皮肤性病学教案及讲稿2006级留学General课程名称年级授课专业Dermatology and Veneraolgy生Contents教师职称大课示教学时陈爱军副教授授课方式题目章节《Pemphigus》教材名称作者Liu Tong《Dermatovenereology》Dean'sXi'anofficeJiaotongof版次First出版社UniversityNovember2004教学目tomaster:Thedefinition of pemphigus1.2.tomaster:The etiologyand pathogenesis ofpemphigus的Stomaster:Theclinicalmanifestationsofpemphigus要towellknown:Thetreatmentofpemphigus4.求教1.The etiology and pathogenesis pemphigus.学2The clinical manifestations of pemphigus.难3.Thetreatmentofpemphigus.点教The definition of pemphigus.1.学2.The clinical manifestations of pemphigus.重3The treatment of pemphigus..点外语全英语教学要求教学方法大课讲述、多媒体、彩色图谱、临床病例手段参考《临床皮肤病学》赵辨等主编，2001年江苏科学技术出版社1.资料2.《AnderwsDiseasesofskin》（第九版英文影印版）Richard.B.O等主编，科学出版社教研室意教学组长：单葵教研室主任：李惠见17日2009年9月
皮肤性病学教案及讲稿 课程名称 General Contents 年级 2006 级留学 生 授课专业 Dermatology and Veneraolgy 教 师 陈爱军 职称 副教授 授课方式 大课 示教 学时 1 题目章节 《Pemphigus》 教材名称 《Dermatovenereology》 作者 Liu Tong 出 版 社 Dean’s office of Xi’an Jiaotong University November 2004 版次 First 教 学 目 的 要 求 1. to master:The definition of pemphigus 2. to master:The etiology and pathogenesis of pemphigus 3. to master:The clinical manifestations of pemphigus 4. to well known:The treatment of pemphigus. 教 学 难 点 1. The etiology and pathogenesis pemphigus. 2. The clinical manifestations of pemphigus. 3. The treatment of pemphigus. 教 学 重 点 1. The definition of pemphigus. 2. The clinical manifestations of pemphigus. 3. The treatment of pemphigus. 外语 要求 全英语教学 教学 方法 手段 大课讲述、多媒体、彩色图谱、临床病例 参考 资料 1. 《临床皮肤病学》赵辨等主编，2001 年江苏科学技术出版社 2. 《Anderws Diseases of skin》（第九版英文影印版）Richard.B.O 等主编，科学出版社 教研 室意 见 教学组长： 单葵 教研室主任：李惠 2009 年 9 月 17 日
2 mDefinitionPemphigus is intraepidermal blistering disease characterized by autoimmunity to specificproteinspresent withineithertheepidermalcell membraneorthedesmosome2 mClassification:Pemphigus vulgaris+Pemphigus vegetansPemphigus foliaceusPemphigus erythematosusPemphigus herpetiformisEtiology and pathogenesis3 mIntercellular antibodies(IC)CirculatingIC antibodies arepresent in mostpemphigus patient's serumCirculating IC antibody titers often parallel disease activity&Direct immunofluorescence (DIF)test shows intercellular IgG throughout theepidermis or the oral epitheliumIgG is found in both involved and clinically normal skin in nearly all patientswith pemphigusC3depositionis also reliablyfound inacantholytic areasThepathologic changes inpemphigusvulgaris areacantholysis.clefis and blister20mformation in the intraepidermal areas just above the basal cell layer.Clinical featuresPemphigus vulgaris:thin-walled, relatively flaccid, easily ruptured bullae that appear on either&apparentlynomalskinandmucousmembranesoronerythematousbases+Sites:the lesions appear first in mouth and next most commonly in the groin,scalp,face,neck, axillae, or genitals.Nikolsky's sign is present:the upper layers are easily made to slip laterallyPemphigus vegetansFlaccid bullae that become erosions and form fungoid vegetations orpapillomatous proliferation.&Sites: nose,mouth, scalp, axillae, groin, genitalia, perineum, and flexuralextremities.