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1、皮肤性病学总论,1,学科的构成,皮肤病学：亚学科构成：美容皮肤病学皮肤外科皮肤病理、免疫、真菌性病学性传播疾病,2,皮肤的结构与功能,3,皮肤是人体最大的器官,重量：占人体的面积：正常成人1.52.0m2厚度：0.5mm，眼睑最薄，足跖最厚,4,皮肤的组成,表皮（epidermis）真皮(dermis)皮下组织(subepidermis)皮肤附属器(skin appendages)毛囊、皮脂腺、小汗腺、顶泌腺和甲皮肤内其它组织结构：血管、淋巴管、神经等,5,表皮,真皮,皮下,6,表皮（epidermis）,组成：角质形成细胞（Keratinocyte）：占表皮的80黑素细胞（melanocyt
2、e）：位于基底层，产生黑色素朗格汉斯细胞（Langerhans cell）：抗原呈递细胞默克细胞（Merkel cell）：可能功能APUD，感觉,7,表皮的结构基底细胞层：层，表皮生发层，连接表皮与真皮棘细胞层：层颗粒细胞层/透明层（掌跖部位）：层角质层：层，无细胞核。表皮的更新表皮通过时间（turnover time）：约天：由基底细胞层移行至颗粒层：约14天由颗粒层移行至角质层表面脱落：约14天,8,基底细胞层,Deepest layer, only a single layer of columnar cells;Connection; Mother layer, new kerati
3、nacyte upwards to renew the outer layer;Epidermis-through-time: 14 days (upper grannular layer) 14 days to fall off mother and neonatal,9,棘细胞层,4-10 layers like pricks;Active: keratinMain force: against water loss; physical chemical ; infectious4. Youth,10,粒细胞层,2-3 layers more flatter;Contains irregu
4、lar basophilic granules of keratohyalin;Karyon and organelle dissolvedmidlife,11,透明层,Only on the palms;Physical barrier: water, electrolyte.Older: non nuclei cells,12,角质层,dead cells: corneocytes, the bricks;2. against: water loss physical chemical infectiousOld: shingled roof,13,Other cells,Keratino
5、cytes: 80% in the epidermisMelanocytesLangerhans cellsMerkel cell,14,黑素细胞,1. In the basal layer;2.Connect with10-36 layer keratinocytes(epidermal melanin unit)3. Contains melanosomes,15,Same: numbers of melanocytesDifferent: melanosome,16,Melanosome: effective forceSkin tumors: blacks white,17,朗格汉氏细
6、胞,Birbeck granules; tennis;Immune reaction: police,18,梅克尔细胞（Merkel cell),FingertipTip of the noseMerkel cell neurite complex,19,20,基底膜带（BMZ),1, attach dermis and epi-;2. Provide support;3. Regulate the permeability across the epidermal-dermal interface,21,表皮,真皮,皮下,22,真皮(Dermis),真皮的细胞成纤维细胞：产生胶原纤维等组织细
7、胞：吞噬异物，清道夫作用肥大细胞：参与I型变态反应真皮的纤维胶原纤维：III型胶原为主弹力纤维网状纤维真皮的基质主要是粘多糖成分,23,胶原纤维 collagen fibers,Pink by HE stainingMajor strutural protein for the entire body.,24,网状纤维 reticular fibers,Showing by silver stainingImmature collagenSupport as basket arrounding the cells (net),25,弹力纤维 elastic fibers,Fine and wa
8、ve-like vertical the epi-;Maintaining the elasticity of the skin.Special staining.,26,皮肤附属器,毛囊和毛发：分长毛、短毛、毳毛，有生长期、退行期、休止期皮脂腺：粘膜处直接开口于表面，其余开口于毛囊 ,无腺小汗腺：受交感神经支配，调节体温顶泌汗腺：分布于腋下、外阴等处，青春期开始发育（大汗腺）甲：甲板、甲根、甲廓、甲半月，甲床、甲母,27,皮肤的生理功能,保护（屏障）功能，维护体内环境稳定免疫功能感觉功能吸收功能体温调节功能分泌排泄功能其它功能：合成维生素D,28,皮肤病的临床表现,症状 symptom体征
9、sign,29,皮 疹SKIN LESIONS,30,皮疹的分类,原发性损害（primary lesions）由皮肤病理变化直接产生的病变斑疹、丘疹、结节、风团、疱疹、脓疱、囊肿、肿瘤等继发性损害（secondary lesions）由原发损害转变而来，或由于治疗、搔抓等引起鳞屑、糜烂、萎缩、溃疡、结痂、苔藓化等,31,原发性损害 primary lesions,32,Macule: A macule is a circumscribed, flat lesion that differs from surrounding skin because of its color.,斑疹：局限性皮肤
10、颜色改变，不高起或凹陷皮面。,33,A,斑疹：局限性色素改变色素沉着斑（A）色素减退斑（B）炎症性充血（C）,B,C,34,淤斑、淤点,35,Papule：A papule is a small, solid, elevated lesion. Papules are usually smaller than 1 cm in diameter.,丘疹：局限性实质性隆起，直径小于1cm。,36,丘疹：局限性实质性隆起，直径通常小于0.51cm炎症性丘疹（A）病毒感染性丘疹（B）,37,Nodule：A nodule is a palpable, solid, round or ellipsoid
