皮肤性病学总论(压缩版)

导论皮肤的结构（重点讲授）皮肤的功能(自学)皮肤病的症状学及诊断学（重点讲授，见习）皮肤的组织病理（讲授+自学）皮肤性病实验室技术（见习讲授）皮肤病的治疗重点讲授外用药物剂型简要讲授四类药物皮肤的保健及美容（自学）,总论,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1.5m2皮肤厚度约0.54mm,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Langerhanscell麦克尔细胞Merkelcell,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Langerhanscell,思考题：HE染色的组织切片中能看到Langerhanscell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Merkelcell轴索复合物，能感受触觉,麦克尔细胞Merkelcell,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basementmembranezoneBMZ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.whatisthemeaningofskinimmunesystem?,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skinlesion原发皮损primarylesion由皮病组织病理变化直接产生，对诊断意义重大。继发皮损secondarylesion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Vesicleandbulla直径小于1cm称水疱、大于1cm称大疱,脓疱Pustule,Pustuleisacircumscribedelevatedlesionwhichcontainspusintheepidermisordermis.Itfrequentlyforminsweatglandsorhairfollicles.Abscessisusuallyinthedermisorsubcutis.,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）:increaseinkeratinocytepopulationofpricklecelllayerwiththickeningoftheepidermis.,角化不全Parakeratosis角质层中有细胞核残留，见于银屑病等,Spongiosis(IntercellularEdema):Wideningoftheinterspacesbetweenkeratinocytesduetoedemafluidwithoutdetachmentofcellsfromeachother.,IntracellularEdema,BallooningDegenerationSuchasherpeszoster,ReticulardegenerationSuchasherpessimplex,棘层松解Acantholysis表皮细胞失去粘连，见于天疱疮,Munro微脓肿(Munrosmicroabscess)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）isasharplylocalizededemaorwhealwithasurroundingerythematousflareoccurringwithinsecondstominutesaftertheskinhasbeenstroked.,斑贴试验PatchTest,Patchtestisusedtodetecthypersensitivitytoasubstancethatisincontactwiththeskinsothattheallergenmaybedeterminedandcorrectivemeasurestaken.,Asuspectedallergenisappliedtotheintactuninflamedskinonasmallsurgicalpadorinanaluminumchamber.Removedthepadin48hrsorearlier.Evaluation(Erythema,papules,vesicles):day2,day4,day5,day7,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TopicalApplicationandDosing(1),Attention:Medicationshouldbegentlymassagedintotheskininonethinlayer.Onegramofcreamcovers1010cmAppliedonceortwiceperdayusually.,Extra-pharmacotherapy,TopicalApplicationandDosing(2),Medicationpenetrationvsskinanatomicsite(Mucousmembraneeyelidsfacetorsoextremitiespalmsandsoles)Skinbreakdownallowsincreaseddrugpenetration.Dressingorbodysuitsincreasedrugabsorption.,Extra-pharmacotherapy,TopicalDrugs,BasicPoints:Twomainfactors:drugandvehicle(base)VehicleassistantinbothdrugdeliveryandtherapeuticpropertiesAdequateconcentrationAdequateformulation,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,Solutioninvolvesthedissolutionoftwoormoresubstancesintohomogenousclarity.Thevehicle(base)maybeaqueous,hydroalcoholic,ornonaqueous(alcohol,oils,orpropyleneglycol).(3%Boracicacid),酊剂Tinctures,Tinctureisahydroalcoholicsolutionwithaconcentrationofalcoholofapproximately50%.(iodine),vs醑剂Spiritus,粉剂Powders,Powdersabsorbmoistureanddecreasefriction.Becausetheyadherepoorlytotheskin,theiruseislimitedtocosmeticandhygienicpurposes.talcumpowder,starch,振荡剂（洗剂）Lotions,Lotions(Suspensions)isatwo-phasesystemconsistingofafinelydivided,insolubledrugdispersedintoaliquidinaconcentrationofupto20%.,mintcalaminelotion,乳剂Emulsions,Emulsionsaretwophasesystemsinvolvingoneormoreimmiscibleliquidsdispersedinanotherwiththeassistanceofemulsifyingagent.Water-in-oilemulsionscontainlessthan25%water,withoilbeingthedispersionmedium.Oil-in-wateremulsions(Creams，霜剂)containgreaterthan31%water.Infact,theaqueousphasemaycompriseupto80%oftheformulation.,zincoxide,软膏Ointments,Ointmentsaresemisolidpreparationsthatspreadeasily.Theycanbeprotective,hydratingandlubricating.Thebasesarehydrocarbonbasesandabsorptionbases.,糊剂Pastes,Pastesaresimplytheincorporationofhighconcentrationsofpowders(upto50%)intoanointmentsuchasahydrocarbonbaseorawater-in-oilemulsion.Thepowdermustbeinsolubleintheointment.,zincoxide,凝胶Gels,Gelsaresemi-solidpreparationscontaininghigh-molecular-weightpolymers,suchascarboxypolymethyleneormethylcellulose,andcanberegardedasthickenaqueouslotion.,硬膏Plasters,Plasters(Adhesiveplaster,Adhesivetape)arekindsofadhesive,whosesurfacepaintedwithnaturalrubberandzincoxideasmainrawmaterials,withweaving-clothbacklining.Itisusedindressingwounds.,角质松解剂,油剂Oils,Oilscanbeobtainedfromnumerousvegetablesourcesbypressingorbysolventextraction.Theseareslipperyorviscousliquidorliquefiablesubstancenotmisciblewithwater.,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Clearingagent,Clearingagentisthesubstanceusedtoclearth