ILA-Module Acne Modified3

8/3/2019 ILA-Module Acne Modified3

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Module III-ILA III ACNE

HistologyDepartment

Dermatology

Department

Prof. Nahed Zohdy

Prof. Hoda Khalifa

Professor of Histology

Dr. Naglaa Fathi

Lecturer of Dermatology

Prepared by:


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Intended learning outcomes ILOs:

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 inthe stucture of the pilosebacious follicle

*understand how the disease process evolves.

*Identify thepredisposing and the provocating factors and the

different types of treatments for this condition.


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Fatma is a 19-years old

student in the Faculty ofMedicine


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she came to the outpatientclinic ofdermatology complaining of

reddish lesions of different sizes on

the face.


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the upper part of the back,

the shoulder, and upperchest.


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The doctor took properhistory from fatma, and

did complete physical

examination.


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There after, some of these

lesions became reddish, painfuland tenderon touching, othersshowed white summit


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She was annoyed

because of these

small lesions and

started to scratch

them and tried to

remove the heads, but

they returned again.


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In your opinion, what is the most

probable diagnosis of Fatmasproblem?AcneWhich gland is involved in this skin

disease?Sebaceous glandsWhat is the function of such gland?Sebum secretion

What is the mode of secretion ofsuch gland?Holocrine secretion.


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Sebaceous glands

Definition:Simple branched alveolar glands

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

melanophores


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The excretory duct:

- wide, short, oblique

- stratified sq. epithelium

- opens into hair follicle or

directly to epidermis as inclitoris, labia minora, glanspenis, eye lids & areola ofthe nipple (not associatedw

ith hair)


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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


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Sebaceous gland is a

holocrine gland(The secretion destroys the cell)


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Activity of the gland

-After puberty

- Arrector pili muscle


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Arrector pili muscle


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At puberty

Sebaceous glands are very sensitive toandrogens, and respond by producing sebum.

If the sebum is thick and the duct is narrow,the exit from the follicle become partlyobstructed.

the flow from the gland slows down; bacteria

from the skin can then infect the stagnatingsebum left in the gland causing localisedirritation and inflammation.


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Pathogenesis of acne vulgaris

there are four major pathogenic factors.

increased sebum production.

hyperkeratinization of pilosebaceous duct.

bacterial infection.

Production of inflammation


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Increased androgens activity

Abnormal follicular keratinization Increased sebumproduction

Obstruction

P. acnes

Noninflammatory lesions (comedones) Inflammatory lesions

(ex: pustules)


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Comedone: is apapule dome shaped,

follicular in position. It is either open (blackhead) orclosed (white head).

Clinical Features ofAcne


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White Head

Comedones

are generally skin

coloured and have

no visible follicular

opening.



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Black Head

Comedones

has dilated

follicular outlet

filled with

keratin.



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Acne


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Is this skin condition hereditary()?

Family/Genetic history. Thetendency to develop acne runs infamiliesWhy did it affect the previouslymentioned areas?

They are areas of skin with thedensest population of sebaceousfollicles What is the most common age?W

hy?Acne occurs most commonly duringadolescence(puberty), due toincrease in male sex hormones, forboth genders.


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Is this condition more common ingirls or in boys?Acne was noted in 55% of boys and

45% of girls aged between 14 and 16yearsWhich of the two sexes shows moresevere manifestations?severe acne was noted in 7% of

males and just 1 % of females


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the doctoradvised her

not to touch the lesions

orthey would becomplicated, he

prescribed topical cream

to be used on her face

only at nightand to be

washed in the morningforat least 6 weeks.


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He also advised her to decrease the amount

of fat in her food, (chocolate and fast foods,

sweets,


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and added that this problem will take

a long period, it will come and go thenit will fade out spontaneously.


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After using the topical

cream, Fatma feltaburning

sensation in her face which

became red and covered bysome scales. Thus, she

stopped the treatment early

and did not follow the

doctors instructions.


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Explain on histological basis the eventsafter the usage of topical treatment?


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Why touching and scratching the lesionsmust be avoided?This may spread the infectionWhat do you think might be thecomplications of these lesions?Formation of pustules, hyperpigmentation orscarring.Were the instructions given by the doctor

clear and efficient?They were not clear and efficient.


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For how long do you think these lesions willremain? Why?They may persist till the age of 30-40 due tohormonal secretionWhat is the final fate of the disease?( )


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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 betweenacne and intake oftotal milk and skim milk.Avoidance of"junk food" with its high fatand sugar content is recommendedIs smoking related to this condition?There is a relationship between acneprevalence and the number of cigarettessmoked daily


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Fatma became very

depressed and sad when

she noticed that the

lesions started to belarger and deeper and

some of them became

painful and appeared in

otherareas on the face.


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She wentto other doctors; some ofthemprescribed topical

and others prescribed systemic medications. She never

continued the full course of treatment. She observed that with or without treatment, thelesions were waxing and waning ( ) at certainperiods of time. She noticed that they became moreobvious at times ofexaminations or before menstruation( ) but not related to food as she didn't eat

much sweets or chocolate.


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W

hy the lesions were increasing duringmenstruation?Due to hormonal activity during menstrualcyclesD

oes it increase with emotional stress?Explain.Increased acne severity is significantlyassociated with increased stress levels.S

tress: hormonal disturbance


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Fatma discovered some

small depressed pinhead

sized scars following the

disappearance of some of the

reddish swellings.


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Her brother

She remembered thather

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.


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The dermatologist prescribed for

her the treatment and explains

thoroughly the sequence of

events which will happen to thelesions and assured Fatma that

when she use the treatment

appropriately there will be no

further scars in her face


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Do you know about the most recenttreatment for such face scars?


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Searching for the ideal face


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ILA III EXAM


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1- All are characters of the excretory duct

of sebaceous gland EXCEPT :

a) it is wide, shortand oblique.

b) it is lined by stratified squamous

epithelium.

c) it opens into the lowerthird ofthe hair

follicle

d) itcontains sebum secretion.


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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


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3- From which part of the hair follicle is

the development of sebaceous glands:

a) the upperthird

b) the middle third

c) the lowerthird

d) the lowerhalf


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4- The sebum is composed of:

a) fatty substance

b) cellular debris

c) keratin

d) All ofthe above

5 Th d f i f b


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5- The mode of secretion of sebaceous

glands is:

a) Apocrine

b) Merocrine

c) Holocrine

d) None ofthe above


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6- The secretion of sebaceous glands is:

a) Watery

b) Viscid

c) oily

d) Viscid withcharacteristic odor


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7- The secretory portion of the sebaceous

gland is lined by:

a) columnarcells

b) squamous cells

c) polyhedral cells

d) polyhedral cells and squamous cells.

e) columnarcells and squamous cells.


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8- The function of sebum is:

a) Lubrication of the skinb) Lubrication of the hair

c) Bactericidal effectd) All of the above


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9- The activity of the sebaceous

gland starts:

a) Immediately after birth.

b) After puberty.c) At seven years of age.d) At twenty years of age.


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10- The excretory duct of sebaceousgland opens directly to epidermis in

all of the following sites EXCEPT:

a) the palmb) glans penisc) eye lids

d) areola of the nipple


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Model Answer

1. c

2. a

3. a

4. d

5. c

6. c

7. d

8. d

9. b

10. a

ILA-Module Acne Modified3

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