4.3 Sebaceous and Sudoriferous Gland Disorders Beyond Acne
Key Takeaways
Milia are small, white, keratin-filled cysts with no pore opening, so they cannot be squeezed out like comedones.
Seborrhea is excessive sebum secretion; asteatosis is dry, scaly skin caused by too little sebum; a steatoma is a sebaceous cyst filled with sebum.
Sebaceous hyperplasia appears as yellowish, doughnut-shaped papules with a central dip on oily areas; it is benign, cannot be extracted, and is referred to a physician for removal.
Hyperhidrosis is excessive sweating, bromhidrosis is foul-smelling sweat, and anhidrosis is a lack of sweating; all three are medical conditions to refer, not treat.
Miliaria rubra (prickly heat) is an acute inflammatory sweat-gland disorder with small red, itchy vesicles caused by heat, so avoid steam and heat over affected skin.
Why these disorders are tested separately
The outline groups skin disorders by structure. Acne (Section 4.2) is the best-known sebaceous gland disorder, but the exam also names milia and seborrhea, and it gives the sudoriferous (sweat) glands their own line: hyperhidrosis, bromhidrosis, and anhidrosis. Expect definition questions, such as "Foul-smelling perspiration is known as...", and service-decision questions, such as "Should these bumps be extracted?"
Remember the two gland types from Section 3.3:
| Gland | What it secretes | Where it opens | Densest areas |
|---|---|---|---|
| Sebaceous (oil) | Sebum | Into the hair follicle | Face, scalp, chest, back; not on palms or soles |
| Sudoriferous (sweat), eccrine | Watery sweat for cooling | Directly onto the skin through a sweat pore | Palms, soles, forehead, underarms |
| Sudoriferous, apocrine | Thicker secretion that bacteria break down into odor | Into hair follicles | Underarms, genital area |
Sebaceous gland disorders
| Disorder | What it is | What it looks like | Esthetician action |
|---|---|---|---|
| Comedo (open/closed) | Hair follicle plugged with sebum and dead cells | Blackhead (open) or whitehead (closed) | Extraction after proper softening (Section 7.2) |
| Milia | Small benign cysts of keratin trapped beneath the surface, with no pore opening | Firm, pearly-white, pinhead-sized bumps, often around the eyes and on the cheeks | Do not squeeze; exfoliation can help prevent new ones; refer when removal is wanted |
| Seborrhea | Excessive secretion of sebum | Very oily, shiny skin, often with enlarged pores | Oil-control cleansing, clay masks, and regular exfoliation |
| Asteatosis | Too little sebum, often from aging or harsh alkaline products | Dry, scaly, sometimes cracked skin | Gentle cleansing, emollients, occlusives, and barrier repair |
| Steatoma | Sebaceous cyst ("wen") filled with sebum | Soft, movable lump under the skin, from pea-sized up to orange-sized, commonly on the scalp, neck, or back | Do not extract; refer to a physician |
| Sebaceous hyperplasia | Benign overgrowth of the oil gland | Yellowish, doughnut-shaped papules with a central depression, on oily areas of mature skin | Cannot be extracted; refer for removal; can resemble basal cell carcinoma, so monitor for change |
| Rosacea | Chronic inflammatory condition (Section 4.1) | Central redness, flushing, papules | Avoid heat and stimulation; refer for medical care |
Milia versus closed comedones
The two look similar but behave differently:
- A closed comedo has a tiny follicular opening. After softening, gentle pressure on either side lifts the plug.
- A milium is a keratin cyst with no opening. Pressure only bruises the skin, and it can scar. Removing one requires opening the skin surface. Missouri's Class E statute and Board rules do not address lancets or opening the skin. If you have not been trained to do it, or are unsure whether it is permitted, don't: refer the client to a physician and focus on prevention (regular exfoliation, and less heavy occlusive product around the eyes).
Seborrhea versus asteatosis
These are opposites. Seborrhea is too much oil, and asteatosis is too little. A question that describes "dry, scaly skin in an elderly client who uses deodorant soap" is describing asteatosis. Treat it with mild, non-alkaline cleansers and lipid-replenishing products.
Sudoriferous (sweat) gland disorders
| Disorder | Definition | Common causes and notes | Esthetician action |
|---|---|---|---|
| Hyperhidrosis | Excessive sweating | Heat or body weakness, or idiopathic; most often affects the palms, soles, and underarms | Refer for medical treatment. Plan for slippery skin and wax adhesion, and keep the room cool. |
| Bromhidrosis | Foul-smelling perspiration | Usually the underarms or feet, where bacteria break down secretions | Refer if persistent. Cleanse the area before services, and keep linens fresh. |
| Anhidrosis | Deficiency or absence of perspiration | Often from fever or disease; the body cannot cool itself | Requires medical treatment. Avoid heat-intensive treatments, because the client may overheat. |
| Miliaria rubra (prickly heat) | Acute inflammatory sweat-gland disorder | Blocked sweat ducts after heat exposure; small red vesicles with burning and itching | Avoid steam, heat masks, and body wraps over the area. It usually resolves in a cool environment. |
Memory aid: hyper means too much, an- means without, and brom- comes from the Greek for "stench."
Service considerations
- Body waxing: heavy perspiration interferes with wax adhesion. Cleanse, dry thoroughly, and use a pre-epilation powder or product as your training directs. Tell clients not to apply antiperspirant to freshly waxed underarms, because the follicles are open and the skin can sting.
- Heat treatments: clients with anhidrosis, or with active miliaria, should not receive saunas, body wraps, hot towels, or long steam exposure.
- Never diagnose. Describe what you see ("I notice you're sweating a lot during the service") and suggest the client ask a physician. The esthetician's role is comfort, hygiene, and referral.
Scenario: three similar bumps
A client points out three kinds of bumps:
- pinhead white bumps under both eyes that do not move when pressed;
- two yellowish, soft-centered papules on the forehead, each with a tiny central dip;
- a soft, movable lump the size of a grape on the back of the neck.
These are milia (keratin cysts with no opening), sebaceous hyperplasia, and a steatoma (sebaceous cyst). None of them is extracted with finger pressure. Recommend exfoliation for the milia, and refer the client to a physician for the hyperplasia and the cyst. Because sebaceous hyperplasia can resemble basal cell carcinoma, document the papules and encourage a medical evaluation.
A client's underarm perspiration has a persistent foul odor. What is the term for this condition?
Miliaria rubra
Anhidrosis
Bromhidrosis
Hyperhidrosis
Why can't milia be removed with the finger-pressure technique used for closed comedones?
They are keratin-filled cysts with no opening, so pressing only bruises
They are caused by a contagious virus that finger pressure would spread
They sit in the reticular dermis, far below the hair follicle opening
They are filled with liquid blood that will spread under the skin if pressed
A mature client has yellowish, doughnut-shaped papules with a central depression on the oily areas of the forehead. What is the most appropriate response?
Treat the papules as active acne, with a drying sulfur mask and extractions
Recognize likely sebaceous hyperplasia, don't extract it, and suggest a physician visit
Extract each papule with firm, steady pressure after steaming the forehead for ten minutes
Apply a 20% phenol preparation to dissolve the enlarged oil glands
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