Hidradenoma nodular maligno / Malignant Nodular Hidradenoma

Introducción: El hidradenoma nodular maligno es un tumor maligno de glándula sudorípara ecrinas, poco común, considerada una lesión de diferenciación anexial ecrinas, que generalmente surge de nuevo, aunque se han descrito unos pocos casos surgidos sobre un hidradenoma nodular. Es decir, representa la contrapartida maligna del hidradenoma nodular. Objetivo: Dar a conocer la presentación de un caso, dada la inusual aparición de esta entidad, con revisión de los criterios para su diagnóstico. Caso clínico: Se informa el caso de un hombre de 74 años de edad con una neo formación en la región parietal derecha del cuero cabelludo. Conclusiones: Debemos pensar en un hidradenoma nodular maligno ante un tumor solitario, firme o fluctuante, infrecuente en el cuero cabelludo, con curso agresivo, recurrencias y metástasis ganglionares y confirmar su diagnóstico con el estudio inmunohistoquímico(AU)

Introduction: Malignant nodular hidradenoma is a rare malignant eccrine sweat gland tumor considered a lesion of eccrine adnexal differentiation, which usually arises again, although a few arising cases on nodular hidradenoma have been described. In other words, it represents the malignant counterpart of nodular hidradenoma. Objective: To report a case, given the unusual occurrence of this entity, with a review of the criteria for its diagnosis. Case report: We report the case of a 74-year-old man with a neoformation in the right parietal region of the scalp. Conclusions: We should consider a malignant nodular hidradenoma when faced with a solitary, firm or fluctuant tumor, rare in the scalp, with aggressive evolution, recurrences and lymph node metastasis, and confirm its diagnosis with immunohistochemical study(AU)

Research advances on the application of stem cells in sweat gland regeneration / 中华烧伤杂志

Sweat gland is one of the important appendage organs of the skin, which plays an important role in thermoregulation and homeostasis maintenance. Sweat glands are damaged and unable to self-repair after burns, resulting in perspiration disorders eventually. However, current clinical strategies cannot restore the function of the damaged sweat glands effectively. Therefore, it is urgent to seek treatments that can promote the regeneration of sweat glands and restore their normal functions. Stem cells have extensive sources, low immunogenicity, high proliferation capacity, and multi-directional differentiation potential, which have become a focus in the field of regenerative medicine. In recent years, a variety of stem cells have been induced to differentiate into sweat gland-like tissue with certain secretory function, which provides treatment direction for sweat gland regeneration after burns in clinic. This article reviews the recent research advances on the application of stem cells in sweat gland regeneration from the perspectives of the manner by which stem cells transform into sweat gland cells in different environments and their influencing factors.

Research advances on signaling pathways affecting sweat gland development and their involvement in the reconstitution of sweat adenoid cells in vitro / 中华烧伤杂志

The damage of sweat glands in patients with extensive deep burns results in the loss of thermoregulation, which seriously affects the quality of life of patients. At present, there are many researches on the repair of sweat gland function, but the mechanism of human sweat gland development has not been fully clarified. More and more studies have shown that the cascaded pathways of Wnt/β-catenin, ecto- dysplasin A/ectodysplasin A receptor/nuclear factor-κB, sonic hedgehog, and forkhead box transcription factor jointly affect the development of sweat glands, and it has been reported that the cascaded signaling pathways can be used to achieve the reconstruction of sweat adenoid cells in vitro. This article reviews the signaling pathways that affect the development of sweat glands and their involvement in the reconstruction of sweat adenoid cells in vitro.

Malignant adnexal cutaneous tumor of the scalp: a case report of difficult differential diagnosis between metastatic breast cancer and primary sweat gland tumor / Neoplasia maligna de glândula anexial cutânea em couro cabeludo: um caso de dúvida diagnóstica entre carcinoma metastático de mama e tumor primário de glândula sudoríparas

This paper describes a case of a 71-year-old female who initially went to a dermatologist to assess a scalp skin tumor, which performed an incisional biopsy. Anatomopathological and immunohistochemical study revealed a preliminary diagnosis of breast carcinoma metastasis. Although the patient had no medical history of breast cancer, due to this result, she was referred to a mastologist, who investigated her breast nodules for the possible primary focus of the carcinoma. Despite an active investigation through imaging tests, biopsies, and mammotomy, without finding any possible primary focus on the breasts. Finally, the lesion on the scalp was entirely removed by a plastic surgeon. New anatomopathological and immunohistochemical exams confirmed the diagnosis of breast carcinoma metastasis. Given these results, the authors discuss the difficulty in diagnosing differentiation from a primary or metastatic neoplasm of the scalp, with the resources currently available, until the conclusion that it was a primary carcinoma of the sweat gland.

