NGOẠI BÌ HỌC I (DA HỌC I)
SKIN DISEASES THEORY
A/. Đại cương về ngoại bì.
Ngoại bì còn gọi là da, thuộc một tạng của cơ thể (bì tạng), liên hệ mật thiết hữu cơ với hệ bài tiết, có nhiệm vụ bao bọc cơ thể, che chở cơ thể khỏi sự tác động, sự ảnh hưởng không có lợi của môi trường bên ngoài đối với cơ thể. Ngoài ra, chức năng chính của da còn để điều hòa, cảm nhận nhiệt độ, tổng hợp vitamin B và D. Da được coi là một trong những bộ phận quan trọng nhất của cơ thể. Diện tích bề mặt da người là khoảng 2 mét vuông.
Theo kiến thức Y học cổ điển từ thế kỷ XVI đến cuối thế kỷ XX, thì da người gồm ba lớp: lớp biểu bì, lớp bì và lớp mỡ dưới da. Nhưng theo bì học hiện đại thì da gồm 5 lớp, trong đó lần lượt là:
1- Lớp biểu bì : hình thái là một tầng sừng gồm có các tế bào đã chết, xếp sít nhau, rất dễ bong ra.
2- Lớp tế bào sống :gồm các tế bào có khả năng phân chia tạo thành tế bào mới, chứa các hạt sắc tố tạo nên màu da, một số tế bào sống phân hóa thành tế bào sinh lông và tế bào sinh móng.
3- Lớp collagen : là màng bán thấm cấu tạo bằng collagen, kết nối lớp tế bào sống với lớp bì ở phia dưới.Đó là một loại protein được tìm thấy nhiều nhất ở động vật có vú, đặc biệt trong các mô thịt, là thành phần chính của mô liên kết, chiếm khoảng 25% đến 35% protein cơ thể. Collagen dạng sợi dài, chủ yếu được tìm thấy trong các mô xơ như dây chằng, gân và da, và cũng có nhiều trong giác mạc, sụn, xương, mạch máu, ruột, và đĩa đệm.
* Nguyên bào sợi là tế bào phổ biến nhất tạo ra collagen. Collagen chiếm 1-2% của các mô cơ, và chiếm 6% trọng lượng của cơ bắp, cơ gân.
* Gelatin, được sử dụng trong thực phẩm và công nghiệp, là collagen đã được thủy phân một phần.
4- Lớp bì : được cấu tạo từ các sợi mô liên kết bền chặt, gồm các thụ quan,tuyến nhờn, tuyến mồ hôi, lông và bao lông, cơ co chân lông, mạch máu, dây thần kinh.
* Tuyến nhờn : Nhiệm vụ của tuyến nhờn là tiết chất nhờn, tạo thành một lớp chất nhờn bao phủ bề mặt da, giúp da mềm mịn, không bị thầm nước và hạn chế sự xâm nhập của vi khuẩn từ môi trường bên ngoài.
* Tuyến mồ hôi : tồn tại dạng chùm dưới da (nhiều nhất ở bàn tay, bàn chân, nách, háng, trán)có từ 2đến 3 triệu tuyến. Nhiệm vụ là tiết mồ hôi (là các chất thải bã được lọc từ máu ra), giúp điều hòa thân nhiệt cơ thể, làm nhiệt độ cơ thể giảm xuống nhiệt độ bình thường khi quá nóng. Muối lysozym có tính kháng khuẩn cao. Có hai loại tuyến mồ hôi là tuyến mồ hôi toàn vẹn và tuyến mồ hôi bán hủy.
* Lông và các phụ quan liên quan :
Lông gồm có:chân lông, bao lông, cơ co chân lông, cơ co chân lông có nhiệm vụ co lại mỗi khi trời lạnh, làm cho lông dựng đứng lên, che khít lỗ chân lông, không cho hơi ấm trong cơ thể bay ra không khí, như thế sẽ giữ ấm được cơ thể.
5- Lớp mỡ dưới da :
* Mô mỡ : Bảo vệ da khỏi những tác động cơ học, cách nhiệt, dự trữ năng lượng.
* Dây thần kinh : Giúp da nhận biết những kích thích từ môi trường.
* Mạch máu : Giúp da trao đổi chất với cơ thể bên ngoài.
B/. Bệnh học về da – bệnh lý da.
I/. Nguyên nhân gây bệnh ngoại bì :
Các bệnh về da (da liễu) xảy ra rất phổ biến trong cuộc sống hàng ngày. Nguyên nhân là do:
– Tình trạng ô nhiễm môi trường toàn diện hiện nay –> hệ miễn dịch hoạt động kém, tê liệt hoặc hoạt động nhầm lẫn (tự miễn).