11、al lesion. Depth of involvement and/or substantive palpability rather than diameter differentiate a nodule from a papule.,结节：实质性隆起，侵犯深度与直径大于丘疹,38,结节：实质性隆起肿瘤性结节（A）代谢异常性结节（B）,A,B,39,Wheal： A wheal is a round or flat-topped papule or plaque that is characteristically evanescent, disppearing within 24 h
12、ours.,风团：暂时性、局限性皮肤水肿性隆起，持续时间通常短于24小时,40,风团：暂时性、局限性皮肤水肿性隆起,41,Vesicle and bullae: A vesicle is a circumscribed, elevated lesion that contains fluid. A bullae is a vesicle larger than 1.0cm. Can be epidermal or subepidermal.水疱：含有液体高出皮面的损害。直径大于1cm为大疱.,A,B,42,疱疹：含有液体高出皮面的损害。,43,疱疹：含有液体高出皮面的损害。,44,疱疹：含有液
13、体高出皮面的损害。,45,大疱：含有液体高出皮面的损害，直径大于1cm。,46,Pustule: A pustule is a circumscribed, raised lesion that contains a purulent exudate.,脓疱: 内含脓液的疱疹。内容物为血液则血疱,47,脓疱: 含有脓液的疱疹.,48,Cysts: A cyst is a sac that contains liquid or semisolid material (fluid, cells, and cell products), on palpation, it is resilient.,
14、囊肿: 含有液体或半固体物质的囊性损害,触之有弹性.,49,囊肿: 含有液体或半固体物质的囊性损害,触之有弹性.,50,继发性损害 secondary lesions,51,Scale, desquamation:Abnormal shedding or accumulation of stratum corneum in perceptible flakes is called scaling.,鳞屑：脱落的表皮细胞及其它成分,52,鳞屑：脱落的表皮细胞及其它成分,53,Erosion: A erosion is a moist, circumscribed, usually depress
15、ed lesion that results from loss of all or a portion of the viable epidermis.,糜烂：表皮的缺损，愈后不留疤痕,54,糜烂：表皮的缺损，浅表,55,Ulcer: An ulcer is a depressed lesion in which the epidermis and at least the upper dermis have been destroied.,溃疡：皮肤缺损达到真皮或真皮以下,56,溃疡：皮肤缺损达到真皮或真皮以下,57,Atrophy: Atrophy refers to a diminut
16、ion in the size of a cell, tissue, organ or part of the body.,萎缩：指机体某部分（包括皮肤）减少,58,萎缩：指机体某部分（包括皮肤）减少,59,Crusts: Crusts are hardened deposits that result when serum, blood, or purulent exudate debris on the skin surface, and they are characteristic of pyogenic infections.,结痂：创面上多种成分混合干燥物,60,结痂：创面上多种成
17、分混合干燥物。,61,浸渍 maceration,62,裂隙 fissure,63,苔藓样变 lichenfication,64,抓痕 excoriation,65,皮肤病的诊断,66,皮疹的自觉症状,瘙痒疼痛烧灼感麻木感其它感觉：刺痛异物感蚁行感,67,皮疹的描述 视诊,位置：按照实际位置描述，屈侧，伸侧性质：原发疹，继发疹大小：以实物为参照: 针头大，粟粒大，绿豆大，黄豆大，核桃大，鸡蛋大数目：单发，多发颜色：正常皮色，红色，黄色，黑色，蓝色，白色，棕色等分布：对称单侧；局限播散；沿神经血管分布排列：散在融合；孤立群集；线状，环状，带状，不规则状,68,皮疹的检查,触诊-质地：坚硬度、韧性
18、与周围组织的关系温度附近淋巴结检查：有无肿大，触痛等,69,皮肤是身体的一部分,皮疹与全身疾病的关系是全身疾病的一种表现是全身疾病的前驱症状是全身疾病的发展结果有独特之处病理组织活检、便利皮肤损害直观,70,辅助检查,多做,71,皮肤斑贴试验,适应症材料方法阅读时间影响因素,72,真菌检查,直接镜检培养 培养基 条件,73,病理检查,取材染色结合,74,临床治疗,内用外用物理治疗 UVB PDT Laser Cooling,75,内用药物的治疗,1抗组胺药：H1受体拮抗剂作用机理：主要与组胺竞争结合靶细胞上的H1受体一代：赛庚啶、酮替芬二代：氯雷他啶、皿唑司汀、西替利嗪,76,2. 糖皮质激素
19、 抗毒、抗炎、抗休克、抗增生、免疫抑制 低效、中效、长效 小量、中量、大量 短期、中期、长期 不良反应：累及各系统,77,3. 抗生素 青霉素、头孢类、四环素类、大环内酯类,78,4. 抗病毒药 核苷类：抑制受感染的细胞内的病毒DNA的复制 ACV、FCV、GCV,79,5. 抗真菌药 唑类：抑制细胞色素P450 丙烯胺类：抑制角鲨烯环氧化酶,80,6. 维A酸类 第一代：全反式 维胺脂 异维A :acne 第二代：单芳香族 阿维A:银屑病 第三代：多芳香族 阿达帕林 他扎罗汀：acne psoriasis,81,7. 免疫抑制剂 MTX CTX AZP CsA,82,8. 免疫调节剂 IFN IVIG TF IL,83,9. 维生素类,84,10. 其他 羟氯喹 雷公藤多苷,85,谢谢！,86,
