皮肤性病学总论压缩版2012

,单击此处编辑母版标题样式,*,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,皮肤性病学总论压缩版2012,皮肤性病学的定义和范畴,研究皮肤、附属器及相关疾病的学科,皮肤性病学的发展史,历史悠久但长期发展缓慢，近年来突飞猛进,皮肤性病学的学科特点,强调皮损和组织病理形态学改变，直观性强,学习方法,重视感性认知过程，注重临床实践和积累,见习教学,PBL,教学法，病案讨论,第一章 皮肤性病学导论,皮肤性病学发展现状,从单纯形态学向分子免疫学、分子生物学、皮肤遗传学等方向纵深发展,分出皮肤美容、皮肤外科等边缘分支学科,我校皮肤性病学概况,始建于上世纪,50,年代初，拥有多名国内知名专家,拥有变应性皮病、真菌、美容、病理、性病等亚专业,西南地区皮肤科疑难重症的诊治中心之一,医教研水平位于国内同行前列,博士学位授予点,化妆品皮肤病诊断机构,人体最大器官,约占体重的,16,成人皮肤总面积约,1.5 m,2,皮肤厚度约,4 mm,第二章 皮肤的结构,remember!,皮肤的构成：,表皮 真皮,皮下组织 附属器,皮肤附属器：,毛发 毛囊 指,(,趾,),甲,皮脂腺 小汗腺 大汗腺,皮肤的结构,来源：,复层鳞状上皮,组成：,角质形成细胞,keratinocyte,黑素细胞,melanocyte,朗格汉斯细胞,Langerhans cell,麦克尔,细胞,Merkel cell,表皮,Epidermis,来源外胚层,分布 表皮主要构成细胞,占,表皮细胞,80,以上,分层 根据分化阶段和特点分为,5,层,基底层 棘层 颗粒层 透明层 角质层,角质形成细胞,keratinocyte,正常的角化,由基底层移行至颗粒层表面约,14,天,由颗粒层移行至角质层表面约,14,天,正常表皮更替时间约为,28,天,角质形成细胞正常细胞周期,remember!,来源外胚层神经嵴,分布 广泛,基底层、毛囊、粘膜、视网膜较多,作用 遮挡和反射光线 保护深部组织,黑素细胞 Melanocyte,思考题：,黑素细胞的数量与人种和肤色有关，对吗？,来源 骨髓及脾,分布基底层以上的表皮及毛囊上皮,性质 免疫活性细胞，有多种表面标记,作用吞噬 吞饮 摄取 抗原呈递等,朗格汉斯细胞,Langerhans cell,思考题,：,HE,染色的组织切片中能看到,Langerhans cell,吗？,形态 具有短指状突的细胞,分布基底层细胞之间,作用形成,Merkel cell,轴索复合物，能,感受触觉,麦克尔,细胞,Merkel,cell,角质形成细胞间及其与真皮间的连接,桥粒,角质形成细胞间连接的主要结构,半桥粒,连接基底层和基底膜带,基底膜带,basement membrane zone,BMZ,连接表皮和真皮,remember!,组成,胶原纤维,网状纤维,弹力纤维,细胞,基质,真皮,Dermis,分层,乳头层,网状层,毛发 毛囊,皮脂腺,汗腺,指（趾）甲,皮肤附属器,毛发生长周期,生长期,3y,退行期,3w,休止期,3m,正常人每日可脱落,100,根头发,皮脂溢出部位,面部“,T”,形区,胸背上部,remember!,屏障,功能,吸收,功能,感觉,功能,分泌排泄,体温调节,代谢功能,免疫,功能,第三章 皮肤的功能（,自学,）,思考题,1.皮肤如何防护光线？,2.比较不同部位皮肤的吸收差异。,3.what is the meaning of,skin immune system?,临床表现,自觉症状（主观感觉）,他觉症状（,皮疹,）,重点掌握,诊断,内科诊断学专科查体,第四章 皮肤性病的临床表现及诊断,皮损 skin lesion,原发皮损,primary lesion,由皮病组织病理变化直接产生，对诊断意义重大。,继发皮损,secondary lesion,由原发皮损演变而来，对诊断意义较小。,注意：两者有时不能截然分开,原发损害,斑疹,macule,斑片,patch,丘疹,papule,斑块,plaque,风团,wheal,水疱,vesicle,大疱,bulla,脓疱,pustule,结节,nodular,囊肿,cyst,糜烂,erosion,溃疡,ulcer,鳞屑,scale,浸渍,maceration,裂隙,fissure,瘢痕,scar,萎缩,atrophy,痂,crust,抓痕,excoration,苔藓样变,lichenification,继发损害,remember!,斑疹,Macule,局限性皮肤粘膜颜色改变，不隆起、不凹陷，直径小于1cm,斑片Patch,直径大于1cm的斑疹称斑片,色素缺失斑,丘疹(Papule),限局性、隆起性、实质性损害，直径小于1cm,Papule,Plaque,斑块,斑块为丘疹增大或融合而成的扁平、隆起性损害,结节,Nodule,限局性、实质性损害，深度可达真皮或皮下组织,风团,Wheal,真皮浅层水肿所致的暂时性、限局性隆起性损害,水疱和大疱,Vesicle and bulla,直径小于1cm称水疱、大于1cm称大疱,脓疱,Pustule,Pustule,is a circumscribed elevated lesion which contains pus in the epidermis or dermis. It frequently form in sweat glands or hair follicles.,Abscess,is usually in the dermis or subcutis.,.,囊肿,cyst,内含液体、粘性物质和细胞成分的限局性囊性损害,浸渍,maceration,皮肤角质层含水量增多，导致的表皮强度减弱,表皮或粘膜上部,的缺损，露出红色糜烂面，愈后不留瘢痕,糜烂,erosion,溃疡,Ulcer,皮肤或粘膜深达,真皮或皮下组织,的缺损，愈后会留有瘢痕,裂隙,Fissure,系皮肤的线条状裂口,瘢痕,Scar,真皮或真皮以下组织的缺损或破坏,经新生结缔组织修复而成,萎缩,Atrophy,退行性的皮肤变薄，可发生于表皮、真皮及皮下组织,鳞屑,Scale,脱落或即将脱落的角质层,由皮损表面的浆液、脓液、血液及脱落组织等干燥、凝固而成的附属物,痂,Crust,抓痕,excoriation,线状或点状表皮缺损，由搔抓所致，可深达真皮浅层。,因搔抓或摩擦所致的皮肤浸润肥厚,皮沟加深及皮嵴突起,苔藓样变,Lichenification,原发损害,斑疹,macule,斑片,patch,丘疹,papule,斑块,plaque,风团,wheal,水疱,vesicle,大疱,bulla,脓疱,pustule,结节,nodular,囊肿,cyst,糜烂,erosion,溃疡,ulcer,鳞屑,scale,浸渍,maceration,裂隙,fissure,瘢痕,scar,萎缩,atrophy,痂,crust,抓痕,excoration,苔藓样变,lichenification,继发损害,remember!,重点掌握表皮基本病理变化,第五章 皮肤组织病理学,皮肤组织病理对皮肤病的诊断有重要价值，是皮肤病诊断中最常用的辅助检查手段之一。