– Cơ thể bị nhiễm độc hoặc suy giảm hệ thích nghi –> dị ứng với đủ loại dị nguyên.
– Làm sạch ko đúng cách, sử dụng thức ăn nước uống quá dư thừa dầu mỡ.
– Môi trường sống ẩm thấp, hẹp, bụi bặm, hoặc chung đụng vật dụng kém vệ sinh.
– Nguồn nước sinh hoạt không đạt tiêu chuẩn.
– Bên cạnh đấy có một lượng ko nhỏ bệnh nhân bị viêm da do dùng mỹ phẩm hóa học độc hại, khi bị bệnh thì điều trị kiểu “ai xui gì làm nấy”, cũng có nguyên nhân dùng thuốc không theo chỉ định, dẫn đến những biến chứng vô lường.
II/. Phân loại bệnh ngoại bì :
Triệu chứng chung của bệnh ngoài da là đau, ngứa gãi ngoài da. Dựa theo nguyên nhân, chúng được phân theo 8 nhóm loại dưới đây :
1/. Nhóm bệnh ngoại bì do xâm nhiễm
1a/. Ghẻ ngứa: Là bệnh nhiễm ký sinh trùng da Sarcopte Scabiei,lây truyền trong gia đình, tập thể. Triệu chứng gồm: nổi mụn nước ở các kẽ tay, cổ tay, vùng bụng, bộ phận sinh dục, ngứa nhiều về ban đêm. Trong gia đình người bệnh thường có vài người mang biểu hiện tương tự.
1b/. Chốc lở: là bệnh nhiễm trùng nông ở da do vi khuẩn gây ra, chủ yếu xảy ra ở trẻ em. Biểu hiện của bệnh là những nốt mụn đỏ, sau đó vỡ ra, rỉ nước trong một vài ngày và đóng vảy, thường xuất hiện ở vùng mặt, nhất là quanh mũi và miệng. Bệnh rất dễ lây lan và thường lây trực tiếp từ vùng da bệnh đến vùng da lành trên cùng một trẻ, hoặc từ trẻ này sang trẻ khác, vì vậy bệnh còn được gọi là “chốc lây”. Chốc lở có thể gặp ở mọi lứa tuổi, nhưng 90% là các bé tuổi nhà trẻ, mẫu giáo. Trên thực tế phụ huynh rất hay nhầm lẫn giữa bệnh chốc lở và bệnh thủy đậu. Nếu được chẩn đoán sớm và xử trí đúng, bệnh chốc lở cải thiện nhanh, khỏi và không để lại sẹo; trường hợp ngược lại bệnh có thể dẫn đến biến chứng nghiêm trọng.
Chốc lở được phân loại theo hình thái thương tổn: chốc có bọng nước và chốc không có bọng nước.
- Chốc có bọng nước
– Nguyên nhân: thường do tụ cầu gây ra.
– Thương tổn cơ bản:
- Khởi đầu là dát đỏ kích thước từ 0,5-1cm, nhanh chóng tạo thành bọng nước trên đó.
- Bọng nước nhăn nheo, xung quanh có quầng đỏ, sau vài giờ thành bọng mủ đục từ thấp lên cao.
- Vài giờ hoặc vài ngày sau các bọng nước dập vỡ, đóng vảy tiết màu vàng nâu hoặc màu nâu nhạt giống màu mật ong.
- Thương tổn khỏi không để lại sẹo.
– Vị trí thường gặp: ở mặt, vùng da hở, hoặc bất kì chỗ nào kể cả lòng bàn tay, bàn chân, không bao giờ xuất hiện ở niêm mạc. Tại vùng da đầu, vảy tiết có thể làm tóc bết lại.
– Biểu hiện toàn thân: viêm hạch lân cận, sốt rất hiếm gặp trừ khi chốc lan tỏa hoặc có biến chứng.
– Bệnh nhân có thể ngứa – gãi làm thương tổn lan rộng chàm hóa, lan sang vùng da khác.
- Chốc không có bọng nuớc
– Nguyên nhân: thường do liên cầu tan huyết nhóm A.
– Thương tổn ban đầu: mụn nước, mụn mủ nhưng dập trợt rất nhanh trên nền da đỏ, tiết dịch ẩm ướt nên không có bọng nước điển hình. Bờ thương tổn thường có ít vảy da trông giống như bệnh nấm da. Vảy tiết phía trên có màu vàng mật ong hoặc nâu sáng, với một quầng đỏ nhỏ bao quanh. Một số trường hợp có thể thấy các thương tổn vệ tinh ở xung quanh.
– Vị trí: hay gặp ở mặt, xung quanh hốc mũi, miệng hoặc tứ chi.
