By R. Johnson
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Extra resources for Fitzpatrick Color Atlas and Synopsis of Clinical Dermatology (Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology)
Acne results from a change in the keratinization pattern in the pilosebaceous unit, with the keratinous material becoming more dense and blocking secretion of sebum. These keratin plugs are called comedones and represent the “time bombs” of acne. Linoleic acid, which regulates keratinocyte proliferation, is decreased in acne. Comedonal plugging and a complex interaction between androgens and bacteria (P. acnes) in the plugged pilosebaceous units lead to inflammation. Androgens (qualitatively and quantitatively normal in the serum) stimulate sebaceous glands to produce larger amounts of sebum.
Occlusion and pressure on the skin, such as by leaning face on hands, very important and often unrecognized exacerbating factor (acne mechanica). Acne is not caused by chocolate or fatty foods or, in fact, by any kind of food. CLINICAL MANIFESTATION Duration of Lesions Weeks to months. Season Often worse in fall and winter. Symptoms Pain in lesions (especially nodulocystic type). Skin Lesions Comedones—open (blackheads) or closed (whiteheads); comedonal acne (Fig. 1-1). , a papule topped by a pustule; papulopustular acne (Fig.
With extensive, chronic disease, complete excision of axilla or involved anogenital area may be required. Excision should extend down to fascia and requires split skin grafting. , pain, soiling of clothing by draining pus, odor, and the site of occurrence (anogenital area). Therefore, every effort should be made to deal with the disease, using every modality possible. SECTION 1 DISORDERS OF SEBACEOUS AND APOCRINE GLANDS 19 FIGURE 1-17 Hidradenitis suppurativa Severe scarring on the buttocks, inflammatory painful nodules with fistulas and draining sinuses.
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