,角化过度,Hyperkeratosis,角质层过度增厚，见于寻常疣等,棘层肥厚（,Acanthosis,）: increase in keratinocyte population of prickle cell layer with thickening of the epidermis.,角化不全,Parakeratosis,角质层中有细胞核残留，见于银屑病等,Spongiosis,(,Intercellular Edema,),:,Widening of the interspaces between keratinocytes due to edema fluid without detachment of cells from each other.,Intracellular Edema,Ballooning Degeneration,Such as herpes zoster,Reticular degeneration,Such as herpes simplex,棘层松解,Acantholysis,表皮细胞失去粘连，见于天疱疮,Munro微脓肿(Munros microabscess),见于寻常型银屑病等,中性粒细胞集聚,课堂内未讲授的其他基本皮肤病理改变请同学们结合教材图片自学,什么叫微脓肿，常见的微脓肿有哪些，出现在哪些疾病中？,思考题,病理检查,真菌检查,变应原检测,滤过紫外线检测,性病检测,螨和阴虱检查,分子生物学技术,第六章 皮肤性病常用实验室检查（,见习讲授,）,思考题,什么叫斑贴试验，它有哪些适应症？,皮肤划痕征（,Dermatographism,） is a sharply localized edema or wheal with a surrounding erythematous flare occurring within seconds to minutes after the skin has been stroked.,斑贴试验,Patch Test,Patch test is used to detect hypersensitivity to a substance that is in contact with the skin so that the allergen may be determined and corrective measures taken.,A,suspected allergen is applied to the intact,uninflamed,skin on a small surgical pad or in an aluminum chamber.,Removed the pad in,48 hrs or earlier.,Evaluation(,Erythema, papules, vesicles): day 2, day 4, day 5, day 7,内用药物疗法,外用药物疗法,重点掌握,物理治疗,外科治疗,第七章 皮肤性病治疗学,机理：竞争性抑制组胺受体,分类：,H1,受体阻断剂,H2,受体阻断剂,第一代抗组胺药：赛庚啶 等,第二代抗组胺药：氯雷他定 等,抗组胺药物,内用药物（一）,糖皮质激素的药理作用,抗炎、抗过敏、免疫抑制剂、抗核分裂、抗毒,在皮肤性病科的适应症主要有,1、结缔组织病 2、大疱性皮肤病,3、变态反应性皮肤病,糖皮质激素,糖皮质激素有哪些副作用？,思考题,内用药物（二）,唑类（咪康唑、氟康唑、伊曲康唑）,灰黄霉素（,1520mg/kg/d,）,头癣首选,抗真菌药物,丙烯胺类：特比奈芬（兰美抒）,内用药物（三）,无环鸟苷类：疱疹病毒首选药,病毒唑（利巴韦林）：流感病毒、疱疹病毒,干扰素：广谱辅助抗病毒作用,抗病毒药物,内用药物（四）,外用药物疗法,Topical Application and Dosing (1),Attention:,Medication should be gently massaged into the skin in one thin layer.,One gram of cream covers 1010cm,Applied once or twice per day usually.,Extra-pharmacotherapy,Topical Application and Dosing (2),Medication penetration vs skin anatomic site (Mucous membraneeyelidsface torsoextremitiespalms and soles),Skin breakdown allows increased drug penetration.,Dressing or body suits increase drug absorption.,Extra-pharmacotherapy,Topical Drugs,Basic Points:,Two main factors: drug and vehicle (base),Vehicle assistant in both drug delivery and therapeutic properties,Adequate concentration,Adequate formulation,Extra-pharmacotherapy,按药物剂型分为,皮肤外用药分类,油剂,乳剂,软膏,糊剂,硬膏,涂膜剂,喷剂,凝胶,溶液,酊剂,粉剂,振荡剂,溶液,Solutions,Solution,involves the dissolution of two or more substances into homogenous clarity. The vehicle (base) may be aqueous, hydroalcoholic, or nonaqueous (alcohol, oils, or propylene glycol) .