《皮肤性病学》课程教学资源（教案）psoriasis

皮肤性病学教案及讲稿皮肤性病2006级留学年级课程名称授课专业皮肤性病学学生教师单葵职称讲师学时授课方式大课示教题目章节Psoriasis教材名称作者Liu Tong《Dermatovenereology》Dean'sXi'anofficeofJiaotong版次出版社FirstUniversityNovember2004教学1.Thedefinition of psoriasis.目2. The clinical manifestations of psoriasis, especially psoriasis vulgaris.的3.Thediagnosis anddifferential diagnosis of psoriasis.要4.The treatment of psoriasis求1.The classification of psoriasis.教2.The clinical manifestations of psoriasis,especially psoriasis vulgaris学3. Three stages of psoriasis vulgaris.难4.The diagnosis and differential diagnosis of psoriasis点5. The treatment of psoriasis, especially the definition of PUVA photochemotherapy.1.Theclassificationofpsoriasis教2.The clinical manifestations ofpsoriasis,especially psoriasis vulgaris学4.The diagnosis and differential diagnosis of psoriasis.重5.The treatment of psoriasis, especially the definition of PUVA photochemotherapy点外语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1.《临床皮肤病学》赵辨等主编，2001年江苏科学技术出版社资料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见教学组长：单葵教研室主任：李惠2009年9月7日

皮肤性病学教案及讲稿 课程名称 皮肤性病 学 年级 2006 级留学 生 授课专业 皮 肤 性 病 学 教 师 单葵 职称 讲师 授课方式 大课 示教 学时 1 题目章节 Psoriasis 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. The definition of psoriasis. 2. The clinical manifestations of psoriasis, especially psoriasis vulgaris. 3. The diagnosis and differential diagnosis of psoriasis. 4. The treatment of psoriasis. 教 学 难 点 1. The classification of psoriasis. 2. The clinical manifestations of psoriasis, especially psoriasis vulgaris. 3. Three stages of psoriasis vulgaris. 4. The diagnosis and differential diagnosis of psoriasis. 5. The treatment of psoriasis, especially the definition of PUVA photochemotherapy. 教 学 重 点 1. The classification of psoriasis. 2. The clinical manifestations of psoriasis, especially psoriasis vulgaris. 4. The diagnosis and differential diagnosis of psoriasis. 5. The treatment of psoriasis, especially the definition of PUVA photochemotherapy. 外语 要求 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 7 日

辅助手段教学内容时间分配Psoriasis1.Definition2分钟Psoriasis is a common, chronic, recurrent, inflammatory disease of the skin characterizedby round, circumscribed, dry, scaling papules and plaques ofvarious sizes, covered by grayishwhite or silvery white, imbricated, and lamellar scales.2分钟2. Psoriasis-Etiology and pathogenesisGeneticfactorsEnvironmental factorsImmunologicalfactors3.Clinical manifestationsPsoriasis varies with race, geography, and environmental factors. It occurs with equal20分钟frequency in both sexes. The onset of psoriasis is at a mean age of27 years. Hot weather andsunlight improve psoriasis. In pregnancy there is a distinct tendency for improvement or eventemporarydisappearance.4.Psoriasis can bedivided intofourvariantsPsoriasis vulgaris(99%)Pastular psoriasisPsoriasis anthropathicaErythrodermic psoriasis5. Psoriasis vulgaris(Figl1-20)Primary lesions: reddish papule or plaque, covered with thick silvery scales or slightlyopalescent shiny scales.Psoriasis characteristically involves the scalp, the extensor surface of the extremitiesthe sacral area, buttocks and penis, and nails.Pruritus is quite variable in intensity.6.Auspitz's signPapules or plaques of psoriasis vulgaris covered with overlapping thick silvery micaceousscales, when slightly scratched, the surface becomes more opaque, while more vigorousscratching produces tiny bleeding points as the scale is removed and elongated dermal papillaeare denuded.Itis pinpoint bleeding when a psoriatic scale is forcibly removed.It occurs because of thesevere thinning ofthe epidermis overthetips ofthedermal papillae.7. Koebner's phenomenonIt is the isomorphic response and the appearance of typical lesions of psoriasis at sites ofeven trivial injuries. It also occurs in many other skin diseases.8. Psoriasis vulgaris can be divided into three stages.Progressive stage: new eruptions, enlarged and confluent, with lamellar scales andcircumscribedflush.Koebner reactionStable stage:the state of psoriasis is constant.withcentralrelieve,Subside stage:lightercolor,anannualerappearancehyperpigmentationorhypopigmentation.9.Psoriasis arthropathicaIt is a chronic inflammatory arthritis that is commonly associated with psoriasis.Approximately 5% of patients with psoriasis develop psoriatic arthritis.Psoriasis appears to precede the onset ofpsoriatic arthritis in 60%-80% of patients.Rheumatoid factor is absent in the serum.In most cases radiographic findings are the same as in rheumatoid arthritis