– Hình thái này thường gặp trên những trẻ bị viêm da cơ địa, ghẻ, hoặc một bệnh da nào đó kèm theo bội nhiễm, hầu như không gặp thương tổn ở niêm mạc.
– Bệnh thường khỏi sau 2-3 tuần, nhưng cũng có thể kéo dài, nhất là khi cơ thể có nhiễm ký sinh trùng, bị chàm hay thời tiết nóng, ẩm ướt.
1c/. Đốm đồi mồi và rám tàn nhang :
Điểm tàn nhang xuất hiện chủ yếu trên mặt nhưng cũng có thể ở nhiều nơi khác trên cơ thể, do tiếp xúc nhiều với ánh sáng cực tím (UV) từ ánh nắng mặt trời và (/hoặc) nhiễm độc từ thực phẩm, nước uống và khí thở. Việc sử dụng các loại đèn thuộc da (nhuộm da nâu) cũng có thể góp phần vào sự phát triển của các đốm đồi mồi. Đồi mồi và tàn nhang có thể xuất hiện ở bất cứ điềm nào trên cơ thể, ở mọi lứa tuổi và giới tính.
1d/. Viêm da tiết bã, gầu.
Viêm da tiết bã là một rối loạn da phổ biến chủ yếu ảnh hưởng tới da đầu, gây ra vảy, ngứa, da đỏ và gàu.
Đối với trẻ sơ sinh, viêm da tiết bã của da đầu được Y học ghi nhận như cradlecap. Ở thanh niên và người lớn, viêm da tiết bã gây ra gầu khô và gầu ướt, kết hợp nhiễm nấm gây ngứa, rựng tóc hàng loạt, tạo ra hiện tượng hói đầu.
2/. Nhóm bệnh ngoại bì do virus :
2a/. Mụn cóc (mụn cơm): Đây không phải là bệnh ung thư mà là do siêu vi trùng papillomavirus gây nên. Mọi người đều có thể bị mụn cơm trẻ em thường bị nhiều hơn người lớn. Mụn cơm có thể lan truyền từ phần này sang phần khác trong cơ thể hoặc lây từ người này hay người kia, tuy ít nguy hại nhưng dây dưa và khó trị dứt.
2b/. Thủy đậu : do một loại siêu vi mang tên varicella zoster virus gây ra. Bệnh này rất dễ lây truyền qua đường hô hấp và qua tiếp xúc dịch tiết. Khoảng 10 – 14 ngày sau khi xâm nhập vào cơ thể, người bệnh bắt đầu biểu hiện triệu chứng nhiễm thủy đậu. Trẻ nhỏ thường sốt nhẹ, biếng ăn còn người lớn bị sốt cao, đau đầu, đau cơ, nôn ói. Sau đó cơ thể sẽ bắt đầu nổi mụn nước ở vùng đầu mặt, chi và thân. Mụn nước có đường kính vài milimet. Nếu bị nặng, mụn nước sẽ to hơn hay khi nhiễm thêm vi trùng mụn nước sẽ có màu đục do chứa mủ. Sau 1-2 ngày mới xuất hiện nốt đậu. Nốt đậu nổi nhiều là dấu hiệu cảnh báo bệnh có thể diễn tiến nặng. Sau khi nốt đậu mọc thì thường người bệnh giảm sốt và tổn thương bóng nước khô dần rồi tự bong vẩy vài ngày sau đó nhưng để lại sẹo mờ trên da sau vài tuần mới hết hẳn. Thông thường bệnh diễn biến kéo dài khoảng 2 tuần.
Là bệnh siêu vi nên thủy đậu có thể phát sinh những biến chứng nguy hiểm nếu điều trị và dưỡng bệnh không đúng cách.
2c/. Bệnh zona: Bệnh có tên khoa học là Herpes zoster, bệnh do virút cùng loại vi-rút thuỷ đậu gây nên. Vi-rút này có tên là Varicella zoster. Bệnh zona có thể lây truyền từ người bị nhiễm sang trẻ em hay người lớn mà những người này trước đây không mắc bệnh thuỷ đậu. Zona là một loại bệnh cấp của hệ thần kinh trung ương, do virus nhiễm vào hạch của các rễ sau gây đau dây thần kinh rồi phát ban, nổi nốt phỏng nước cấp tính, có đặc điểm là nhsững thủy bào tụ thành hỡnh đai mọc theo đường dây thần kinh một bên người, kèm theo triệu chứng đau như lửa châm và các hạch bạch huyết ngoại vi sưng to, giống Herpes trên vùng da thuộc về dây thần kinh đó. Có biểu hiện viêm ở hạch đàng sau và đôi khi trong sừng sau của tủy. Nốt phỏng là do huyết thanh tiết dưới lớp sừng.
