Next, let's talk about disorders
of sebaceous and apocrine glands.
Before we jump into a case, we should just
do a quick review of the glands of the skin.
First off, we have the sebaceous glands and
these are responsible for making sebum
and putting it into hair follicles.
Sebum is an oily substance that's designed to lubricate
and waterproof the skin and the hair of mammals.
And then we have the eccrine
and apocrine glands.
Each one of these are essentially sweat glands
that are releasing sweat directly under the skin
or providing sweat around
hair follicles themselves.
With that primer, let's jump into a case.
Alright, so we have a 41-year old EMT with no significant
past medical history who's now presenting with a facial rash.
She does take an oral contraceptive pill
but otherwise takes no medications.
She drinks one to two glassess of
wine every night and she has noticed
that the rash seems to be more noticeable on
very hot days and when she eats spicy food.
She remembers having problems with acne during high
school but this largely resolved in her early 20's
and she doesn't understand why
it seems to be returning now.
Family history is non-contributory
and on review of systems,
she denies myalgias, there's no arthralgias,
fevers, weight loss or dysphagia.
She does however, report some red, itchy eyelids bilaterally
for the past few months, denies any blurred vision.
On exam, we see a fair complexion, she
has numerous erythematous papules
on a symmetric, confluent erythematous base,
diffusely spread across her nose and medial cheeks.
There are some scattered telangiectasias but no pustules and
the remainder of the skin exam is within normal limits.
So with that history in physical, which of
the following is the most likely diagnosis?
Well, frist off, acne vulgaris.
We are told that she had history
of acne as a young woman.
And of course, acne is the most common
skin condition in young people,
85% of young people will
experience acne at some point.
So we'll have to keep that one on our
list and talk about it a bit more later.
Acne rosacea, this affects about
10% of fair skinned people.
She is fair-skinned and 10%
is a decent prevalence.
In addition, it does typically present with chronic facial
redness and papules which also sounds to fit the description
and the question is whether or not it's associated
with this eye lid symptoms that she is describing.
So, let's keep that one on our list too.
Next stop, dermatomyositis.
Well, is the lesion she's reporting around her face, something to
do with the heliotropic rash that we think of with dematomyositis?
We have to keep that one on our list
too and talk about it more later.
Lupus, so again, this rash that's going to cross
her cheeks makes me think of that malar rash,
typical of acute cutaneous
So, our patient also fits the right demographic though ideally
it would be an African-American and probably a bit younger.
Nonetheless, this one's
gonna stay on the list too.
And finally, seborrheic dermatosis.
This can affect
people of any age.
It often involves the face and including the nasolabial
folds, potentially the eyebrows, the eyelids.
So, this strong association between seborrheic
dermatosis and all of these features
makes me obligated to leave
that on our list as well,
Alright, let's go through each one in
turn, starting with acne vulgaris.