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Chapter: Clinical Dermatology: Sebaceous and sweat gland disorders

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Apocrine sweat glands

Apocrine glands are limited to the axillae, nipples, peri-umbilical area, perineum and genitalia.

Apocrine sweat glands

Apocrine glands are limited to the axillae, nipples, peri-umbilical area, perineum and genitalia. The coiled tubular glands (larger than eccrine glands) lie deep in the dermis, and during sweating the luminal part of their cells is lost (decapitation secretion). Apocrine sweat passes via the duct into the mid-portion of the hair follicle. The action of bacteria on apocrine sweat is responsible for body odour. The glands are innervated by adrenergic fibres of the sym-pathetic nervous system. 

Suppurative hidradenitis (apocrine acne)

This is a severe chronic suppurative disorder of the apocrine glands. Many papules, pustules, cysts, sinuses and scars occur in the axillae, groin and perianal areas. The condition may coexist with conglobate acne. Its cause is unknown, but an underlying follicu-lar abnormality seems likely. Slightly raised androgen levels are found in some affected females. It is prob-ably not an immunodeficiency or a primary infection of the apocrine glands, although Staphylococcusaureus, anaerobic streptococci and Bacterioides spp.are frequently present. One group of workers has implicated Streptococcus milleri as the main pathogen. Treatment is unsatisfactory but should be as for acne vulgaris in the first instance. Systemic antibiotics help early lesions to resolve but are ineffective for chronic draining abscesses and sinuses. Incision and drainage of abscesses, and injections of intralesional triamci-nolone (5 –10 mg /mL) may reduce the incidence of deforming scars and sinus formation. Topical clin-damycin has been shown to prevent new lesions from forming. Systemic antiandrogens help some women. Severe cases need plastic surgery to remove large areas of affected skin.

Fox–Fordyce disease

This rare disease of the apocrine ducts is comparable to miliaria rubra of the eccrine duct. It occurs in women after puberty. Itchy skin-coloured or light brown papules appear in the axillae and other areas where apocrine glands are found, such as the breasts and vulva. Treatment is not usually necessary but removal of the affected skin, or electrodessication of the most irritable lesions can be considered.

 

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