds the forehead-hair line
- Stage III: The Rhinophym is a tuberous hypertrophy of the sebaceous glands in the nose.
The diagnosis of rosacea
For the diagnosis of rosacea the typical clinic is crucial. Ophthalmorosacea occurs in up to 50 % of cases and should therefore be excluded.
The treatment of rosacea
Particularly relevant for the treatment is the avoidance of aggravating factors.
Stage I is treated with 0.75 % Metronidazole-containing externa. Stage II combines the therapy of the first stage with a systemic antibiosis (doxycycline) or retinoids (low dose) over several weeks. Rhinophym can be treated with an operational or laser surgical resection.
Perioral dermatitis is an inflammatory skin disease. It appears primarily perioral and periocular, through excessive skin care. This dermatosis mostly concerns young women.
Etiology of Perioral dermatitis
The etiology of this disease is yet unclear. Factors that can trigger the perioral dermatitis are excessive cosmetic care, the use of external corticosteroids, fluorinated toothpastes and soaps as well as stress situations and hormonal disturbances.
The result of excessive care could lead to a swelling of the horny layer. This disrupts the skin barrier and offers entrance for super infections. That effect is often reinforced by topical glucocorticoids.
Clinic of perioral dermatitis
Small bound follicular papules and pustules appear around the mouth and eyes. Burning and the feel of skin tension are also typical symptoms.
Perioral dermatitis therapy
The treatment of Perioral dermatitis is the “zero-therapy“. This means that the patients avoid all externa. Initially, it usually comes to a deteriorated condition in the first two weeks. For patients with cosmetic awareness, the zero therapy is often very difficult to achieve. The patient should be informed about the probable deterioration.
Popular Exam Questions on the Topic of Acne
The correct answers can be found beneath the references.
1. Which form of acne occurs in hot climate under the use of oily sun creams?
- Acne vulgaris
- Acne nodosum
- Acne papulopustulosa
- Acne tarde
- Acne aestivalis
2. Which clinical manifestation determines the second Stage of rosacea?
What is the recommended treatment for perioral dermatitis?
- Topical glucocorticoids
- Prophylactic anti-seborrheic skin care and cleaning
- Zero therapy
- 0.75 % Metronidazole-containing externa
- Systemic antibiosis