教学内容 辅助手段 时间分配 Psoriasis 1. Definition Psoriasis is a common, chronic, recurrent, inflammatory disease of the skin characterized by round, circumscribed, dry, scaling papules and plaques of various sizes, covered by grayish white or silvery white, imbricated, and lamellar scales. 2. Psoriasis-Etiology and pathogenesis Genetic factors Environmental factors Immunological factors 3. Clinical manifestations Psoriasis varies with race, geography, and environmental factors. It occurs with equal frequency in both sexes. The onset of psoriasis is at a mean age of 27 years. Hot weather and sunlight improve psoriasis. In pregnancy there is a distinct tendency for improvement or even temporary disappearance. 4. Psoriasis can be divided into four variants. Psoriasis vulgaris(99%) Pastular psoriasis Psoriasis anthropathica Erythrodermic psoriasis 5. Psoriasis vulgaris(Fig11-20) Primary lesions：reddish papule or plaque, covered with thick silvery scales or slightly opalescent shiny scales. Psoriasis characteristically involves the scalp, the extensor surface of the extremities, the sacral area, buttocks and penis, and nails. Pruritus is quite variable in intensity. 6.Auspitz’s sign Papules or plaques of psoriasis vulgaris covered with overlapping thick silvery micaceous scales, when slightly scratched, the surface becomes more opaque, while more vigorous scratching produces tiny bleeding points as the scale is removed and elongated dermal papillae are denuded. It is pinpoint bleeding when a psoriatic scale is forcibly removed. It occurs because of the severe thinning of the epidermis over the tips of the dermal papillae. 7. Koebner’s phenomenon It is the isomorphic response and the appearance of typical lesions of psoriasis at sites of even trivial injuries. It also occurs in many other skin diseases. 8. Psoriasis vulgaris can be divided into three stages. Progressive stage: new eruptions, enlarged and confluent, with lamellar scales and circumscribed flush. Koebner reaction. Stable stage: the state of psoriasis is constant. Subside stage: lighter color, an annualer appearance with central relieve, hyperpigmentation or hypopigmentation. 9. Psoriasis arthropathica It is a chronic inflammatory arthritis that is commonly associated with psoriasis. Approximately 5% of patients with psoriasis develop psoriatic arthritis. Psoriasis appears to precede the onset of psoriatic arthritis in 60%-80% of patients. Rheumatoid factor is absent in the serum. In most cases radiographic findings are the same as in rheumatoid arthritis. 2 分钟 2 分钟 20 分钟

