skin disease
Dermatosis (dermatosis) is a general term for diseases that occur in the skin and skin accessory organs. The skin is the largest organ of the human body. Not only are there many types of skin diseases, a variety of diseases that occur in the internal organs can also be manifested on the skin. There are many reasons for skin diseases. For example, skin diseases caused by infectious factors, such as leprosy, scabies, fungal diseases, skin bacterial infections, etc., are often contagious, which not only affects health, but also causes panic and social discrimination. With the improvement of living standards and advances in science and technology, infectious diseases such as leprosy have been clearly controlled all over the world. Other internal and external factors that cause skin diseases, such as mechanical, physical, chemical, biological, endocrine, immune, etc., are currently receiving more and more attention.
Etiological speech
As the first physiological defense line and the largest organ of the human body, the skin always participates in the functional activities of the body and maintains the unity of opposites between the body and the natural environment. The abnormal conditions of the body can also be reflected on the surface of the skin. Skin has almost perfect physiological protection functions: such as barrier function, sensory function, regulating body temperature, absorption function, secretion and excretion function, which plays a very important role in maintaining the health of the body. The physiological function of the skin is damaged, causing skin diseases.
The most common pathogenic factors in skin diseases are infectious diseases and allergic dermatitis. However, with the degenerative changes of aging, senile skin diseases and skin cancer are also important skin diseases. In addition, we should pay attention to various skin disorders caused by side effects caused by drug treatment of diseases. It can be divided into the following categories:
1. Physical and chemical factors
Skin diseases can be caused by pressure and friction, rapid change of local temperature, radiation, light, thermal radiation, chemical reagents and other factors. Some factors can aggravate skin diseases. Such as excessive scratching secondary infection; Hot water scalding, soap washing and improper medication aggravate eczema lesions; Exposure can aggravate photosensitive diseases.
2. Biological factors
Insect bites, contact with some plants, parasites and microbial infections are common pathogenic factors, such as various viral skin diseases caused by viral infection.
3. Food and other diseases
Some foods such as shrimp are easy to cause allergic diseases. Visceral lesions, local infections, blood and lymph circulation disorders can cause skin diseases, such as diabetes mellitus, Yi Huan pruritus, local infection caused infectious eczema like dermatitis, circulatory disorders can cause cyanosis, rubber swelling.
4. Heredity
Some diseases have obvious family history, such as ichthyosis and albinism.
5. Neuropsychiatric factors
Nerve injury can cause nutritional ulcer; Stress is closely related to stress, alopecia areata and chronic simple moss.
6. Metabolic and endocrine factors
Metabolic disorders can cause skin amyloidosis and xanthoma, while Cushing's syndrome is prone to acne and hairiness.
Classified speech
1. Viral skin disease
Common are herpes simplex, herpes zoster, wart (common wart, plantar wart, flat wart, infectious soft wart, condyloma acuminatum), chickenpox, rubella, hand, foot and mouth disease.
2. Bacterial dermatosis
Common are pustulosis, folliculitis, furuncle, carbuncle, cellulitis, erysipelas and leprosy.
3. Fungal dermatosis
Common are tinea capitis, tinea corporis and tinea cruris, tinea manus and pedis, onychomycosis, pityriasis versicolor, Malassezia Folliculitis.
4. Skin diseases caused by animals
Such as scabies, mite dermatitis, paederus dermatitis, lice, insect claw injury or bite.
5. Sexually transmitted diseases
Such as syphilis, gonorrhea and condyloma acuminatum.
6. Allergic and autoimmune skin diseases
Common contact dermatitis, eczema and urticaria; Allergic cutaneous vasculitis, drug-induced dermatitis, anaphylactic shock, etc.
7. Physical skin diseases
The common ones are solar skin diseases, summer dermatitis, prickly heat, chilblain, corns, chapped hands and feet, and pressure sores.
8. Neurodysfunctional dermatosis
The common ones are pruritus, neurodermatitis and parasitic paranoia.
9. Erythematous papulosquamous dermatosis
Common diseases include psoriasis, pityriasis simplex, pityriasis rosea, lichen planus and erythroderma.
10. Connective tissue diseases
The common are lupus erythematosus, scleroderma, Sjogren's syndrome and dermatomyositis.
11. Bullous dermatosis
The common ones are herpes simplex and bullous pemphigoid.
12. Pigmented skin disease
The common ones are chloasma, vitiligo, tattoo, freckles, pigmented nevus, coffee spot, chloasma, freckle like nevus, Riehl melanosis, perioral sunspot, OTA nevus, pigmented epidermal nevus, generalized sunspot disease, face neck follicular erythematous melanosis nevus, pigmented pityriasis rosea, nevus, congenital nevus pigmentosus, reticular pigmentation anomaly at the fold, Mongolian spot Tattoo, vitiligo, non pigmented nevus, centrifugal acquired leukoplakia, hereditary symmetrical pigment abnormality, anemia nevus, etc.
13. Skin adnexal diseases
Common are acne, rosacea, seborrheic dermatitis, alopecia areata, alopecia, hyperhidrosis and sweating.
14. Hereditary skin diseases
Common diseases include ichthyosis, perihairy keratosis, hair moss, hereditary epidermolysis bullosa, familial benign chronic pemphigus.