Dùng một số loại thuốc bôi mỡ kháng sinh, mỡ corticoid, mỡ kháng nấm. Dùng kết hợp với một số thảo dược như lá trầu không, sài đất, … Tuân thủ dùng thuốc đều dặn bệnh sẽ sớm khỏi.
2d/. Bệnh zona thần kinhlà bệnh gây ra bởi chủng virus cùng loại với virus gây bệnh thủy đậu. Sau khi khỏi bệnh thủy đậu thì virus thủy đậu không hề chết hoàn toàn mà một số trú ngụ tại các dây thần kinh trong trạng thái ngủ. Chờ điều kiện thuận lợi các virus này sẽ hoạt động trở lại gây viêm dây thần kinh biểu hiện ra bệnh zona thần kinh.
Triệu chứng của bệnh ngoài da này là các mụn nước nhỏ bằng hạt đậu xanh, sau đó các mụn nước này lan rộng và kiên kết thành từng mảng dải theo hướng đi của dây thần kinh, sau cùng gây loét và gây tổn thương trên da. Bệnh thường xuất hiện trên mặt, mí mắt, cổ, lưng,…
2e/. Bệnh lang ben là một bệnh ngoài da khá phổ biến, do virut Pityrosporum orbiculaire gây nên thường có biểu hiện xuất hiện một đốm hay một mảng có màu trắng thường không ngứa hay ngứa ít, nhưng khi ra nắng, đổ mồ hôi thì ngứa nhiều. Bệnh lang ben tùy thuộc khá nhiều vào việc vệ sinh da, sức đề kháng của cơ thể, phụ thuộc vào độ PH của da và cả độ ẩm của da. Cho nên có thể giải thích một số trường hợp trong một gia đình có người mắc bệnh lang ben nhưng người khác lại không mắc.
3/. Nhóm bệnh ngoại bì do nấm :
3a/. Nấm da : thủ phạm chính là do nhiều loại vi nấm từ môi trường, tiếp xúc lây nhiễm gây tác hại lên da. Vi nấm sinh sôi và phát triển trên da gây tổn thương thượng bì gây viêm. Nhận biết bệnh viêm nấm da dựa vào các dấu hiệu như ngứa da bứt dứt khó chịu, viêm loét, đỏ sưng. Bệnh thường xuất hiện vào thời điểm thời tiết, môi trường ẩm ướt, các vị trí trên cơ thể nơi ẩm ướt, nhiều mồ hôi.
Tổn thương do nấm da gây ra chủ yếu là nấm ở da đầu, nấm ngoài da, nấm đường sinh dục… Khi xác định được các loại vi nấm gây viêm thì sẽ dùng các thuốc để bôi hoặc uống để điều trị trị bệnh nấm da theo chỉ định của bác sĩ. Điều trị nấm da cần chú ý kiên trì điều trị dùng hết đợt liệu trị nhằm phòng ngừa nấm da tái phát trở lại.
3b/. Nấm da đùi (tinea cruris): là một bệnh nấm hay gặp xảy ra ở da vùng mặt trong đùi, mông và vùng sinh dục. Bệnh do nấm dermatophytes gây ra. Bệnh lây do dùng chung khăn, quần áo hoặc qua quan hệ tình dục với người nhiễm bệnh.
3c/. Nấm da đầu: Bệnh có tên gọi khác là bệnh Ecpet mảng tròn, là bệnh nhiễm nấm dưới chân tóc và dưới da. Nếu quan sát kỹ sẽ thấy nó biểu hiện bằng từng mảng tròn trắng, gây ngứa ngáy khó chịu. Bệnh này có khả năng lây qua đồ dùng nếu dùng chung như mũ, nón, lược.
3d/. Nấm kẽ chân: do các loài nấm Epidermophyton, Trichophyton gây nên. Tổn thương ban đầu bợt trắng hơi bong vảy, nổi một số mụn nước, ngứa nhiều, gãi trợt da, có nền đỏ, có khi viêm nề, sưng tấy do nhiễm khuẩn thứ phát, khi đó bệnh nhân có thể sốt, hạch bẹn sưng. Nấm có thể lan lên mu bàn chân, xuống mặt dưới bàn chân, đôi khi có mụn nước sâu dạng tổ dỉa ở lòng bàn chân .
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3f/.Ngứa phát ban do virus Herpes : nhiễm virus nhóm herpes B có thể tạo ra mề đay dị ứng diện rộng và lây lan rất nhanh, chủ yếu ở trẻ em.
———-Wambuakim———- (còn tiếp)
Xin xem tiếp NGOẠI BÌ HỌC II
2.450 Trả lời “NGOẠI BÌ HỌC PHẦN I (DA HỌC I) – SKIN DISEASES THEORY”
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