10.Erythrodermic psoriasisit is a particularly inflammatory form of psoriasis that often affects most of the bodysurface.The entire cutaneous surface is red and covered with fine scales.Typical psoriaticlesions may be obscured or absent.It istheleastcommonformofpsoriasisItmostcommonlyappearsonpeoplewhohaveunstableplaquepsoriasis,orcomeongradually in people with psoriasis especially who have improper treatment.11.PustularpsoriasisSome factors may trigger the attacks: systemic steroids withdrawal, strong irritatingtopical agents (tar, iodides, anthralin), infections, etc.The onset is sudden, with closely distribution ofsuperficial sterile pustules, orformationof lakes of pus periungually, on the palms, and at the edge of psoriatic plaquesGeneralized pustular psoriasis (all over the body) and localized pustular psoriasis (palmsand soles). The former may accompany severe symptoms, such as fever, chills, cachexia.Mucous membranelesions are common on the tongue and in themouth.12.Psoriasis arthropathicaIt is a chronic inflammatory arthritis that is commonly associated with psoriasis.Approximately 5% of patients with psoriasis develop psoriatic arthritisPsoriasis appears to precede the onset ofpsoriatic arthritis in 60%-80% of patients.Rheumatoid factor is absent in the serumInmostcasesradiographicfindings arethesameas in rheumatoid arthritis13.DiagnosisPsoriasis vulgaris:3分钟It characteristically involves the scalp, the extensor surface ofthe extremities.Lesions areredpapulesand plaqueswith silvery scales.MembranephenomenonandAuspitz's signCharacteristic histologic feature, chronic duration, aggravation in the winter.Psoriatic anthropathicaLesions of psoriasisArthritisRheumatoid factor is usually negativeErythrodermic psoriasisThe entire cutaneous surface is red and covered with fine scalesHistory of psoriasis.Pustular psoriasisClustersof sterilepustulesGeneralizedor localized14.Differential diagnosisSeborrheic dermatitis3分钟Lesions are located in seborrheic areas.The scales are greasy and lusterless.Lichen planusChiefly affects the flexor surfaces ofthe forearms and wrists, and the shins and ankles.Violaceous color.Characteristic histopathologySecondary syphilidPatches of copper-colored papules, general adenopathy,mucous patches, condylomataand other symptoms of secondary syphilis are present.Serologic tests for syphilis are positive.ChroniceczemaSevere prurituslichenification15.TherapyTopical treatmentIn many patients topical applications alone will suffice to keep psoriasis under control.10分钟retinoidNumerous local medications are available, such as corticosteroids

10. Erythrodermic psoriasis It is a particularly inflammatory form of psoriasis that often affects most of the body surface. The entire cutaneous surface is red and covered with fine scales. Typical psoriatic lesions may be obscured or absent. It is the least common form of psoriasis. It most commonly appears on people who have unstable plaque psoriasis, or come on gradually in people with psoriasis especially who have improper treatment. 11. Pustular psoriasis Some factors may trigger the attacks: systemic steroids withdrawal, strong irritating topical agents (tar, iodides, anthralin), infections, etc. The onset is sudden, with closely distribution of superficial sterile pustules, or formation of lakes of pus periungually, on the palms, and at the edge of psoriatic plaques. Generalized pustular psoriasis (all over the body) and localized pustular psoriasis (palms and soles). The former may accompany severe symptoms, such as fever, chills, cachexia. Mucous membrane lesions are common on the tongue and in the mouth. 12. Psoriasis arthropathica It is a chronic inflammatory arthritis that is commonly associated with psoriasis. Approximately 5% of patients with psoriasis develop psoriatic arthritis. Psoriasis appears to precede the onset of psoriatic arthritis in 60%-80% of patients. Rheumatoid factor is absent in the serum. In most cases radiographic findings are the same as in rheumatoid arthritis. 13. Diagnosis Psoriasis vulgaris: It characteristically involves the scalp, the extensor surface of the extremities. Lesions are red papules and plaques with silvery scales. Membrane phenomenon and Auspitz’s sign. Characteristic histologic feature, chronic duration, aggravation in the winter. Psoriatic anthropathica Lesions of psoriasis Arthritis Rheumatoid factor is usually negative. Erythrodermic psoriasis The entire cutaneous surface is red and covered with fine scales. History of psoriasis. Pustular psoriasis Clusters of sterile pustules Generalized or localized 14. Differential diagnosis Seborrheic dermatitis Lesions are located in seborrheic areas. The scales are greasy and lusterless. Lichen planus Chiefly affects the flexor surfaces of the forearms and wrists, and the shins and ankles. Violaceous color. Characteristic histopathology Secondary syphilid Patches of copper-colored papules, general adenopathy, mucous patches, condylomata, and other symptoms of secondary syphilis are present. Serologic tests for syphilis are positive. Chronic eczema Severe pruritus lichenification 15. Therapy Topical treatment In many patients topical applications alone will suffice to keep psoriasis under control. Numerous local medications are available, such as corticosteroids, retinoid 3 分钟 3 分钟 10 分钟

derivatives: tazarotene, synthetic vitamin D3 analogs, tar-containing preparations, anthralinsalicylic acidSystemic treatmentSystemic treatment only initiate after both topical treatments and phototherapy havefailed.For patients with very active erythrodermic psoriasis, pustular psoriasis, psoriaticarthritis.immunosuppressivedrugs:methotrexate,cyclosporinvitaminsetretinateand isotretinoinantibiotics:guttatepsoriasiscorticosteroidstraditional ChinesemedicinePhysical treatmentPUVA photochemotherapy: photosensitizing drug methoxsalen (8-mop) in combinationwith ultravioletA(UVA)irradiation(320nmto 400nm).UltravioletB(UVB)phototherapy:290-320nm,311nmSchott bath:water bath, mineral spring bath, tar bath, medicated bath