15. Nutritional and metabolic disorders
Common vitamin deficiency (toad skin disease, riboflavin deficiency, niacin deficiency), enteropathic acrodermatitis and xanthomatosis.
16. Skin tumor
Precancerous skin diseases, such as solar keratosis and mucosal leukoplakia; Malignant skin tumors, such as Bowen's disease (skin carcinoma in situ), eczema like carcinoma (Paget's disease), basal cell carcinoma, squamous cell carcinoma, mycosis fungoides, and malignant melanoma.
Diagnostic speech
Like other diseases, the diagnosis of skin diseases must be comprehensively analyzed according to medical history, physical examination and laboratory examination:
1. Ask for medical history
The dermatology department should focus on asking whether the patients have conscious symptoms, duration and degree, the prone site of skin lesions, the order of occurrence, distribution, shape, color, whether there are other diseases or drugs used before the onset, whether there are systemic symptoms, whether it is related to season, climate, living and working environment, diet, etc., and whether there are similar skin diseases in the family, How about the diagnosis and treatment and curative effect after onset.
2. Physical examination
(1) Focus on the distribution of lesions, the type, number, size, shape, surface and base of lesions, and whether the color, blister content and its color, arrangement characteristics and boundary are clear.
(2) Auxiliary physical inspection
1) Slide compression method: press the slide firmly on the damage for 10 ~ 20 seconds, and the color of inflammatory erythema and hemangioma can disappear. It can be used to distinguish erythema and purpura, and to observe lupus nodules.
2) Skin scratch: scratch the skin with a blunt instrument. If there is a wind mass at the scratch, it is called positive skin scratch. Patients with urticaria are often positive. When the skin of atopic dermatitis and erythroderma is mechanically stimulated, the skin appears pale anemic reaction.
3) Sensory examination includes temperature, touch and pain.
4) Filtered ultraviolet examination, such as tinea flavum, dark green fluorescence in hair and bright green fluorescence in tinea albicans. Other diseases, such as tinea versicolor and porphyria, can emit different colors of fluorescence.
5) Spinous layer cell lysis sign (Nissl sign) is positive when the blister spreads around, the normal skin is pushed and the skin with normal appearance between the blisters is wiped off.
3. Laboratory inspection
(1) Skin histopathological examination some skin diseases have their unique pathological changes, which can be used for diagnosis and differential diagnosis.
(2) Skin test ① patch test is used to check contact allergens. ② Scratch test or intradermal test is used to check immediate allergic reaction and determine whether a substance has allergic reaction (type I). ③ Leprosy test is used to judge the immune status of leprosy patients. ④ Tinea test is helpful to the diagnosis of tinea rash.
(3) Microbiological examination of skin fungi, leprosy bacilli and scabies are helpful to the diagnosis of corresponding skin diseases.
Therapeutic speech
External medication is the most widely used in the treatment of skin diseases. If the external medication is selected or used improperly, it is often ineffective and even aggravate the disease.
Attention should be paid to the following aspects in the selection of external drugs for skin diseases: the same drugs have different dosage forms, such as solution, paste, powder, cream, lotion, ointment, tincture and emulsion. Different dosage forms have different functions and indications. Therefore, different dosage forms of topical drugs should be correctly selected according to the clinical symptoms and skin lesions in different stages.
1. Generally, in case of local redness, swelling, blisters and erosion in the acute stage, wet compress with solution is often used, which can play the role of anti-inflammatory and heat dissipation; If there is seepage, wet compress with solution first, and then oil.
2. When the skin lesion is in the subacute stage, the redness and swelling will be reduced and the exudation will be reduced. Paste, powder and lotion can be selected as appropriate to play the role of anti-inflammatory, antipruritic, astringent and protective.
3. Cream, ointment, hard ointment, etc. can be used when the skin lesions are thickened and mossy in the chronic stage.
4. Pay attention to the medication time and times of skin diseases. Potions and lotions are easy to volatilize and reduce the curative effect. The number of medication is relatively large. Generally, they are applied once every 3 hours; Tincture and ointment have a long-lasting effect, and can be used once a day in the morning and evening. Wet compress method should also be appropriate. Before medication, in addition to cleaning the affected part, the scab should be disinfected and softened with food oil before wiping off. If blisters with a diameter of more than half a centimeter are seen at the skin lesions, the contents shall be extracted with a sterile empty syringe and the blister wall shall be retained. The hair should be shaved before applying the medicine.
5. The selection of drugs should also consider age, gender, disease location and patient constitution. If the old and young patients should choose low concentration drugs; When pregnant women use topical drugs, they should take into account the impact on the fetus and suckling infants; Do not use drugs with high concentration or strong irritation on the face, breast and vulva, and children and women should use them with caution; High concentration drugs can be used for palm and plantar parts; For those with sensitive skin, use low concentration first and then high concentration. For new drugs or sensitizing drugs, first use them in a small area. If there is no response, gradually increase the concentration and expand the use area as needed.
Physical therapy is also a common treatment for skin diseases. Common physical therapies include electrotherapy, phototherapy, microwave therapy, cryotherapy, laser, hydrotherapy and radiotherapy.
评论
发表评论