Este artigo descreve o caso de uma mulher de 71 anos que inicialmente foi ao dermatologista para avaliação de tumor de pele no couro cabeludo, e que realizou biópsia incisional desta lesão. O estudo anatomopatológico e imuno-histoquímico revelou um diagnóstico preliminar de metástase de carcinoma de mama. Embora a paciente não tivesse história clínica de câncer de mama, devido a esse resultado, foi encaminhada à mastologista, que investigou seus nódulos mamários para localizar o possível foco primário do carcinoma. Apesar de uma investigação ativa por meio de exames de imagem, biópsias e mamotomia, não foi encontrado nenhum possível foco primário nas mamas. Por fim, a lesão no couro cabeludo também foi totalmente removida por um cirurgião plástico. Novos exames anatomopatológicos e imuno-histoquímicos confirmaram o diagnóstico de metástase de carcinoma de mama. Diante desses resultados, os autores discutem a dificuldade em diagnosticar a diferenciação de uma neoplasia primária ou metastática do couro cabeludo, com os recursos disponíveis atualmente, até a conclusão de que se tratava de um carcinoma primário da glândula sudorípara.

Eccrine cell tumor with natural evolution / Tumor de células ecrinas con evolución natural

Abstract Eccrine cell carcinoma constitutes a group of rare skin malignancies which are slow-growing but highly invasive. A case of multiple skin lesions with multifocal involvement, concluding with the histopathological documentation of this condition, is presented. (Acta Med Colomb 2019; 44. DOI:https://doi.org/10.36104/amc.2019.1203).

Resumen El carcinoma de células ecrinas constituye un grupo de neoplasias raras de la piel, de crecimiento lento pero altamente invasor. Se presenta un caso de lesiones cutáneas múltiples con compromiso multifocal que concluye con la documentación histopatológica de esta condición. (Acta Med Colomb 2019; 44. DOI:https://doi.org/10.36104/amc.2019.1203).

A propósito de un caso: la niña que suda sangre: un raro caso de hematohidrosis / About a case: The girl who sweats blood: A rare case of hematohidrosis

Introducción: la hematohidrosis es una rara condición clínica donde el paciente exuda sangre. Presentación de caso: se presenta el caso de una joven de 13 años, sin antecedentes mórbidos conocidos, que fue referida por Departamento de Hematología a Salud Mental por presentar cuadro de 7 meses de evolución, caracterizado por sangrado de oídos, ojos, boca, ombligo, cabeza, mamas y dedos, ocurriendo con más frecuencia cuando cursa con períodos menstruales. Se le realizaron analíticas y estudios especializados que incluían hemograma, glicemia, perfil renal, hepático, virales, electrolitos, perfil tiroideo, uroanálisis, Factor viii, Factor vii, Factor de Von Willebrand, TP, TTP, INR, fibrinógeno y extendido de sangre periférica. Además, se realizó TAC de cráneo y radiografía de senos paranasales. Todas las pruebas estaban dentro de los parámetros de normalidad. Se inicia tratamiento con Hidroxicina 25 mg c/24 horas y clonazepam 2mg c/24 horas. Con el tratamiento farmacológico cedió el sangrado de la paciente. Conclusión: el paciente fue diagnosticado con hematohidrosis, clínicamente, por exclusión. Actualmente no hay tratamiento disponible para esta condición. La etiología es desconocida hasta la fecha. El estrés se vincula como un factor precipitante

Introduction: Hematohidrosis is a rare clinical condition where the patient exudes blood. Presentation: We present the case of a 13-year-old girl, with no known morbid history, who was referred by department of hematology to mental health for presenting a 7-month evolution, characterized by bleeding of ears, eyes, mouth, navel, head, breasts and fingers occurring more often when going through menstrual periods. Analyzes and specialized studies were performed that included hemogram, glycemia, renal, hepatic, viral, electrolyte, thyroid profile, uroanalysis, Factor viii, Factor vii, Von Willebrand Factor, TP, TTP, INR, fibrinogen and peripheral blood smear. In addition, a CT scan of the skull and x-ray of the paranasal sinuses was performed. All the tests were within normal parameters. Treatment was started with Hydroxyzine 25 mg every 24 hours and clonazepam 2mg every 24 hours. With the pharmacological treatment, the bleeding of the patient subsided. Conclusion: The patient was diagnosed with hematohidrosis clinically by exclusion. Currently, there is no treatment available for this condition. The etiology is unknown to date. Stress is linked as a precipitating factor