&Nikolsky's sign is presentPemphigus foliaceusBegin with small, flaccid bullaethat rupturealmost asthey evolvetofromcrusting, below that is a moist surface with a tendency to bleed心Nikolsky's sign is present.Ages:occursmostlyinadultsbetween40and50years.Pemphigus erythematosus:4The early lesions are circumscribed patches of erythema and crusting+The lesions areerythematous and thickly crusted, bullous, or evenhyperkeratoticThe lesions are localized on nose, check and ears. Crusting are impetiginouslesions appear amid bullae on the scalp, chest, and extremities. Bullae occuronthetrunkfromtimetotimePemphigus herpetiformis:"Ages: the middle-aged and the elder peopleSites: trunk and upper extremities, macules&Features: annular and multi-annular erythematous macules with edges.Tensevesicles and/or papulovesicles can be seen on themacules.Nikolsky's sign isnot present.2 m&Self-symptom: tense itchingHistopathologyThe pathologic changes in pemphigus vulgaris are acantholysis, clefis and blisterformation,and the prescence of acantholytic cells(Tzanck cells)lining the bullain the1 mintraepidermal areas just about the basal cell layerImmunopathologyDirect immunofluoresence(DIF) of involved and perilesional skin in pemphigus reveals the
Definition Pemphigus is intraepidermal blistering disease characterized by autoimmunity to specific proteins present within either the epidermal cell membrane or the desmosome. Classification: Pemphigus vulgaris Pemphigus vegetans Pemphigus foliaceus Pemphigus erythematosus Pemphigus herpetiformis Etiology and pathogenesis ❖ Intercellular antibodies(IC) – Circulating IC antibodies are present in most pemphigus patient’s serum. – Circulating IC antibody titers often parallel disease activity ❖ Direct immunofluorescence (DIF) test shows intercellular IgG throughout the epidermis or the oral epithelium – IgG is found in both involved and clinically normal skin in nearly all patients with pemphigus. C3 deposition is also reliably found in acantholytic areas The pathologic changes in pemphigus vulgaris are acantholysis, clefts and blister formation in the intraepidermal areas just above the basal cell layer. Clinical features • Pemphigus vulgaris: ❖ thin-walled, relatively flaccid, easily ruptured bullae that appear on either apparently nomal skin and mucous membranes or on erythematous bases. ❖ Sites:the lesions appear first in mouth and next most commonly in the groin, scalp, face, neck, axillae, or genitals. • Nikolsky’s sign is present: the upper layers are easily made to slip laterally Pemphigus vegetans: ❖ Flaccid bullae that become erosions and form fungoid vegetations or papillomatous proliferation. ❖ Sites: nose , mouth, scalp, axillae, groin, genitalia, perineum, and flexural extremities. ❖ Nikolsky’s sign is present • Pemphigus foliaceus ❖ Begin with small, flaccid bullae that rupture almost as they evolve to from crusting, below that is a moist surface with a tendency to bleed. ❖ Nikolsky’s sign is present. ❖ Ages: occurs mostly in adults between 40 and 50 years. • Pemphigus erythematosus: ❖ The early lesions are circumscribed patches of erythema and crusting ❖ The lesions are erythematous and thickly crusted, bullous, or even hyperkeratotic. ❖ The lesions are localized on nose, check and ears. Crusting are impetiginous lesions appear amid bullae on the scalp, chest, and extremities. Bullae occur on the trunk from time to time • Pemphigus herpetiformis: ❖ Ages: the middle-aged and the elder people ❖ Sites: trunk and upper extremities, macules ❖ Features: annular and multi-annular erythematous macules with edges. Tense vesicles and/or papulovesicles can be seen on the macules. Nikolsky’s sign is not present. ❖ Self-symptom: tense itching Histopathology The pathologic changes in pemphigus vulgaris are acantholysis, clefts and blister formation,and the prescence of acantholytic cells(Tzanck cells) lining the bulla in the intraepidermal areas just about the basal cell layer Immunopathology Direct immunofluoresence(DIF) of involved and perilesional skin in pemphigus reveals the 2 m 2 m 3 m 20 m 2 m 1 m
