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TheskinandSkinRegenerativeMedicine再生醫(yī)學LujunYangBurnsandPlasticsuregeryCenterforTranslationalmedicine2ndHospitalofShantouUniversityKayiName?Agingskinskin
thelargestorganinthebodyprotectsenseregulatetemperatureProductionofVitaminDClininiansDermatology-----dermatologistPlasticandestheticsurgery------plasticsurgeonKeratinocytefibroblastOBJECTIVEMaster
skinstructureandfunction
epidermis-----keratinization角化作用:proliferation增殖/differentiation分化AcquaitanceAnomalies異?,F(xiàn)象
ofskin----commonskindiseases
AdvanceSkinregenerativemedicine皮膚再生醫(yī)學INTRODUCTIONepidermisdermishypodermisDermis真皮Papillarylayer乳頭層+Reticularlayer網狀層第二節(jié)真皮epidermishypodermisdermisskindermis真皮papillarylayer乳頭層reticularlayer網織層appendages附屬器hair毛sebaceousgland皮脂腺sweatgland汗腺THESTRUCTUREOFSKINepidermis表皮stratumcorneum角質層stratumlucidum(透明層)stratumgranulosum顆粒層stratumspinosum棘層stratumbasale基底層nail指(趾)甲EPIDERMIS主要細胞組成keratinocyte(角質形成細胞
)non-keratinocyte(非角質形成細胞)differentiationstratumcorneum角質層
stratumgranulosum顆粒層stratumlucidum(透明層)
stratificationstratumbasale基底層stratumspinosum棘層(一)EpidermalstratificationanddifferentiationPSORIASIS銀屑病redandwhitehuesofscalypatchesappearingonthetopfirstlayeroftheepidermis(skin).Langerhanscell(郞格漢斯細胞)Langerhanscellsaredendriticcells(antigen-presentingimmunecells)oftheskinandmucosa,andcontainlargegranulescalledBirbeckgranules.Theyarepresentinalllayersoftheepidermis,butaremostprominentinthestratumspinosum.Inskin
infections,thelocalLangerhanscellstakeupandprocessmicrobial
antigenstobecomefullyfunctionalantigen-presentingcells.Langerhanscellsderivefromthecellulardifferentiationofmonocyteswiththemarker"Gr-1"(alsoknownas"Ly-6G/Ly-6C").Thisdifferentiationrequiresstimulationbycolonystimulatingfactor(CSF)-1.6Theyaresimilarinmorphologyandfunctiontomacrophages.Albinoslackanenzymecalledtyrosinase絡氨酸酶.Tyrosinaseisrequiredformelanocytestoproducemelaninfromtheaminoacid
tyrosine
melanocyte(黑素細胞)Melanocytesaremelanin-producingcellslocatedinthebottomlayer(thestratumbasale)oftheskin‘sepidermis,themiddlelayeroftheeye(theuvea),theinnerear,meninges,Melaninisapigment色素
thatisresponsibleprimarilyforthecolorofskin.Nodifferenceinmelanocytenumberbetweenspecies.Thedistributionandtyrosinaseactivity!VitiligoMelanoma(黑色素瘤):4%ofalldiagnosedskincancers,melanomabeginsinthemelanocytes,cellswithintheepidermisthatgiveskinitscolor.Melanomahasbeencoined“themostlethalformofskincancer”becauseitcanrapidlyspreadtothelymphsystemandinternalorgans.Withearlydetectionandpropertreatment,thecurerateformelanomaisabout95%.Onceitsspreads,theprognosisispoor.Melanomamostoftendevelopsinapre-existingmoleorlookslikeanewmole,whichiswhyitisimportantforpeopletoknowwhattheirmoleslooklikeandbeabletodetectchangestoexistingmolesandspotnewmoles.
