皮膚總論英文版(共73張課件)

1Dermatology&VenereologyXinsuo-Duan

2ScheduleofDermatology&VenereologyLectureNo.DateContentsTimeTeacher12-26Generalconsideration(1)2hXinsuoDuan23-5Generalconsideration(2)2hXinsuoDuan33-12Generalconsideration(3)2hXinsuoDuan43-19Viraldermatoses&Bacteriadermatoses2hShupingYu53-26Fungaldermatoses2hShupingYu64-2STD(1)syphilis，AIDS2hXinsuoDuan74-9STD(2)gonorrhea,NGU,CA,chancroid2hXinsuoDuan84-16Eczema&Dermatitis(1)2hJinWang94-23Eczema&Dermatitis(2)2hJinWang104-30Drugeruption2hJingliangWu115-7Urticaria2hJingliangWu125-14Papulosquamousdiseases2hBaoqiangLi135-21BullousDermatoses2hBaoqiangLi145-28Cutaneousvasculitis2hBaoqiangLi156-4Skinappendages2hBaoqiangLi166-11Vitiligo&Skintumors2hBaoqiangLi176-18Practice2h

186-25Test2h

3SectionⅠ

GeneralConsiderationIntroductionStructureofSkinFunctionofSkinSymptom,SignandDiagnosisofDermatosesTreatmentofDermatoses4IntroductionTheskinisthelargestorganofthebodyTherearemorethan2000kindofskindiseaseinDermatologyChapterⅠ

Structureofskin671.Epidermis(structure)81.EpidermiscellskeratinocytemelanocyteLangerhanscellMerkelcell9（1）Keratinocyte④③②①1011Hemi-desmosome12（1）Keratinocyte④③②①13desmosomehemi-desmosomeDesmosome&Hemi-desmosome14Desmosome15Hemi-desmosome16desmosomehemi-desmosomeDesmosome&Hemi-desmosome17（1）Keratinocyte④③②①28d18（2）Melanocytemelanocytepigment-producingcell1920（2）Melanocyte212223（2）Melanocyte24(3)Langerhanscell

Langerhanscellantigenpresentingcell25(3)LangerhanscellLangerhanscells(CD1a)26(4)Merkelcell

Merkelcellcontainintracytoplasmicneurosecretory-likegranules,and,throughtheirassociationwithneurites,actasslowadaptingtouchreceptors.27(4)Merkelcellinthebasallayerofthepalmsandsoles,theoralandgenitalmucosa,thenailbed,andthefollicularinfundibula.

282.Dermiscollagenfiberreticularfiberelasticfibersbasematerial（groundsubstance）：proteoglycanCells:FibroblastmastcellMacrophagedermicarborescentcellLanggerhanscellPigmentophageLymphocyteleukocyte292.Dermiscollagenfibers30reticularfiber312.DermiselasticfibersCorrelatewithtensityofskin322.Dermisreticularedermispapillarydermis333.Hypodermis(subcutaneoustissue)Hypodermis343.Hypodermis(subcutaneoustissue)354.Appendageshairfolliclesebaceousglandseccrineglandsapocrineglandsnail36（1）HairandHairfollicleHair：LonghairShorthairWollyhairEpidermisSebaceousglandsHairrootMedullaryHaircuticleCortexInnerrootsheathOuterrootsheathHairmatrixHairpapilla37DistributionofhairLonghair：scalp,beard,axillaeandpubesShorthair

：eyebrows,eyelids,noseandauditorymeatesSmoothness：vermilionofthelipmammarypapillaPalm,soles,sideofthefingersandtoes,nailbeds,andcertainareasadjacenttomucosalsurface,suchastheglanspenisvellushair(Wollyhair)：

face,neckandtrunk38Hairgrowthcycle

（speed0.27~0.4mm/d，loss70-100/d）

anagen3-10yGrowingphase

catagen3-4wTransitionalphase

telogen3mRestingphase39LonghairgirlLength(1000~1500mm)=0.27~0.4mm/d×365d/y×10y40（2）SebaceousglandsItiscomposedoflobulesofpale-stainingcellswithabundantlipidintheircytoplasm.

41distributionBefoundingreatestabundanceonthefaceandscalp.Theyaredistributedthroughoutallskinsitesexceptthepalmsandsoles.Theyarealwaysassociatedwithhairfolliclesexceptatthefollowingsites:theeyelids(meibomianglands),thebuccalmucosavermilionborderofthelip(Fordyce'sspots)theprepuce(Tyson'sglands)thefemaleareolas(Montgomery'stubercles).42（2）sebaceousglandsDiseases:Comedopapulepustulecyst

43Itopensintotheinfundibularportionofthehairfollicle.Thecoiledsecretoryglandislocatedatthejunctionofthedermisandsubcutaneousfat.（3）Apocrineglands44（3）ApocrineglandsdecapitationsecretionItiscomposedofadoublelayerofcuboidalepithelialcells.Sweatissimilarincompositiontoplasma,containingthesameelectrolytes,thoughinamorediluteconcentration.ShupingYureticularedermisSecretionofsweatoccursasresultofmanyfactorsandismediatedbycholinergicinnervation.sebaceousglandsCutaneousvasculitisTheskinisthelargestorganofthebodyantigenpresentingcellSecretionandExcretionpapillarydermisantigenpresentingcellelasticfibersTreatmentofDermatosesPhysicalProtectionVitiligo&SkintumorsTherearemorethan2000kindofskindiseaseinDermatology45Apocrineunitsofthehumanbodyaregenerallyconfinedtothefollowingsites:axillae,areolae,theanogenitalregion,theexternalauditorycanal(ceruminousglands),andtheeyelids(glandsofMoll).Theglandsdonotbegintofunctionuntilpuberty.（3）Apocrineglands46（4）eccrineglands47（4）eccrineglandscellsareoftwotypes:glycogen-rich,largepalecellssmaller,darkerstainingcellsThepaleglycogen-richcellsformsweat48（4）eccrineglandsThedarkercellsmayactivelyreabsorbsodium,therebymodifyingsweatfromabasicallyisotonicsolutiontoahypotoniconebythetimeitreachestheskinsurface.Sweatissimilarincompositiontoplasma,containingthesameelectrolytes,thoughinamorediluteconcentration.49RegulationSecretionofsweatoccursasresultofmanyfactorsandis