(3% Boracic acid),酊剂,Tinctures,Tincture,is a hydroalcoholic solution with a concentration of alcohol of approximately 50%.,(,iodine),vs,醑剂 Spiritus,粉剂,Powders,Powders,absorb moisture and decrease friction. Because they adhere poorly to the skin, their use is limited to cosmetic and hygienic purposes.,talcum powder, starch,振荡剂 （洗剂）,Lotions,Lotions,(Suspensions) is a two-phase system consisting of a finely divided, insoluble drug dispersed into a liquid in a concentration of up to 20%.,mint calamine lotion,乳剂,Emulsions,Emulsions,are twophase systems involving one or more immiscible liquids dispersed in another with the assistance of emulsifying agent.,Water-in-oil emulsions,contain less than 25% water, with oil being the dispersion medium.,Oil-in-water emulsions,(Creams，,霜剂,),contain greater than 31% water. In fact, the aqueous phase may comprise up to 80% of the formulation.,zinc oxide,软膏,Ointments,Ointments,are semisolid preparations that spread easily. They can be protective, hydrating and lubricating. The bases are hydrocarbon bases and absorption bases.,糊剂,Pastes,Pastes,are simply the incorporation of high concentrations of powders (up to 50%) into an ointment such as a hydrocarbon base or a water-in-oil emulsion. The powder must be insoluble in the ointment,.,zinc oxide,凝胶,Gels,Gels,are semi-solid preparations containing high-molecular-weight polymers, such as carboxypolymethylene or methylcellulose, and can be regarded as thicken aqueous lotion.,硬膏,Plasters,Plasters,( Adhesive plaster, Adhesive tape ) are kinds of adhesive, whose surface painted with natural rubber and zinc oxide as main raw materials, with weaving-cloth back lining. It is used in dressing wounds,.,角质松解剂,油剂,Oils,Oils,can be obtained from numerous vegetable sources by pressing or by solvent extraction. These are slippery or viscous liquid or liquefiable substance not miscible with water.,气雾剂,Aerosols,气雾剂：系将药物和抛射剂装入高压容器中，掀动阀门时，药物借助压缩气体或液化气体的压力以雾状喷出。,溶液,酊剂,粉剂,洗剂,油剂,霜剂,乳剂,软膏,气雾剂,糊剂,洗剂,醑剂,气雾剂,霜剂,按药物性质分为,皮肤外用药分类,抗真菌剂,抗细菌剂,抗病毒剂,杀虫剂,角质促成剂,角质松解剂,收敛剂,遮光剂,清洁剂,保护剂,止痒剂,清洁剂,Clearing agent,Clearing agent,is the substance used to clear the exudation, scale or crust of the skin,.,保护剂,Protective agents,Protective agents,help protecting the skin and reducing the irritant from external.,Antipruritics,can relieve pruritus (itching).,止痒剂,Antipruritics,角质促成剂,Keratoplastics,Keratoplastics,tend to increase the thickness of the stratum corneum).,1% to 2% salicylic acid,Keratolytics,can remove or soften the stratum corneum.,4% to 10% salicylic acid,角质松解剂,Keratolytics,正确选用药物,抗细菌、抗真菌、糖皮质激素、角质促成剂,正确选用剂型,（掌握具体内容）,根据皮损特点选用适合剂型,注意事项,过敏史、详细使用方法,注意药物的刺激性,用药浓度由低到高,外用药物治疗原则,急性期,糜烂、渗出,红斑、丘疹,亚急性,过度阶段,慢性期,苔藓化、角化异常,外用药物治疗原则,外用剂型,溶液,粉剂、洗剂,糊剂、油剂,软膏、霜剂,第六章 皮肤的美容与保健,（,自学,）,思考题,医学美容和生活美容有区别吗？,皮损定义及特点,外用药物剂型及治疗原则,表皮解剖结构,基本病理改变,掌 握,参 考 书,杨国亮，现代皮肤病学（第,2,版）,Thomas P.,Clinical Dermatology: A Color Guide to Diagnosis and Therapy 4th edition,Irwin M.,Freedberg,Fitzpatricks Dermatology In General Medicine 6th edition,谢谢观赏！,2020/11/5,90,