presence of tissue-bound IgG, IgA, IgM autoantibodies or C3 in crisp,uniform arry alongkeratinocytemembranesIndirect immunofluoresence(IIF)show circulating intercellular antibodies can be demonstrated4minmostpatientsseraDiagnosis1.Flaccid bullae that become erosions and crusts in the skin, usually with mucousmembranes2.Positive Nikolsky's sign3.Tzanck cells in the base of a bulla or the bulla cavity4.Histopathologic characteristic findings consist of acantholysis and intraepidermal blisterformation5.Immunopathologic tests show IgG, C3 along keratinocyte membranes6 m6.IIF shows circulating intercellular antibodiesTreatment1.Systemictherapy2.Immunosuppressive drugs3.Corticosteroids: the standard and the most efficient treatment4.Plasma exchange and immunoglobulins5.Antibiotics6.Topicaltherapy7.Protect raw surface, daily bath, topic applied
presence of tissue-bound IgG, IgA, IgM autoantibodies or C3 in crisp,uniform arry along keratinocyte membranes Indirect immunofluoresence(IIF) show circulating intercellular antibodies can be demonstrated in most patients’ sera Diagnosis 1. Flaccid bullae that become erosions and crusts in the skin, usually with mucous membranes 2. Positive Nikolsky’s sign 3. Tzanck cells in the base of a bulla or the bulla cavity 4. Histopathologic characteristic findings consist of acantholysis and intraepidermal blister formation 5. Immunopathologic tests show IgG, C3 along keratinocyte membranes 6. IIF shows circulating intercellular antibodies Treatment 1.Systemic therapy 2.Immunosuppressive drugs 3.Corticosteroids: the standard and the most efficient treatment 4.Plasma exchange and immunoglobulins 5.Antibiotics 6.Topical therapy 7.Protect raw surface, daily bath, topic applied 4 m 6 m
1.There aretwo sorts of etiologyOne is individual difference The other reason is medicine itself2.There aremanyfeatures ofthis type of pemphigus3.Treatmentofseverepemphigus小结1.What is the difference of histopathology between pemphigus and bullous pemphigoid?2.Whataretheclinicalmanifestationsofpemphigusandbullouspemphigiod?3.What is thesuitablemethod of managing severetypes of pemphigus?思考题及预习
小结 1. There are two sorts of etiology• One is individual difference The other reason is medicine itself 2. There are many features of this type of pemphigus 3. Treatment of severe pemphigus 思考 题及 预习 1. What is the difference of histopathology between pemphigus and bullous pemphigoid? 2. What are the clinical manifestations of pemphigus and bullous pemphigiod? 3. What is the suitable method of managing severe types of pemphigus?
教案讲稿质量评价表ABcD权重好较好一般差评估内容权重1.0-0.90.89-0.79-0.59-010编写认真、教学态度端正1.202.教学目的明确、概念清楚、内容准确53.教学注意系统性及先进性154.重点突出、难点清楚10010教学方法、手段适当5.06.运用专业外语适当、准确10 7、理论联系实际、举例恰当108.知识容量密度适宜、时间分配合理评价得分=（A级=100-90分；B级=89-80分；C级=79-60分：D级=59-0分）意见评价者：评价时间：
教案讲稿质量评价表 权重 评 估 内 容 权重 A 好 1.0-0.9 B 较好 0.89- C 一般 0.79- D 差 0.59-0 100 1. 编写认真、教学态度端正 10 2. 教学目的明确、概念清楚、内容准确 20 3. 教学注意系统性及先进性 15 4. 重点突出、难点清楚 15 5. 教学方法、手段适当 10 6. 运用专业外语适当、准确 10 7. 理论联系实际、举例恰当 10 8. 知识容量密度适宜、时间分配合理 10 意见 评价得分= （A 级=100-90 分；B 级=89-80 分；C 级=79-60 分；D 级=59-0 分） 评价者： 评价时间：