derivatives: tazarotene, synthetic vitamin D3 analogs, tar-containing preparations, anthralin, salicylic acid. Systemic treatment Systemic treatment only initiate after both topical treatments and phototherapy have failed. For patients with very active erythrodermic psoriasis, pustular psoriasis, psoriatic arthritis. immunosuppressive drugs: methotrexate, cyclosporin, vitamins etretinate and isotretinoin antibiotics: guttate psoriasis corticosteroids traditional Chinese medicine Physical treatment PUVA photochemotherapy: photosensitizing drug methoxsalen (8-mop) in combination with ultraviolet A (UVA) irradiation (320nm to 400nm). Ultraviolet B (UVB) phototherapy: 290-320 nm, 311nm. Schott bath: water bath, mineral spring bath, tar bath, medicated bath

1.Psoriasisis a common,chronic,recurrent,inflammatorydiseaseof theskincharacterized by round, circumscribed, dry, scaling papules and plaques ofvarious sizes,covered by grayish white or silvery white, imbricated, and lamellar scales.2.Psoriasis can be divided into four variants:Psoriasis vulgaris, Pastularpsoriasis,Psoriasis anthropathica,Erythrodermic psoriasis.3. Auspitz's sign: Papules or plaques of psoriasis vulgaris covered with overlapping thicksilvery micaceous scales,when slightly scratched, the surface becomesmore opaque,while more vigorous scratching produces tiny bleeding points as the scale is removedand elongated dermal papllae are denuded. It is pinpoint bleeding when a psoriatic scaleis forcibly removed.It occurs because of the severe thinning of the epidermis over the小结tips of the dermal papillae.4.Psoriasis vulgaris can be diagnose by it's characteristically involves the scalp, theextensor surface of the extremities. Lesions are red papules and plaques with silveryscales. Membrane phenomenon and Auspitz's sign. Characteristic histologic feature,chronic duration, aggravation in the winter.5.Differential diagnosis: Seborrheic dermatitis, Lichen planus, Secondary syphilid,Chronic eczema.6.PUVAphotochemotherapy:photosensitizingdrug methoxsalen(8-mop)incombinationwithultravioletA(UVA)irradiation(320nmto400nm)1.What's thedefinition ofcontact dermatitis?2.What is Auspitz's sign?3. How to diagnose psoriasis vulgaris?思考4. What is PUVA?题及预习

小结 1. Psoriasis is a common, chronic, recurrent, inflammatory disease of the skin characterized by round, circumscribed, dry, scaling papules and plaques of various sizes, covered by grayish white or silvery white, imbricated, and lamellar scales. 2. Psoriasis can be divided into four variants: Psoriasis vulgaris, Pastular psoriasis,Psoriasis anthropathica, Erythrodermic psoriasis. 3. Auspitz’s sign: Papules or plaques of psoriasis vulgaris covered with overlapping thick silvery micaceous scales, when slightly scratched, the surface becomes more opaque, while more vigorous scratching produces tiny bleeding points as the scale is removed and elongated dermal papillae are denuded. It is pinpoint bleeding when a psoriatic scale is forcibly removed. It occurs because of the severe thinning of the epidermis over the tips of the dermal papillae. 4. Psoriasis vulgaris can be diagnose by it’s characteristically involves the scalp, the extensor surface of the extremities. Lesions are red papules and plaques with silvery scales. Membrane phenomenon and Auspitz’s sign. Characteristic histologic feature, chronic duration, aggravation in the winter. 5. Differential diagnosis: Seborrheic dermatitis, Lichen planus, Secondary syphilid, Chronic eczema. 6. PUVA photochemotherapy: photosensitizing drug methoxsalen (8-mop) in combination with ultraviolet A (UVA) irradiation (320nm to 400nm). 思考 题及 预习 1. What’s the definition of contact dermatitis? 2. What is Auspitz’s sign? 3. How to diagnose psoriasis vulgaris? 4. What is PUVA?