Heat-related skin disease

Skin disease can be caused by high temperature, and it is related to the temperature regulation mechanism of human body, adaptation reaction to temperature change, and health problems due to the recent problematic climate change. In hyperthermia, hot and dry skin is typical manifestation, and sometimes the skin color turns red. On the other hand, the skin color can become pale in severe febrile convulsion. Burn is a skin damage caused by heat, and not only the skin but also the underlying tissues can be destroyed in severe case. It is important to determine the degree and extent of the burn to treat adequately. In the case of severe burns, systemic treatment and prevention of infection or shock should be needed. Miliaria, also called “sweat rash,” occurs when the sweat is accumulated as the sweat gland is closed and sweat cannot be secreted to the surface of the skin. The basis of treating miliaria is to keep the patient in a cool environment. Erythema ab igne is defined as a network of hyperpigmentation that occurs after prolonged exposure to heat that is not enough to cause burn. It may disappear when exposure to heat is interrupted, but it may remain permanently. The extent and mechanism of heat-induced skin disease very diverse and it should be carefully assessed for the severity of each disease, the treatment method and prognosis.

Eccrine porocarcinoma on the cheek

Eccrine porocarcinoma is a rare malignant tumor arising from the intraepidermal ductal portion of the eccrine sweat gland. It develops either spontaneously or from a long standing benign eccrine poroma. This entity usually affects older people and is commonly located on the lower extremities, the trunk, and the head. We report a case of eccrine porocarcinoma on the left cheek in an 85-year-old male. In our case, the tumor was treated with wide excision and postoperative adjuvant radiation therapy. The patient recovered well without local recurrence and distant metastasis during the 14-month follow-up period. Wide excision and postoperative adjuvant radiation therapy can be considered as a safe and effective treatment option in treating patients with eccrine porocarcinoma.

A case of anhidrotic ectodermal dysplasia presenting with pyrexia, atopic eczema, and food allergy

Anhidrotic ectodermal dysplasia (AED) is a rare hereditary disorder with a triad of sparse hair, dental hypoplasia, and anhidrosis. Here we report a case of AED with food allergy and atopic eczema. The patient was a 11-month-old boy admitted to our hospital with pyrexia for 2 weeks. He presented with a history of dry skin, eczema, and food allergy to egg. On clinical examination, his body temperature was 38.8°C, with dry skin and eczema almost all over the body, sparse eyebrows, and scalp hair. Laboratory investigations and physical examination did not show any evidence of infection. Radioallergosorbent test was positive to egg yolk, egg white, ovomucoid, milk, house dust, and house dust mite. As the child did not sweat despite the high fever, we performed the sweat test which revealed a total lack of sweat glands. Genetic examination revealed a mutation of the EDA gene and he was diagnosed as AED. His pyrexia improved upon cooling with ice and fan. His mother had lost 8 teeth and her sweat test demonstrated low sweating, suggestive of her being a carrier of AED. Atopy and immune deficiencies have been shown to have a higher prevalence in patients with AED. Disruption of the skin barrier in patients with AED make them more prone to allergic diseases such as atopic eczema, bronchial asthma, allergic rhinitis and food allergy. Careful assessment of the familial history is essential to differentiate AED when examining patients with pyrexia of unknown origin and comorbid allergic diseases.

