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Schedule of Dermatology&Venereology LectureNo.DateContentsTimeTeacher12-26General consideration(1)2hXinsuo Duan 23-5General consideration(2)2hXinsuo Duan 33-12General consideration(3)2hXinsuo Duan 43-19Viral dermatoses&Bacteria dermatoses 2hShuping Yu 53-26Fungal dermatoses2hShuping Yu 64-2STD(1)syphilis，AIDS2hXinsuo Duan 74-9STD(2)gonorrhea,NGU,CA,chancroid2hXinsuo Duan 84-16Eczema&Dermatitis(1)2hJin Wang 94-23Eczema&Dermatitis(2)2hJin Wang 104-30Drug eruption2hJingliang Wu115-7Urticaria 2hJingliang Wu125-14Papulosquamous diseases2hBaoqiang Li 135-21Bullous Dermatoses2hBaoqiang Li 145-28Cutaneous vasculitis2hBaoqiang Li 156-4Skin appendages2hBaoqiang Li 166-11Vitiligo&Skin tumors2hBaoqiang Li 176-18Practice2h186-25Test2h1Section General ConsiderationIntroductionStructure of SkinFunction of SkinSymptom,Sign and Diagnosis of DermatosesTreatment of Dermatoses2 IntroductionThe skin is the largest organ of the bodyThere are more than 2000 kind of skin disease in Dermatology 3Chapter Chapter Structure of skinStructure of skin451.Epidermis(structure)61.EpidermiscellskeratinocytemelanocyteLangerhans cellMerkel cell7（1）Keratinocyte89Hemi-desmosome10（1）Keratinocyte11desmosomehemi-desmosomeDesmosome&Hemi-desmosome12Desmosome13Hemi-desmosome14desmosomehemi-desmosomeDesmosome&Hemi-desmosome15（1）Keratinocyte28d16（2）Melanocytemelanocytepigment-producing cell 1718（2）Melanocyte192021（2）Melanocyte22(3)Langerhans cell Langerhans cellantigen presenting cell23(3)Langerhans cellLangerhans cells (CD1a)24(4)Merkel cell Merkel cellcontain intracytoplasmic neurosecretory-like granules,and,through their association with neurites,act as slow adapting touch receptors.25(4)Merkel cellin the basal layer of the palms and soles,the oral and genital mucosa,the nail bed,and the follicular infundibula.262.Dermiscollagen fiberreticular fiberelastic fibersbase material（ground substance）：proteoglycanCells:Fibroblastmast cellMacrophagedermic arborescent cellLanggerhans cellPigmentophageLymphocyteleukocyte272.Dermiscollagen fibers28reticular fiber292.Dermiselastic fibersCorrelate with tensity of skin302.Dermisreticulare dermispapillary dermis313.Hypodermis(subcutaneous tissue)Hypodermis323.Hypodermis(subcutaneous tissue)334.Appendageshair folliclesebaceous glandseccrine glandsapocrine glandsnail34（1）Hair and Hair follicleHair：Long hairShort hairWolly hairEpidermisSebaceous glandsHair rootMedullaryHair cuticleCortexInner root sheathOuter root sheathHair matrixHair papilla35Distribution of hairLong hair：scalp,beard,axillae and pubesShort hair：eyebrows,eyelids,nose and auditory meatesSmoothness：vermilion of the lipmammary papillaPalm,soles,side of the fingers and toes,nail beds,and certain areas adjacent to mucosal surface,such as the glans penisvellus hair(Wolly hair)：face,neck and trunk36Hair growth cycle（speed 0.270.4mm/d，loss70-100/d）anagen3-10yGrowing phase catagen3-4wTransitional phase telogen3mResting phase37Long hair girlLength(10001500mm)=0.270.4mm/d365d/y10y38（2）Sebaceous glandsIt is composed of lobules of pale-staining cells with abundant lipid in their cytoplasm.39distributionBe found in greatest abundance on the face and scalp.They are distributed throughout all skin sites except the palms and soles.They are always associated with hair follicles except at the following sites:the eyelids(meibomian glands),the buccal mucosa vermilion border of the lip(Fordyces spots)the prepuce(Tysons glands)the female areolas(Montgomerys tubercles).40（2）sebaceous glandsDiseases:Comedopapulepustulecyst 41It opens into the infundibular portion of the hair follicle.The coiled secretory gland is located at the junction of the dermis and subcutaneous fat.（3）Apocrine glands42（3）Apocrine glandsdecapitation secretion It is composed of a double layer of cuboidal epithelial cells.43Apocrine units of the human body are generally confined to the following sites:axillae,areolae,the anogenital region,the external auditory canal(ceruminous glands),and the eyelids(glands of Moll).The glands do not begin to function until puberty.