皮肤病学：皮肤病学总论.ppt

三、微波治疗microwave 四、冷冻疗法Cryotherapy 五、水疗法hydrotherapy 药浴 六、放射疗法 Radiotherapy 第四节、皮肤外科治疗 一、体表小外科手术 二、皮肤移植术 三、毛发移植术 四、腋臭手术疗法 五、Mohs 外科切除技术（Mohs microsurgery 六、皮肤磨削术、切割术 THE SKIN IS LIKE A BOX OF CHOCOLATES YOU NEVER KNOW WHAT YOU’RE GOING SEE NEXT 思考题： 如何理解皮肤的屏障功能和免疫器官？ 如何选用外用药？ 如何区别各种皮损？ * *Knowledge of the anatomy and physiology of the skin is essential to accurate patient assessment. * Skin also varies in thickness among anatomic location, sex, and age of the individual. This varying thickness primarily represents a difference in dermal thickness, as epidermal thickness is rather constant throughout life and from one anatomic location to another. Skin is thickest on the palms and soles of the feet (~1.5 mm thick), while the thinnest skin is found on the eyelids and in the postauricular region (~0.05 mm thick). Male skin is characteristically thicker than female skin in all anatomic locations. Children have relatively thin skin, which progressively thickens until the fourth or fifth decade of life when it begins to thin. This thinning is also primarily a dermal change, with loss of elastic fibers, epithelial appendages, and ground substance.  * The integument consists of 2 mutually dependent layers, the epidermis and dermis, which rest on a fatty subcutaneous layer, the panniculus adiposus. The epidermis is derived primarily from surface ectoderm but is colonized by pigment-containing melanocytes of neural crest origin, antigen-processing Langerhans cells of bone marrow origin, and pressure-sensing Merkel cells of neural crest origin. The dermis is derived primarily from mesoderm and contains collagen, elastic fibers, blood vessels, sensory structures, and fibroblasts. During the fourth week of embryologic development, the single cell thick ectoderm and underlying mesoderm begin to proliferate and differentiate. The specialized structures formed by the skin, including teeth, hair, hair follicles, fingernails, toenails, sebaceous glands, sweat glands, apocrine gl