1、1Schedule of Dermatology&Venereology LectureNo.DateContentsTimeTeacher12-26General consideration(1)2hXinsuo Duan 23-5General consideration(2)2hXinsuo Duan 33-12General consideration(3)2hXinsuo Duan 43-19Viral dermatoses&Bacteria dermatoses 2hShuping Yu 53-26Fungal dermatoses2hShuping Yu 64-2STD(1)sy
2、philis，AIDS2hXinsuo Duan 74-9STD(2)gonorrhea,NGU,CA,chancroid2hXinsuo Duan 84-16Eczema &Dermatitis(1)2hJin Wang 94-23Eczema &Dermatitis(2)2hJin Wang 104-30Drug eruption2hJingliang Wu115-7Urticaria 2hJingliang Wu125-14Papulosquamous diseases2hBaoqiang Li 135-21Bullous Dermatoses2hBaoqiang Li 145-28Cu
3、taneous vasculitis2hBaoqiang Li 156-4Skin appendages2hBaoqiang Li 166-11Vitiligo &Skin tumors2hBaoqiang Li 176-18Practice2h186-25Test2h2Section General Consideration Introduction Structure of Skin Function of Skin Symptom, Sign and Diagnosis of Dermatoses Treatment of Dermatoses3 Introduction The sk
4、in is the largest organ of the body There are more than 2000 kind of skin disease in Dermatology Structure of skin561. Epidermis(structure)71.Epidermis cells keratinocyte melanocyte Langerhans cell Merkel cell8（1） Keratinocyte910Hemi-desmosome11（1） KeratinocyteTransitional phaseVasculature , Muscles
5、 , and Nerves of skinTouch is mediated by Meissner corpuscles and in the dermal papillae, particularly on the palms and soles（3）Apocrine glandsSweat is similar in composition to plasma, containing the same electrolytes, though in a more dilute concentration.Chapter Structure of skinThe skins functio
6、ns includeA significant amount of metabolic wastes and salts is disposed from the sweat.Hair matrixprotein metabolismBaoqiang Liand muscle activity, including shivering(resulting in warmth).Cutaneous mechanisms of temperature control includeMerkel cellMerkel cellThe body interprets external stimuli
7、as heat, cold, pain, light touch, pressure, itch, and even tickleGrowing phasevermilion of the lipSchedule of Dermatology&Venereology Lecturevermilion border of the lip (Fordyces spots)12desmosomehemi-desmosomeDesmosome & Hemi-desmosome13Desmosome14Hemi-desmosome15desmosomehemi-desmosomeDesmosome &
8、Hemi-desmosome16（1） Keratinocyte28d17（2）Melanocytemelanocytepigment-producing cell 1819（2）Melanocyte202122（2）MelanocyteThe vasculature of the dermis is particularly well developed at sites of adnexal structures.Baoqiang Lihemi-desmosomeThey are most abundant on theDistribution of hairthe external au
9、ditory canal (ceruminous glands),Cutaneous vasculitisvermilion of the lipMerkel cellVasculature , Muscles , and Nerves of skinSkin appendages（1） Keratinocyte（4）eccrine glandsIt is composed of a double layer of cuboidal epithelial cells.General consideration(1)Eccrine sweat units are found at virtual
10、ly all skin sites except the vermillion border of the lips, nailbeds, labia minora,glans penis,and inner aspect of the prepuce .protein metabolismPrevent the loss of fluid, electrolyte and nutrient substance.Epidermis(structure)Sweat is secreted by the sweat glands and gives a function of discipatin
11、g heat.23(3) Langerhans cell Langerhans cellantigen presenting cell24(3) Langerhans cellLangerhans cells (CD1a)25(4) Merkel cell Merkel cellcontain intracytoplasmic neurosecretory-like granules, and, through their association with neurites, act as slow adapting touch receptors. 26(4) Merkel cellin t
12、he basal layer of the palms and soles, the oral and genital mucosa, the nail bed, and the follicular infundibula. 272.Dermis collagen fiber reticular fiber elastic fibers base material（ground substance）：proteoglycan Cells: Fibroblast mast cell Macrophage dermic arborescent cell Langgerhans cell Pigm
13、entophage Lymphocyte leukocyte282.Dermis collagen fibers29reticular fiber302.Dermis elastic fibersCorrelate with tensity of skin312.Dermisreticulare dermispapillary dermis323. Hypodermis(subcutaneous tissue)HypodermisHypodermis333. Hypodermis(subcutaneous tissue)344. Appendages hair follicle sebaceo
14、us glands eccrine glands apocrine glands nail35（1）Hair and Hair follicleHair：Long hairShort hairWolly hairEpidermisSebaceous glandsHair rootMedullaryHair cuticleCortexInner root sheathOuter root sheathHair matrixHair papilla36Distribution of hair Long hair：scalp, beard, axillae and pubes Short hair
15、：eyebrows, eyelids, nose and auditory meates Smoothness： vermilion of the lip mammary papilla Palm,soles, side of the fingers and toes, nail beds,and certain areas adjacent to mucosal surface,such as the glans penis vellus hair(Wolly hair) ： face,neck and trunkAppendageselastic fibersThere are more
16、than 2000 kind of skin disease in DermatologyThe comeum stratum, hair follicle and sebaceous gland are the main path.The deeper, lower horizontal plexus is found at the dermal-subcutaneous interface and is composed of larger blood vessels than those of the superficial plexus.Outer root sheathvermili
17、on of the lipChapter Structure of skin（3）Apocrine glandsCutaneous mechanisms of temperature control includevermilion border of the lip (Fordyces spots)hemi-desmosomedistributionLanggerhans cellapocrine glandsvellus hair(Wolly hair) ： face,neck and trunkIt is composed of a double layer of cuboidal ep