（3）Apocrine glands44（4）eccrine glands45（4）eccrine glandscells are of two types:glycogen-rich,large pale cells smaller,darker staining cellsThe pale glycogen-rich cells form sweat46（4）eccrine glandsThe darker cells may actively reabsorb sodium,thereby modifying sweat from a basically isotonic solution to a hypotonic one by the time it reaches the skin surface.Sweat is similar in composition to plasma,containing the same electrolytes,though in a more dilute concentration.47RegulationSecretion of sweat occurs as result of many factors and is mediated by cholinergic innervation.Heat is a prime stimulus to increased sweating,Other physiologic stimuli,including emotional stress,are important as well.Increased sweat production in response to heat is part of the thermoregulatory system of the body;together with increased cutaneous blood flow,it can effectively dissipate excessive body heat.At friction surfaces,such as the palms and soles,eccrine secretion is thought to assist tactile sensibility and improve adhesion.48 distributionEccrine sweat units are found at virtually all skin sites except the vermillion border of the lips,nailbeds,labia minora,glans penis,and inner aspect of the prepuce.They are most abundant on the palms,soles,forehead,axillae.Some eccrine glands in the axillae,especially inpatients with hyperhidrosis,may have widely dilated secretary coils that contain apocrine-appearing cells.49（5）nailnail foldsnail lunula nail platefree margin of nailnail groovegrowth velocity：nail of finger 0.1mm/d，toenail 0.1cm/3dnail foldsnail platenail bednail rootnail matrixdigital bone50Vasculaturethree important intercommunicating plexuses:the subpapillary plexusupper horizontal networkThe deeper,lower horizontal plexus is found at the dermal-subcutaneous interface and is composed of larger blood vessels than those of the superficial plexus.The vasculature of the dermis is particularly well developed at sites of adnexal structures.Associated with the vascular plexus are the dermal lymphatics.5.Vasculature,Muscles,and Nerves of skin 5152muscleSmooth muscle occurs in the skin as arrectores pilorum(erectors of the hairs),as the tunica dartos(or dartos)of the scrotum,and in the areolas around the nipples.The arrectores pilorum are attached to the hair follicles below the sebaceous glands and,in contracting,pull the hair follicle upward,producing gooseflesh.5.Vasculature,Muscles,and Nerves of skin muscle535.Vasculature,Muscles,and Nerves of skin Nerves：Touch is mediated by Meissner corpuscles and in the dermal papillae,particularly on the palms and soles Pressure is mediated by Vater-Pacini corpuscles which locate in the deeper portion of the dermis of weight-bearing surfaces.Temperature,pain,and itch sensation are transmitted by unmyelinated nerve fibers which terminate in the papillary dermis and around hair follicles.54Chapter Chapter Function of Skin Function of Skin55 The skins functions include ProtectionAbsorptionSensationsecretion and excretiontemperature regulationmetabolism and immuneFunction of Skin561.Protection Physical Protection Chemical Protection Protection against pathogenic micro-organisms Prevent the loss of fluid,electrolyte and nutrient substance.572.Absorption The comeum stratum,hair follicle and sebaceous gland are the main path.The absorption can be affected by some facors:structure and site of the skin,hydration of the corneum stratum,nature of the substance,environment factors583.SensationThe body interprets external stimuli as heat,cold,pain,light touch,pressure,itch,and even tickle heatcold594.Secretion and Excretion Sweat is secreted by the sweat glands and gives a function of discipating heat.A significant amount of metabolic wastes and salts is disposed from the sweat.Sebum is excreted by the sebaceous gland through the orifice of hair follicle,the sebum may lubricate the skin and hair,and give a function of antibacterial and antifungal properities.605.Temperature regulation Cutaneous mechanisms of temperature control include insulation(primarily subcutaneous fat),regulation of cutaneous blood flow,eccrine sweat activity(resulting in cooling through evaporation),and muscle activity,including shivering(resulting in warmth).616.Metabolism Water metabolismcarbohydrate and salt metabolism protein metabolism lipid and vitamin metabolismmelanin metabolism 62 7.Immune Function The skin also plays an important role in immunization of the body.6364
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