Differential Innervation of Secretory Coils and Ducts in Human Eccrine Sweat Glands / 中华医学杂志(英文版)

Background@#Previous studies demonstrate that eccrine sweat glands are innervated by both cholinergic and adrenergic nerves. However, it is still unknown whether the secretory coils and ducts of eccrine sweat glands are equally innervated by the sympathetic nerve fibers. To well understand the mechanisms on sweat secretion and reabsorption, the differential innervation of secretory coils and ducts in human eccrine sweat glands was investigated in the study.@*Methods@#From June 2016 to June 2017, six human skins were fixed, paraffin-embedded, and cut into 5 μm-thick sections, followed by costaining for nerve fiber markers protein gene product 9.5 (PGP 9.5), tyrosine hydroxylase (TH) and vasoactive intestinal peptide (VIP), and eccrine sweat gland markers K7, S100P, and K14 by combining standard immunofluorescence with tyramide signal amplification (IF-TSA). Stained sections were observed under the microscope, photographed, and analyzed.@*Results@#The fluorescent signals of PGP 9.5, TH, and VIP were easily visualized, by IF-TSA, as circular patterns surrounding eccrine sweat glands, but only PGP 9.5 could be observed by standard IF. The IF-TSA method is more sensitivity than standard IF in detecting antigens expressed at low levels. PGP 9.5, TH, and VIP appeared primarily surrounding the secretory coils and sparsely surrounding the sweat ducts.@*Conclusion@#Sweat secretion is mainly controlled by autonomic nerves whereas sweat reabsorption is less affected by nerve activity.

Primary Cutaneous Mucinous Carcinoma with Extramammary Paget’s Disease: Eccrine or Apocrine?

Primary cutaneous mucinous carcinoma (PCMC) is an uncommon tumor of the sweat gland origin. The occurrence of PCMC is mostly in middle-aged and older patients, with a slight male predominance. Most cases of PCMC arise on the head, with a preference for eyelids. The histogenesis of PCMC, whether eccrine or apocrine, remains controversial. We report a rare case of PCMC with secondary extramammary Paget’s disease in the groin of a 75-year-old man, which favored an apocrine origin. Furthermore, based on a review of the literature, we provide several histologic clues that can be used to differentiate PCMC from metastatic mucinous carcinoma.

DNA methylation of HDAC4 gene affects the trans-differentiation process of hMSCs into sweat gland like cells / 中国应用生理学杂志

OBJECTIVE@#To investigate the changesof DNA methylation in histone deacetylases 4 gene (HDAC4) and its effectduring the trans-differentiation process of human mesenchymal stem cells (hMSCs) into sweat gland like cells (SGLCs).@*METHODS@#Selected cell lines of human mesenchymal stem cells (hMSCs) were cultured and expended , the third generation ofhMSCs and heat-shocked sweat gland cells were picked up, and were co-culturedwith adding inducible factor in the transwell chamber. The sweat gland like cells (SGLCs)in experiment group and the hMSCs in control group were collected, the changes of DNA methylation degree of CpG dinucleotide sitesin histone deacetylases 4 gene (HDAC4) promotor were detected by methylation specific PCR (MSP)andMaldi-TOF Mass Array. And then, the hMSCs in experiment group were treated with 5-aza-CdR (5-aza-2-deoxycytidine, 10 μmol/L), while the hMSCsin control group were culturedwith PBS at the same time. ThemRNA expressions of HDAC4 gene and carcino-embryonic antigen (CEA)gene in the two groups were measured by RT-PCR.@*RESULTS@#The methylation of HDAC4gene in hMSCs was in high level before induction, the methylation degreeof CpG dinucleotide sites located in cg2463009 was 0.901, and the methylation degree of HDAC4gene in SGLCs was markedly decreased by 37% after induction, which was 0.531. The methylationlevel of CpG dinucleotide sites located in cg14823429was changed from 0.687to 0.386 after induction. The mRNA expression of HDAC4 gene was upregulated in test group after treated with 5-aza-CdR for 48 hours, the mRNA expression of CEA gene related with transdifferentiation was enhanced too at the same term, there was significantly statistic difference compared with control group (<0.05).@*CONCLUSIONS@#Methylation of HDAC4 gene participates in the regulation of the trans-differentiation of hMSCs into sweet gland like cells.

Tratamento cirúrgico da bromidrose / Surgical treatment of bromhidrosis

INTRODUÇÃO:A bromidrose ou osmidrose é um problema que leva inúmeros pacientes a procurar tratamento médico especializado. A remoção das glândulas sudoríparas da região axilar por meio de exérese e lipoaspiração complementar é um procedimento de pequeno porte, tecnicamente simples e com poucas complicações. O objetivo deste trabalho é mostrar a aplicação da cirurgia neste problema, suas complicações e o grau de satisfação dos pacientes. MÉTODO: Trinta e dois pacientes foram submetidos à lipoaspiração e retirada dos tecidos da axila, sob anestesia local e sedação. Acompanhou-se por no mínimo 6 meses estes pacientes no pós-operatório, avaliando a evolução e possíveis complicações e aplicou-se o questionário CSQ-8 para o grau de satisfação no sexto mês. RESULTADOS: Após 6 meses de acompanhamento, poucas foram as complicações e as respostas ao questionário demonstraram alto grau de satisfação. CONCLUSÃO: Além de ser facilmente exequível, o procedimento se mostrou seguro e com poucas complicações.

