皮肤病学-总论PPT课件.ppt

皮肤性病学总论,2019/12/13,苏州大学附属第二医院皮肤性病科,1,学科的构成,2019/12/13,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,2019/12/13,3,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,2019/12/13,4,皮肤的组成,表皮（epidermis）真皮(dermis)皮下组织(subepidermis)皮肤附属器(skinappendages)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,2019/12/13,5,2019/12/13,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（melanocyte）：位于基底层，产生黑色素朗格汉斯细胞（Langerhanscell）：抗原呈递细胞默克细胞（Merkelcell）：可能功能APUD，感觉,2019/12/13,7,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（turnovertime）：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,2019/12/13,8,基底细胞层,2019/12/13,Deepestlayer,onlyasinglelayerofcolumnarcells;Connection;Motherlayer,newkeratinacyteupwardstorenewtheouterlayer;Epidermis-through-time:14days(uppergrannularlayer)14daystofalloffmotherandneonatal,9,棘细胞层,2019/12/13,4-10layerslikepricks;Active:keratinMainforce:againstwaterloss;physicalchemical;infectious4.Youth,10,粒细胞层,2019/12/13,2-3layersmoreflatter;Containsirregularbasophilicgranulesofkeratohyalin;Karyonandorganelledissolvedmidlife,11,透明层,2019/12/13,Onlyonthepalms;Physicalbarrier:water,electrolyte.Older:nonnucleicells,12,角质层,2019/12/13,deadcells:corneocytes,thebricks;2.against:waterlossphysicalchemicalinfectiousOld:shingledroof,13,Othercells,Keratinocytes:80%intheepidermisMelanocytesLangerhanscellsMerkelcell,2019/12/13,14,黑素细胞,2019/12/13,1.Inthebasallayer;2.Connectwith10-36layerkeratinocytes(epidermalmelaninunit)3.Containsmelanosomes,15,2019/12/13,Same:numbersofmelanocytesDifferent:melanosome,16,2019/12/13,Melanosome:effectiveforceSkintumors:blackswhite,17,朗格汉氏细胞,2019/12/13,Birbeckgranules;tennis;Immunereaction:police,18,梅克尔细胞（Merkelcell),FingertipTipofthenoseMerkelcellneuritecomplex,2019/12/13,19,2019/12/13,20,基底膜带（BMZ),2019/12/13,1,attachdermisandepi-;2.Providesupport;3.Regulatethepermeabilityacrosstheepidermal-dermalinterface,21,2019/12/13,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,2019/12/13,23,胶原纤维collagenfibers,2019/12/13,PinkbyHEstainingMajorstruturalproteinfortheentirebody.,24,网状纤维reticularfibers,2019/12/13,ShowingbysilverstainingImmaturecollagenSupportasbasketarroundingthecells(net),25,弹力纤维elasticfibers,2019/12/13,Fineandwave-likeverticaltheepi-;Maintainingtheelasticityoftheskin.Specialstaining.,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,2019/12/13,27,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,2019/12/13,28,皮肤病的临床表现,症状symptom体征sign,2019/12/13,29,皮疹SKINLESIONS,2019/12/13,30,皮疹的分类,原发性损害（primarylesions）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（secondarylesions）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,2019/12/13,31,原发性损害primarylesions,2019/12/13,32,2019/12/13,Macule:Amaculeisacircumscribed,flatlesionthatdiffersfromsurroundingskinbecauseofitscolor.,斑疹：局限性皮肤颜色改变，不高起或凹陷皮面。