Isolated areolar apocrine chromhidrosis

Chromhidrosis: An Unusual Cause of Skin Discoloration

ABSTRACT

Chromhidrosis is a rare condition characterized by the secretion of colored sweat. We report a case of a preadolescent healthy girl presenting with acute, recurrent blue discoloration of her armpits. The blue discoloration can be wiped off but recurs. As providers, it is useful to be familiar with this diagnosis and course of disease.

Apocrine secretion: New insights into an old phenomenon

BACKGROUND

While apocrine secretion was among the earliest secretory mechanisms to be identified, its underlying basis remains poorly understood.

SCOPE OF REVIEW

This review reappraises our understanding of apocrine secretion using insights about apocrine secretion from the salivary glands of Drosophila, in which molecular genetic analyses have provided a glimmer of hope for elucidating the mechanistic aspects of this fundamental process.

MAJOR CONCLUSIONS

In contrast to the well-defined process of exocytosis, apocrine secretion is non-vesicular transport and secretory pathway that entails the loss of part of the cytoplasm. It often involves apical protrusions and generates cytoplasmic fragments inside a secretory lumen. In its most intense phase this process is accompanied by the release of large fragments of cellular structures and entire organelles that include mitochondria, Golgi, and portions of the endoplasmic reticulum, among others. Proteomic analyses revealed that the secretion is composed of hundreds to thousands of membranous, cytoskeletal, microsomal, mitochondrial, ribosomal, and even nuclear as well as nucleolar proteins. Strikingly, although many nuclear proteins are released, the nuclear deoxyribonucleic acid itself remains intact. In spite of this complexity, it appears that several protein components of apocrine secretion are identical, regardless of the location of the apocrine gland.

GENERAL SIGNIFICANCE

This type of secretion appears to be common to many, if not all, barrier epithelial tissues including skin derivatives and the epididymis, and is implicated also in lung/bronchi and intestinal epithelium. Apocrine secretion is a mechanism that provides the en masse delivery of a very complex proteinaceous mixture from polarized epithelial tissues to allow for communication at exterior interfaces.

Haematidrosis associated with epilepsy in a girl successfully treated with oxcarbazepine: case report

The aetiology and pathological mechanisms involved in the development of haematidrosis (bloody sweat) remain unclear. There is no specific treatment for this disorder. This case report describes the clinical manifestations and treatment of a 9-year-old female with haematidrosis associated with epilepsy. The diagnosis of haematidrosis was confirmed by medical personnel who observed the bleeding and were able to rule out other causes of the bloody exudate. The episodes of bleeding were spontaneous, transient, and self-limited. Smears of the bloody exudate contained all of the components of peripheral blood. A skin biopsy taken at one site of the bloody exudate was normal, showing no signs of blood extravasation or bleeding sweat glands. The bleeding events were found to be immediately preceded by tonic seizures. An electroencephalogram indicated cerebral parietooccipital epilepsy, which was characterized by an intermittent medium-high amplitude θ rhythm (5-7 Hz) with a few spikes. The symptoms of both epilepsy and haematidrosis resolved after treatment with the antiepileptic drug 150 mg oxcarbazepine, orally, twice a day, which suggests that the epileptic seizures triggered haematidrosis in this patient.

Apocrine secretion in Drosophila salivary glands: subcellular origin, dynamics, and identification of secretory proteins

In contrast to the well defined mechanism of merocrine exocytosis, the mechanism of apocrine secretion, which was first described over 180 years ago, remains relatively uncharacterized. We identified apocrine secretory activity in the late prepupal salivary glands of Drosophila melanogaster just prior to the execution of programmed cell death (PCD). The excellent genetic tools available in Drosophila provide an opportunity to dissect for the first time the molecular and mechanistic aspects of this process. A prerequisite for such an analysis is to have pivotal immunohistochemical, ultrastructural, biochemical and proteomic data that fully characterize the process. Here we present data showing that the Drosophila salivary glands release all kinds of cellular proteins by an apocrine mechanism including cytoskeletal, cytosolic, mitochondrial, nuclear and nucleolar components. Surprisingly, the apocrine release of these proteins displays a temporal pattern with the sequential release of some proteins (e.g. transcription factor BR-C, tumor suppressor p127, cytoskeletal β-tubulin, non-muscle myosin) earlier than others (e.g. filamentous actin, nuclear lamin, mitochondrial pyruvate dehydrogenase). Although the apocrine release of proteins takes place just prior to the execution of an apoptotic program, the nuclear DNA is never released. Western blotting indicates that the secreted proteins remain undegraded in the lumen. Following apocrine secretion, the salivary gland cells remain quite vital, as they retain highly active transcriptional and protein synthetic activity.

A case of hematidrosis successfully treated with propranolol

We report a typical case of hematidrosis in a Chinese girl who had experienced frequent bleeding episodes for more than 3 years. During hospitalization, spontaneous bleeding from her intact skin was witnessed by our staff on more than 20 occasions. Characteristically, bloody droplets from the intact skin contained all blood components. Histopathologic examination showed some inconspicuous abnormalities, with normal sweat gland structure containing no blood, and bloody exudate also came from some areas that do not contain sweat glands. We believe that the blood was mixed with a sweat-like fluid, rather than real sweat. The patient's bleeding problem was dramatically resolved by treatment with propranolol. We suggest that sympathetic nerve activation might play a role in these events, and that β-adrenoceptor antagonists might be an effective treatment for this disorder.