INTRODUCTION: Bromhidrosis or osmidrosis causes many patients to seek specialized medical treatment. Removal of the sweat glands from the axillary region through excision and complementary liposuction is a minor, technically simple procedure, with few complications. The objective of this study is to review the role of surgery in bromhidrosis, complications of treatment, and the degree of patient satisfaction. METHOD: Thirty-two patients underwent liposuction and removal of axillary tissue under local anesthesia and sedation. The patients were followed up for at least 6 months postoperatively, to evaluate the outcome and possible complications. The Client Satisfaction Questionnaire was completed after 6 months. RESULTS: After 6 months of follow-up, there were few complications and the questionnaire revealed a high degree of satisfaction. CONCLUSION: In addition to being easily performed, the procedure was safe, with few complications.

Porocarcinoma Ecrino / Ecrine Porocarcinoma

Resumen:El porocarcinoma ecrino es un tipo muy poco frecuente de cáncer de piel, originado en la porción epidérmica de las glándulas sudoríparas ecrinas. Representa no más del 0.01% de los tumores cutáneos. El 20% de los porocarcinomas ecrinos son recurrentes y el 20% producen metástasis a ganglios linfáticos. Se ha reportado escasos casos de metástasis a distancia. Tiene un índice de mortalidad del 67% de los pacientes con metástasis.El diagnóstico es basado en los hallazgos histopatológicos y los estudios complementarios de inmunohistoquímica, a veces necesarios para el diagnóstico diferencial con otros tipos más frecuentes de cáncer de piel.No existen pruebas de que este tipo de carcinoma responda a la quimioterapia ni la radioterapia. Se considera que el manejo principal debe ser la resección quirúrgica y la electroquimioterapia.

Abstract:Eccrine porocarcinoma is a rare type of skin cáncer arising from the intraepidermal portion of eccrine sweat glands, representing no more tan 0.01% of all cutaneous tumors. 20% of the Eccrine porocarcinoma will recur and 20% will metastasize to regional lymph nodes. Few cases of distant metastases has been reported . There is a mortality rate of 67% in patients with metastases. The diagnosis is primarily based on histopathologic findings and complementary immunohistochemistry for differential diagnosis mainly with more frequent skin cáncer.Neither chemotherapy nor radiation therapy has been proven to be of clinical benefit in treating this type of carcinoma. It is considered that the management should be based on surgical resection and electrochemotherapy.

Oxybutynin as an alternative treatment for hyperhidrosis

Abstract: Hyperhidrosis is the excessive production of sweating, which can be primary and focal or secondary to various pathologies. The exact cause of primary focal hyperhidrosis is still unknown, although a genetic basis is recognized, and its prevalence varies from 1% to 2.8%. The most affected sites are the armpits, palms, soles and face. It causes much discomfort, affects the quality of life, and is estimated to be undervalued by health professionals. Many treatment options are proposed, both clinical and surgical. The aim of this review is to focus on the treatment of hyperhidrosis with oxybutynin, an anticholinergic drug originally used to control overactive bladder.

A Case of Apocrine Hidrocystoma on the Ankle / 계명의대학술지

Apocrine hidrocystoma is a benign tumor arising from apocrine sweat gland. It presents as a solitary translucent nodule, usually on the face, head, and neck. However it is extremely rare for the apocrine hidrocystoma to arise on the extremities, and no case of apocrine hidrocystoma on lower extremity has been reported in Korean dermatologic literature. Herein, we report a case of 63-year-old male apocrine hidrocystoma that developed in ankle area with a review of the literature.