18、ithelial cells.Palm,soles, side of the fingers and toes, nail beds,and certain areas adjacent to mucosal surface,such as the glans penisShort hair ：eyebrows, eyelids, nose and auditory meatesdermic arborescent cell37Hair growth cycle（speed 0.270.4mm/d，loss70-100/d） anagen3-10yGrowing phase catagen3-
19、4wTransitional phase telogen3mResting phase38Long hair girlLength(10001500mm)= 0.270.4mm/d365d/y10y39（2）Sebaceous glandsIt is composed of lobules of pale-staining cells with abundant lipid in their cytoplasm. 40distributionBe found in greatest abundance on the face and scalp.They are distributed thr
20、oughout all skin sites except the palms and soles. They are always associated with hair follicles except at the following sites: the eyelids (meibomian glands),the buccal mucosa vermilion border of the lip (Fordyces spots)the prepuce (Tysons glands)the female areolas (Montgomerys tubercles). 41（2）se
21、baceous glandsDiseases:Comedopapulepustulecyst 42 It opens into the infundibular portion of the hair follicle. The coiled secretory gland is located at the junction of the dermis and subcutaneous fat. （3）Apocrine glands43（3）Apocrine glandsdecapitation secretion It is composed of a double layer of cu
22、boidal epithelial cells.44Apocrine units of the human body are generally confined to the following sites: axillae, areolae, the anogenital region, the external auditory canal (ceruminous glands), and the eyelids (glands of Moll). The glands do not begin to function until puberty. （3）Apocrine glands4
23、5（4）eccrine glands46（4）eccrine glands cells are of two types: glycogen-rich, large pale cells smaller, darker staining cells The pale glycogen-rich cells form sweatTransitional phaseDistribution of hairOuter root sheathTemperature, pain, and itch sensation are transmitted by unmyelinated nerve fiber
24、s which terminate in the papillary dermis and around hair follicles.Hypodermis(subcutaneous tissue)protein metabolismLanggerhans cellPrevent the loss of fluid, electrolyte and nutrient substance.base material（ground substance）：proteoglycanGeneral consideration(1)The pale glycogen-rich cells form swe
25、atEccrine sweat units are found at virtually all skin sites except the vermillion border of the lips, nailbeds, labia minora,glans penis,and inner aspect of the prepuce .the eyelids (meibomian glands),AbsorptionSkin appendages（3）Apocrine glandsvermilion of the lip（4）eccrine glandscarbohydrate and sa
26、lt metabolismBaoqiang LiThe body interprets external stimuli as heat, cold, pain, light touch, pressure, itch, and even tickleApocrine units of the human body are generally confined to the following sites:47（4）eccrine glands The darker cells may actively reabsorb sodium, thereby modifying sweat from
27、 a basically isotonic solution to a hypotonic one by the time it reaches the skin surface. Sweat is similar in composition to plasma, containing the same electrolytes, though in a more dilute concentration. 48RegulationSecretion of sweat occurs as result of many factors and is mediated by cholinergi
28、c innervation. Heat is a prime stimulus to increased sweating, Other physiologic stimuli, including emotional stress, are important as well. Increased sweat production in response to heat is part of the thermoregulatory system of the body; together with increased cutaneous blood flow, it can effecti
29、vely dissipate excessive body heat. At friction surfaces, such as the palms and soles, eccrine secretion is thought to assist tactile sensibility and improve adhesion. 49 distributionEccrine sweat units are found at virtually all skin sites except the vermillion border of the lips, nailbeds, labia m
30、inora,glans penis,and inner aspect of the prepuce . They are most abundant on the palms, soles, forehead, axillae. Some eccrine glands in the axillae, especially inpatients with hyperhidrosis, may have widely dilated secretary coils that contain apocrine-appearing cells. 50（5）nailnail foldsnail lunu
31、la nail platefree margin of nailnail groovegrowth velocity：nail of finger 0.1mm/d，toenail 0.1cm/3dnail foldsnail platenail bednail rootnail matrixdigital bone51Vasculature three important intercommunicating plexuses: the subpapillary plexus upper horizontal network The deeper, lower horizontal plexu
32、s is found at the dermal-subcutaneous interface and is composed of larger blood vessels than those of the superficial plexus. The vasculature of the dermis is particularly well developed at sites of adnexal structures. Associated with the vascular plexus are the dermal lymphatics. 5. Vasculature , M
33、uscles , and Nerves of skin 5253 muscle Smooth muscle occurs in the skin as arrectores pilorum (erectors of the hairs), as the tunica dartos (or dartos) of the scrotum, and in the areolas around the nipples. The arrectores pilorum are attached to the hair follicles below the sebaceous glands and, in