TheHair
SebaceousGlands
皮脂腺SweatGlands
TheNails
TheAccessaryStructuresoftheSkinAcnevulgaris尋常痤瘡普通粉刺
(orcysticacne)isacommondisease,characterizedbyareasofskinwithscaly鱗狀的
redskin,blackheads黑頭粉刺
andwhiteheads,pinheads針頭,pimples丘疹,nodules小瘤
andpossiblyscarring結疤.Acneaffectsmostlyskinwiththedenset密集
populationofsebaceousfollicles皮脂腺;theseareasincludetheface,theupperpartofthechest,andtheback.Severeacneisinflammatory炎癥性的,butacnecanalsomanifest顯現(xiàn)
innoninflammatoryforms.2Thelesions損傷
arecausedbychangesinpilosebaceous毛囊皮脂腺
units,skinstructuresconsistingofahairfollicleanditsassociatedsebaceousgland,changesthatrequireandrogen雄性激素
stimulation.Acneoccursmostcommonlyduringadolescence,andoftencontinuesintoadulthood.Inadolescence,acneisusuallycausedbyanincreaseintestosterone睪丸素,whichpeopleofbothgenders性別
accrueduringpuberty青春期.AlopeciaTotalis(全頭脫毛癥)Alopeciameanslossofhairfromtheheadorbody.baldness,Hemidesmosomes(HD)areverysmallstud-orrivet-likestructuresontheinnerbasalsurfaceofkeratinocytesintheepidermisofskin.Theyaresimilarinformtodesmosomeswhenvisualizedbyelectronmicroscopy.Whiledesmosomeslinktwocellstogether,hemidesmosomesattachonecelltotheextracellularmatrix.Desmosomes細胞橋粒
aremolecularcomplexesofcelladhesion黏著蛋白
proteinsandlinkingproteinsthatattachthecellsurfaceadhesionproteinstointracellularkeratin
角蛋白cytoskeletal細胞支架細胞
filaments細絲.Thecelladhesionproteinsofthedesmosome,desmoglein橋粒芯蛋白
anddesmocollin橋粒膠蛋白,aremembersofthecadherin鈣粘蛋白
familyofcelladhesionmolecules.Theyaretransmembraneproteinsthatbridgethespacebetweenadjacentepithelialcellsbywayofhomophilicbindingoftheirextracellulardomainstootherdesmosomalcadherinsontheadjacentcell.Bothhavefiveextracellulardomains,andhavecalcium-bindingmotifs.Age-associatedskinchangesincludethinning,skinlaxity松弛,fragility脆弱,andwrinkles皺紋.Sun-exposedareasdemonstrateadditionalagingchanges,includingdyspigmentation,prematurewrinkling,telangiectasia,andactinicelastosis.UVA400–315nmUVB315–280nmThesun
emitsultravioletradiationintheUVA,UVB,andUVCbands.TheEarth'sozonelayer
blocks97–99%ofthisUVradiationfrompenetratingthroughtheatmosphere.OftheultravioletradiationthatreachestheEarth'ssurface,98.7%isUVAPhotoaging光老化UVandmolecularandgeneticchangesUVBrayisconsideredasaprimarymutagenthatcanonlypenetratethroughtheepidermaloroutermostlayeroftheskin,resultinginDNAmutations.Theepidermallayerdoesnotcontainanybloodvesselsornerveendingsbutmelanocytesandbasalcellsareembeddedinthislayer.UponexposuretoUVBrays,melanocyteswillproducemelanin,apigmentthatgivestheskinitscolortone.However,UVBwillcausetheformationoffrecklesanddarkspots,bothofwhicharesymptomsofphotoaging.WithconstantexposuretoUVBrays,signsofphotoagingmightappearandprecancerouslesionsorskincancermaydevelop.UVAraysareabletopenetratedeeperintotheskinascomparedtoUVBrays.Hence,inadditiontotheepidermallayer,thedermallayerwillalsobedamaged.Thedermisisthesecondmajorlayeroftheskinanditcomprisescollagen,elastin,andextrafibrillarmatrixwhichprovidesstructuralsupporttotheskin.However,withconstantUVAexposure,thesizeofthedermislayerwillbereduced,therebycausingtheepidermistostartdroopingoffthebody.Duetothepresenceofbloodvesselsinthedermis,UVArayscouldleadtodilatedorbrokenbloodvesselsmostcommonlyvisibleonthenoseandcheeks.Photoaging:telangiectasia,pigmentationLaserandPhotonskintreatmentSunscreenSPF:ratiooftheminimalerythemadose(MED)ofsunscreen-protectedskinovertheMEDofunprotectedskin.CurrentlyavailableproductsofferexcellentprotectionfromUVBa
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