mediatedbycholinergicinnervation.Heatisaprimestimulustoincreasedsweating,Otherphysiologicstimuli,includingemotionalstress,areimportantaswell.Increasedsweatproductioninresponsetoheatispartofthethermoregulatorysystemofthebody;togetherwithincreasedcutaneousbloodflow,itcaneffectivelydissipateexcessivebodyheat.Atfrictionsurfaces,suchasthepalmsandsoles,eccrinesecretionisthoughttoassisttactilesensibilityandimproveadhesion.50distributionEccrinesweatunitsarefoundatvirtuallyallskinsitesexceptthevermillionborderofthelips,nailbeds,labiaminora,glanspenis,andinneraspectoftheprepuce.

Theyaremostabundantonthepalms,soles,forehead,axillae.Someeccrineglandsintheaxillae,especiallyinpatientswithhyperhidrosis,mayhavewidelydilatedsecretarycoilsthatcontainapocrine-appearingcells.51（5）nailnailfoldsnaillunula

nailplatefreemarginofnailnailgroovegrowthvelocity：nailoffinger0.1mm/d，toenail0.1cm/3dnailfoldsnailplatenailbednailrootnailmatrixdigitalbone52Vasculaturethreeimportantintercommunicatingplexuses:

thesubpapillaryplexusupperhorizontalnetworkThedeeper,lowerhorizontalplexusisfoundatthedermal-subcutaneousinterfaceandiscomposedoflargerbloodvesselsthanthoseofthesuperficialplexus.Thevasculatureofthedermisisparticularlywelldevelopedatsitesofadnexalstructures.Associatedwiththevascularplexusarethedermallymphatics.5.Vasculature,Muscles,andNervesofskin5354muscleSmoothmuscleoccursintheskinasarrectorespilorum(erectorsofthehairs),asthetunicadartos(ordartos)ofthescrotum,andintheareolasaroundthenipples.Thearrectorespilorumareattachedtothehairfolliclesbelowthesebaceousglandsand,incontracting,pullthehairfollicleupward,producinggooseflesh.5.Vasculature,Muscles,andNervesofskinmuscle555.Vasculature,Muscles,andNervesofskinNerves

：

TouchismediatedbyMeissnercorpusclesandinthedermalpapillae,particularlyonthepalmsandsoles

PressureismediatedbyVater-Pacinicorpuscleswhichlocateinthedeeperportionofthedermisofweight-bearingsurfaces.Temperature,pain,anditchsensationaretransmittedbyunmyelinatednervefiberswhichterminateinthepapillarydermisandaroundhairfollicles.

ChapterⅡ

FunctionofSkin57Theskin'sfunctionsincludeProtectionAbsorptionSensationsecretionandexcretiontemperatureregulationmetabolismandimmuneFunctionofSkin581.ProtectionPhysicalProtectionChemicalProtectionProtectionagainstpathogenicmicro-organismsPreventthelossoffluid,electrolyteandnutrientsubstance.592.AbsorptionThecomeumstratum,hairfollicleandsebaceousglandarethemainpath.Theabsorptioncanbeaffectedbysomefacors:structureandsiteoftheskin,hydrationofthecorneumstratum,natureofthesubstance,environmentfactors603.SensationThebodyinterpretsexternalstimuliasheat,cold,pain,lighttouch,pressure,itch,andeventickleheatcold614.SecretionandExcretionSweatissecretedbythesweatglandsandgivesafunctionofdiscipatingheat.Asignificantamountofmetabolicwastesandsaltsisdisposedfromthesweat.Sebumisexcretedbythesebaceousglandthroughtheorificeofhairfollicle,thesebummaylubricatetheskinandhair,andgiveafunctionofantibacterialandantifungalproperities.625.TemperatureregulationCutaneousmechanismsoftemperaturecontrolinclude

insulation(primarilysubcutaneousfat),

regulationofcutaneousbloodflow,eccrinesweatactivity(resultingincoolingthroughevaporation),andmuscleactivity,includingshivering(resultinginwarmth).636.MetabolismWatermetabolismcarbohydrateandsaltmetabolismproteinmetabolismlipidandvitaminmetabolismmelaninmetabolism647.ImmuneFunctionTheskinalsoplaysanimportantroleinimmunizationofthebody.65Theend!66IntroductionTheskinisthelargestorganofthebodyTherearemorethan2000kindofskindiseaseinDermatologyChapterⅠ

Structureofskin682.Dermisreticularedermispapillarydermis69（3）ApocrineglandsdecapitationsecretionItiscomposedofadoublelayerofcuboidalepithelialcells.70Apocrineunitsofthehumanbodyaregenerallyconfinedtothefollowingsites:axillae,a