34、 contracting, pull the hair follicle upward, producing gooseflesh. 5. Vasculature , Muscles , and Nerves of skin muscle545. Vasculature , Muscles , and Nerves of skin Nerves ： Touch is mediated by Meissner corpuscles and in the dermal papillae, particularly on the palms and soles Pressure is mediate
35、d by Vater-Pacini corpuscles which locate in the deeper portion of the dermis of weight-bearing surfaces. Temperature, pain, and itch sensation are transmitted by unmyelinated nerve fibers which terminate in the papillary dermis and around hair follicles. 56 The skins functions include Protection Ab
36、sorption Sensation secretion and excretion temperature regulation metabolism and immuneFunction of SkinBullous DermatosesJin WangSmoothness：Merkel cellOuter root sheathEczema &Dermatitis(1)Shuping Yu(4) Merkel cellmammary papilla（3）Apocrine glandsChapter Structure of skingrowth velocity：eccrine glan
37、dsResting phaseIncreased sweat production in response to heat is part of the thermoregulatory system of the body; together with increased cutaneous blood flow, it can effectively dissipate excessive body heat.Function of SkinSTD(2)gonorrhea,NGU,CA,chancroidThe arrectores pilorum are attached to the
38、hair follicles below the sebaceous glands and, in contracting, pull the hair follicle upward, producing gooseflesh.Protection against pathogenic micro-organismsLanggerhans cellIt opens into the infundibular portion of the hair follicle.（2）Sebaceous glands571.Protection Physical Protection Chemical P
39、rotection Protection against pathogenic micro-organisms Prevent the loss of fluid, electrolyte and nutrient substance. 582. Absorption The comeum stratum, hair follicle and sebaceous gland are the main path. The absorption can be affected by some facors: structure and site of the skin, hydration of
40、the corneum stratum, nature of the substance, environment factors593.Sensation The body interprets external stimuli as heat, cold, pain, light touch, pressure, itch, and even tickle heatcold604.Secretion and Excretion Sweat is secreted by the sweat glands and gives a function of discipating heat. A
41、significant amount of metabolic wastes and salts is disposed from the sweat. Sebum is excreted by the sebaceous gland through the orifice of hair follicle, the sebum may lubricate the skin and hair, and give a function of antibacterial and antifungal properities. 615.Temperature regulation Cutaneous
42、 mechanisms of temperature control include insulation (primarily subcutaneous fat), regulation of cutaneous blood flow, eccrine sweat activity (resulting in cooling through evaporation), and muscle activity, including shivering(resulting in warmth). 626.Metabolism Water metabolism carbohydrate and s
43、alt metabolism protein metabolism lipid and vitamin metabolism melanin metabolism 63 7.Immune Function The skin also plays an important role in immunization of the body.6465 Introduction The skin is the largest organ of the body There are more than 2000 kind of skin disease in Dermatology Structure
44、of skin672.Dermisreticulare dermispapillary dermis68（3）Apocrine glandsdecapitation secretion It is composed of a double layer of cuboidal epithelial cells.69Apocrine units of the human body are generally confined to the following sites: axillae, areolae, the anogenital region, the external auditory
45、canal (ceruminous glands), and the eyelids (glands of Moll). The glands do not begin to function until puberty. （3）Apocrine glandsA significant amount of metabolic wastes and salts is disposed from the sweat.Merkel cellXinsuo DuanShort hair ：eyebrows, eyelids, nose and auditory meatesChapter Structu
46、re of skinSmoothness：Some eccrine glands in the axillae, especially inpatients with hyperhidrosis, may have widely dilated secretary coils that contain apocrine-appearing cells.Vasculature , Muscles , and Nerves of skinHemi-desmosomeTemperature, pain, and itch sensation are transmitted by unmyelinat
47、ed nerve fibers which terminate in the papillary dermis and around hair follicles.Baoqiang Li1mm/d，toenail 0.collagen fibersThe vasculature of the dermis is particularly well developed at sites of adnexal structures.Immune FunctionThe body interprets external stimuli as heat, cold, pain, light touch
48、, pressure, itch, and even ticklereticulare dermisFunction of SkinDistribution of hairBaoqiang Li70 distributionEccrine sweat units are found at virtually all skin sites except the vermillion border of the lips, nailbeds, labia minora,glans penis,and inner aspect of the prepuce . They are most abund
49、ant on the palms, soles, forehead, axillae. Some eccrine glands in the axillae, especially inpatients with hyperhidrosis, may have widely dilated secretary coils that contain apocrine-appearing cells. 714.Secretion and Excretion Sweat is secreted by the sweat glands and gives a function of discipati
50、ng heat. A significant amount of metabolic wastes and salts is disposed from the sweat. Sebum is excreted by the sebaceous gland through the orifice of hair follicle, the sebum may lubricate the skin and hair, and give a function of antibacterial and antifungal properities. Increased sweat productio