Eccrine Hidrocystoma in External Auditory Canal / 대한이비인후과학회지

Hidrocystomas, eccrine or apocrine are rare ductal cystic benign lesions of the sweat gland. These uncommon cystic lesions are extremely rare in the external ear. Here, we discuss the clinical features and management of eccrine hydrocystoma in the external ear by describing the clinical, radiographic, pathologic features and management of an external auditory canal eccrine hidrocystoma in a 73-year-old Korean man. To the best of our knowledge, this tumor has not been reported previously in this site. Five month after surgery, there has been no evidence of local recurrence.

Espiroadenocarcinoma localizado en pabellón auricular y cuero cabelludo: reporte de un caso de localización inusual / Spiroadenocarcinoma located on ear auricle and scalp: a case report of unusual location

Introducción: El espiradenocarcinoma es una neoplasia maligna inusual que suele surgir de un espiradenoma benigno solitario preexistente. La mayoría de las lesiones aparecen en tronco y extremidades, pero casos extremadamente raros se han reportado en la región del cuero cabelludo y pabellón auricular. Objetivo: Describir el caso de un paciente en quien se diagnosticó espiradenocarcinoma. Diseño: Reporte de caso. Materiales y métodos: Se presenta el caso de un paciente adulto mayor con masa en región auricular y cuero cabelludo, de crecimiento progresivo. Resultados: Los estudios imagenológicos e histopatológicos mostraron una lesión tumoral maligna derivada de los anexos cutáneos complicada con infección y miasis. Se le informa la importancia de resección quirúrgica, pero los familiares se negaron a dicho procedimiento. Por lo cual se le ofrecen medidas paliativas. Conclusión: Describimos un caso extremadamente raro de un espiroadenocarcinoma en cuero cabelludo cerca del pabellón auricular; siendo el primer caso descrito en Colombia.

Introduction: Spiradenocarcinomas an extremely rare malignant neoplasm. Most often arises from a preexisting solitary benign spiroadenoma. Most of the lesions often appear on the trunk, limbs and unusually, on the region of the scalp near the pinna. Objective: To describe a case of a patient who was diagnosed with spiroadenoma. Design: Case report. Methods: We present the case of an elderly patient with a progressive growth mass on the scalp near the pinna. Results: Imaging studies in conjunction with histopathology allowed to evidence a malignant tumor lesion derived from skin annexes and complicated with an infection process and secondary myiasis. We told him the importance of performing surgery but the family refused this procedure. Conclusion: We report an extremely rare case of a spiroadenocarcinoma of the scalp near the pinna; this is the first case reported in Colombia

A Case of Vulvar Milium-like Syringoma in a Child Treated with Tranilast / 대한피부과학회지

Syringoma is the most common type of benign intraepidermal eccrine sweat gland tumor in Korea, and is usually found in women in their forties. It presents mostly as a localized lesion, preferring the lower eyelid, cheek, or forehead, and rarely invades the vulval area, and in the case of children, vulvar invasion is even more rare. Tranilast is an antihistamine used for atopic dermatitis and asthma, and has recently been used for the treatment of keloid. A few previous studies have reported both localized and generalized forms of syringoma being effectively resolved with tranilast. Herein, we report a rare and interesting case of milium-like syringoma, which manifested on the vulval area of 10-year old girl that was successfully treated with tranilast.

Substance P and Calcitonin Gene-Related Peptide in the Glands of External Auditory Canal Skin

OBJECTIVES: The earwax (cerumen) that covers external auditory canal (EAC) skin contains a mixture of ceruminous and sebaceous gland substances, such as lipids, peptides, and proteins. The components secreted from the ceruminous gland that is a modified sweat gland form cerumen and contain several antimicrobial factors. Since substance P (SP) and calcitonin gene-related peptide (CGRP), known as a secretagogue, have been found in sweat glands, our purpose was to determine the expression of SP and CGRP in the glands of EAC skin. METHODS: Sections of normal human EAC skins were immunostained for the presence of SP and CGRP using polyclonal antibodies. Immunoreactivity was detected using an avidin-biotin peroxidase complex method. RESULTS: SP staining was found in ceruminous gland acini and myoepithelial cells. But the SP staining was not found in the sebaceous glands and epidermal region. CGRP was strongly stained in the ceruminous gland and weakly in the sebaceous gland cells. Interestingly, most prominent staining of SP and CGRP was noted in the myoepithelial cells of the ceruminous gland. CONCLUSION: The findings in this study suggest that SP and CGRP are expressed in the glands of the EAC skin and secreted in the process of ceruminous gland secretion.