Module III-ILA III

Prepared by:

ACNE

Histology Department

Dermatology

Department

Prof. Nahed Zohdy Prof. Hoda Khalifa Professor of Histology

Dr. Naglaa Fathi Lecturer of Dermatology

Intended learning outcomes ILO s:

By the end of this ILA session , the students will be able to:
*Recognize the clinical features of a common problem among the teenagers,which is acne which results primarily from disturbance in the stucture of the pilosebacious follicle *understand how the disease process evolves. *Identify the predisposing and the provocating factors and the different types of treatments for this condition.

Fatma is a 19-years old student in the Faculty of Medicine

she came to the outpatient clinic of dermatology complaining of reddish lesions of different sizes on the face.

the upper part of the back, the shoulder, and upper chest.

The doctor took proper history from fatma, and did complete physical examination.

On asking Fatma, when these lesions started ; she said that this condition started when she was 17 years old but the lesions were on the face only as black heads white heads and not red.

There after, some of these lesions became reddish, painful and tender on touching, others showed white summit

She was annoyed because of these small lesions and started to scratch them and tried to remove the heads, but they returned again.

In your opinion, what is the most probable diagnosis of Fatmas problem? Acne Which gland is involved in this skin disease? Sebaceous glands What is the function of such gland? Sebum secretion What is the mode of secretion of such gland? Holocrine secretion.

Sebaceous glands
 Definition:
Simple branched alveolar glands
melanophores

 Development:
From the upper 1/3 of the outer root sheath of hair follicle

The excretory duct:

- wide, short, oblique - stratified sq. epithelium - opens into hair follicle or directly to epidermis as in clitoris, labia minora, glans penis, eye lids & areola of the nipple (not associated with hair)

The secretory portion:

2 types of cells:
1- basal s. sq. cells 2- polyhedral cells Type of secretion:

Sebum: (fatty substance +

cellular debris + keratin) Lubrication Bactericidal effect

 Sebaceous gland is a holocrine gland

(The secretion destroys the cell)

Activity of the gland

-After puberty

- Arrector pili muscle

Arrector pili muscle

At puberty
Sebaceous glands are very sensitive to androgens, and respond by producing sebum. If the sebum is thick and the duct is narrow, the exit from the follicle become partly obstructed. the flow from the gland slows down; bacteria from the skin can then infect the stagnating sebum left in the gland causing localised irritation and inflammation.

Pathogenesis of acne vulgaris

there are four major pathogenic factors. increased sebum production. hyperkeratinization of pilosebaceous duct. bacterial infection. Production of inflammation

Increased androgens activity

Abnormal follicular keratinization Obstruction P. acnes Noninflammatory lesions (comedones) Inflammatory lesions (ex: pustules) Increased sebum production

Clinical Features of Acne

Comedone: is a papule dome shaped, follicular in position. It is either open (black head) or closed (white head).

Clinical Features of Acne

White Head Comedones
are generally skin coloured and have no visible follicular opening.

Clinical Features of Acne

Black Head Comedones has dilated follicular outlet filled with keratin.

Acne

Is this skin condition hereditary ( )? Family/Genetic history. The tendency to develop acne runs in families Why did it affect the previously mentioned areas? They are areas of skin with the densest population of sebaceous follicles What is the most common age? Why? Acne occurs most commonly during adolescence(puberty), due to increase in male sex hormones, for both genders.

Is this condition more common in girls or in boys? Acne was noted in 55% of boys and 45% of girls aged between 14 and 16 years Which of the two sexes shows more severe manifestations? severe acne was noted in 7% of males and just 1 % of females

the doctor advised her not to touch the lesions or they would be complicated, he prescribed topical cream to be used on her face only at night and to be washed in the morning for at least 6 weeks.

He also advised her to decrease the amount of fat in her food, (chocolate and fast foods, sweets,

and added that this problem will take a long period, it will come and go then it will fade out spontaneously.

After using the topical cream, Fatma felt a burning sensation in her face which became red and covered by some scales. Thus, she stopped the treatment early and did not follow the doctor s instructions.

Explain on histological basis the events after the usage of topical treatment?

Why touching and scratching the lesions must be avoided? This may spread the infection What do you think might be the complications of these lesions? Formation of pustules, hyperpigmentation or scarring. Were the instructions given by the doctor clear and efficient? They were not clear and efficient.

For how long do you think these lesions will remain? Why? They may persist till the age of 30-40 due to hormonal secretion What is the final fate of the disease?( )

Is food related to this condition? Rapidly digested carbohydrate foods (such as soft drinks, sweets, white bread) may facilitate acne formation. There is a positive association between acne and intake of total milk and skim milk. Avoidance of "junk food" with its high fat and sugar content is recommended Is smoking related to this condition? There is a relationship between acne prevalence and the number of cigarettes smoked daily

Fatma became very depressed and sad when she noticed that the lesions started to be larger and deeper and some of them became painful and appeared in other areas on the face.

 She went to other doctors; some of them prescribed topical and others prescribed systemic medications. She never continued the full course of treatment. She observed that with or without treatment, the lesions were waxing and waning ( ) at certain periods of time. She noticed that they became more obvious at times of examinations or before menstruation ( ) but not related to food as she didn't eat much sweets or chocolate.

Why the lesions were increasing during menstruation? Due to hormonal activity during menstrual cycles Does it increase with emotional stress? Explain. Increased acne severity is significantly associated with increased stress levels. Stress: hormonal disturbance

Fatma discovered some small depressed pinhead sized scars following the disappearance of some of the reddish swellings.

Her brother

She remembered that her older brother had the same reddish lesions when he was 20 years old, but they were much more severe and he has disfiguring scars on his face.

 The dermatologist prescribed for her the treatment and explains thoroughly the sequence of events which will happen to the lesions and assured Fatma that when she use the treatment appropriately there will be no further scars in her face

Do you know about the most recent treatment for such face scars?

Searching for the ideal face

ILA III

EXAM

1- All are characters of the excretory duct of sebaceous gland EXCEPT :

a) it is wide, short and oblique. b) it is lined by stratified squamous epithelium. c) it opens into the lower third of the hair follicle d) it contains sebum secretion.

2- The sebaceous glands are considered as: a) simple branched alveolar glands b) simple branched tubuloalveolar glands c) compound alveolar glands d) compound tubuloalveolar glands

3- From which part of the hair follicle is the development of sebaceous glands:

a) b) c) d)

the upper third the middle third the lower third the lower half

4- The sebum is composed of:

a) fatty substance b) cellular debris c) keratin d) All of the above

5- The mode of secretion of sebaceous glands is: a) Apocrine b) Merocrine c) Holocrine d) None of the above

6- The secretion of sebaceous glands is:

a) b) c) d)

Watery Viscid oily Viscid with characteristic odor

7- The secretory portion of the sebaceous gland is lined by: a) columnar cells b) squamous cells c) polyhedral cells d) polyhedral cells and squamous cells. e) columnar cells and squamous cells.

8- The function of sebum is: a) b) c) d) Lubrication of the skin Lubrication of the hair Bactericidal effect All of the above

9- The activity of the sebaceous gland starts: a) b) c) d) Immediately after birth. After puberty. At seven years of age. At twenty years of age.

10- The

excretory duct of sebaceous gland opens directly to epidermis in all of the following sites EXCEPT:

a) b) c) d)

the palm glans penis eye lids areola of the nipple

Model Answer
1. 2. 3. 4. 5. c a a d c 6. c 7. d 8. d 9. b 10. a