,33,2019/12/13,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,34,2019/12/13,淤斑、淤点,35,2019/12/13,Papule：Apapuleisasmall,solid,elevatedlesion.Papulesareusuallysmallerthan1cmindiameter.,丘疹：局限性实质性隆起，直径小于1cm。,36,2019/12/13,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）,37,2019/12/13,Nodule：Anoduleisapalpable,solid,roundorellipsoidallesion.Depthofinvolvementand/orsubstantivepalpabilityratherthandiameterdifferentiateanodulefromapapule.,结节：实质性隆起，侵犯深度与直径大于丘疹,38,2019/12/13,结节：实质性隆起肿瘤性结节（A）代谢异常性结节（B）,A,B,39,2019/12/13,Wheal：Awhealisaroundorflat-toppedpapuleorplaquethatischaracteristicallyevanescent,disppearingwithin24hours.,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,40,2019/12/13,风团：暂时性、局限性皮肤水肿性隆起,41,2019/12/13,Vesicleandbullae:Avesicleisacircumscribed,elevatedlesionthatcontainsfluid.Abullaeisavesiclelargerthan1.0cm.Canbeepidermalorsubepidermal.水疱：含有液体高出皮面的损害。直径大于1cm为大疱.,A,B,42,2019/12/13,疱疹：含有液体高出皮面的损害。,43,2019/12/13,疱疹：含有液体高出皮面的损害。,45,2019/12/13,疱疹：含有液体高出皮面的损害。,46,2019/12/13,大疱：含有液体高出皮面的损害，直径大于1cm。,47,2019/12/13,Pustule:Apustuleisacircumscribed,raisedlesionthatcontainsapurulentexudate.,脓疱:内含脓液的疱疹。内容物为血液则血疱,48,2019/12/13,脓疱:含有脓液的疱疹.,49,2019/12/13,Cysts:Acystisasacthatcontainsliquidorsemisolidmaterial(fluid,cells,andcellproducts),onpalpation,itisresilient.,囊肿:含有液体或半固体物质的囊性损害,触之有弹性.,50,2019/12/13,囊肿:含有液体或半固体物质的囊性损害,触之有弹性.,51,继发性损害secondarylesions,2019/12/13,52,2019/12/13,Scale,desquamation:Abnormalsheddingoraccumulationofstratumcorneuminperceptibleflakesiscalledscaling.,鳞屑：脱落的表皮细胞及其它成分,53,2019/12/13,鳞屑：脱落的表皮细胞及其它成分,54,2019/12/13,Erosion:Aerosionisamoist,circumscribed,usuallydepressedlesionthatresultsfromlossofalloraportionoftheviableepidermis.,糜烂：表皮的缺损，愈后不留疤痕,55,2019/12/13,糜烂：表皮的缺损，浅表,56,2019/12/13,Ulcer:Anulcerisadepressedlesioninwhichtheepidermisandatleasttheupperdermishavebeendestroied.,溃疡：皮肤缺损达到真皮或真皮以下,57,2019/12/13,溃疡：皮肤缺损达到真皮或真皮以下,58,2019/12/13,Atrophy:Atrophyreferstoadiminutioninthesizeofacell,tissue,organorpartofthebody.,萎缩：指机体某部分（包括皮肤）减少,59,2019/12/13,萎缩：指机体某部分（包括皮肤）减少,60,2019/12/13,Crusts:Crustsarehardeneddepositsthatresultwhenserum,blood,orpurulentexudatedebrisontheskinsurface,andtheyarecharacteristicofpyogenicinfections.,结痂：创面上多种成分混合干燥物,61,2019/12/13,结痂：创面上多种成分混合干燥物。,62,浸渍maceration,2019/12/13,63,裂隙fissure,2019/12/13,64,苔藓样变lichenfication,2019/12/13,65,抓痕excoriation,2019/12/13,66,皮肤病的诊断,2019/12/13,67,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,2019/12/13,68,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,2019/12/13,69,皮疹的检查,触诊-质地：坚硬度、韧性与周围组织的关系温度附近淋巴结检查：有无肿大，触痛等,2019/12/13,70,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,2019/12/13,71,辅助检查,多做,2019/12/13,72,皮肤斑贴试验,适应症材料方法阅读时间影响因素,2019/12/13