Rovner

DISEASES OF SKIN APPENDAGES

1. Pilo-sebaceous unit

1. Acne: inflammatory papules, cysts, or nodules due to follicular plugging and anaerobic breakdown of trapped sebum due to Propionbacterium acnes.

1. Types:

1. A. vulgaris
2. A. cosmetica
3. A. fulminans
4. A. conglobata
5. Chloracne--dioxin induced (Agent Orange)

2. Treatment:

1. avoidance of comedogenic materials
2. Retin-A (tretinoic acid)
3. Benzoyl peroxide
4. Antibiotics:

1. tetracyclines
2. erythromycins (topical or systemic)
3. amoxicillin, Bactrim
4. clindamycin (Cleocin-T), usually topical

5. Accutane (isotretinoic acid)
6. Diet and acne cleansers have NO therapeutic effect

2. Sweat ducts

1. Eccrine--Miliaria

1. Miliaria rubra--"prickly heat" perifollicular papules
2. Miliaria crystallina--crystal clear superficial vesicles, febrile
3. Miliaria profunda--hyperthermia, no skin signs

2. Apocrine

1. Hidradenitis suppurativa--cysts, nodules, sinus tracts and scarring in axillary, inguinal areas

3. Alopecia

1. Scarring--DLE, lichen planus, male pattern
2. Non scarring

1. Alopecia areata--stress induced; pernicious anemia, thyroid disease
2. Telogen effluvium--post partum, stress, crash diets, febrile illness, drugs
3. Anagen effluvium--chemotherapy, trichotillomania

4. Nails

1. Tinea unguium
2. Psoriasis
3. 1/2 and 1/2 nails--renal disease
4. White nails (Terry's nails)--liver disease
5. Nail Tic Deformity

5. Pigmentation

1. Melasma, chloasma--reticular hyperpigmentation in sun exposed areas of face, more common in females, estrogen induced
2. Vitiligo

1. Autoimmune--may be associated with thyroid anti-microsomal antibodies and pernicious anemia; symmetric depigmentation, accentuated by Wood's light exam; etiology unknown, may run in families

Treatment: psoralens, UVB or UVA, topical steroids

2. Contact: phenols (photographic developers)