临床医生简报-继发继发病变图片库

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clinician's brief

临床医生简报

Image Gallery: Secondary Skin Lesions

图片库：继发皮肤病变照片库

Alexander Werner Resnick, VMD, DACVD, Animal Dermatology Center

DERMATOLOGY | JUNE 2019 | PEER REVIEWED | WEB-EXCLUSIVE

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翻译：刘双元

校对：赵博

In dermatologic diseases, abnormalities are visually apparent; thus, accurate recognition of skin lesions is key to diagnosis and management. Dermatologic diseases are often chronic, requiring clear documentation in patient medical records. Accurate recognition of skin lesions, as well as concise documentation, permits the formulation of a relevant differential list and appropriate record of disease progression and/or patient response to treatment.

在皮肤科疾病中，异常是肉眼可见的；因此，准确识别皮肤病变是诊断和治疗的关键。皮肤病通常是慢性的，需要明确记录患病动物的病历。对皮肤病变的准确识别，以及简明的记录，制定相关的鉴别诊断列表并适当的记录病情发展和/或患病动物的治疗反应。

Whereas primary lesions (Part 1) involve changes in the skin caused directly by the disease process, secondary skin lesions most often develop from primary skin lesions as a result of patient or environmental factors. Several skin lesions (eg, scale, crust, stria, pigmentation change) may be considered either primary or secondary, depending on the cause. For example, hereditary abnormalities of keratinization (eg, congenital ichthyosis in golden retrievers) produce, as a primary lesion, excessive scale due to the lack of proper desquamation, with resultant accumulation of rafts of keratinocytes being shed together rather than imperceptibly as individual cells. Conversely, inflammatory dermatoses produce scale as a secondary lesion by increasing epidermal turnover, resulting in excessive production of keratinocytes that ultimately require shedding. The following images exhibit secondary dermatologic lesions.

原发病变（第1部分）是疾病过程直接引起的皮肤变化，继发皮肤病变通常是由患病动物或环境因素导致的原发皮肤病变发展而来的。根据病因，一些皮肤病变（例如皮屑、结痂、瘢痕、色素沉着改变）即可认为是原发的也可被认为是继发的。如遗传性角化异常（如金毛寻回犬先天性鱼鳞病）是一种原发病变，由于不能正常脱皮屑，导致皮屑过多，因此造成角质形成细胞大量聚集在一起，而不是作为单个细胞悄然脱落。相反，炎性皮肤病使表皮更新产生的皮屑，导致角质形成细胞产生过度，最终需要脱落，是一种继发病变。下图显示继发皮肤病变。

FIGURE 1 Alopecia. Alopecia is a visible decrease in or loss of the hair coat. Secondary alopecia may result from manual removal of the hair by scratching.

图1 脱毛。脱毛是指被毛明显减少或脱落。继发脱毛可能是由于搔抓毛发自损所致。

FIGURE 2 Scale. Scale is an increased accumulation of keratinocytes producing a visible thin fragment. Scaling is often caused by chronic inflammation, resulting in increased epidermopoiesis.

图2 皮屑。皮屑是角质形成细胞的积聚增加，形成可见的薄片。皮屑常由慢性炎症引起，慢性炎症导致表皮生成增加。

FIGURE 3 Crust. Crust is a thick accumulation of cells within dried exudate (eg, serum, blood, cellular debris, or medications)

图3 结痂。结痂是细胞有厚度的堆积，混合着干燥渗出物（由血清、血液、细胞碎片或药物）

FIGURE 4 Epidermal collarette. Epidermal collarette is an often circular lesion with a margin of crust and/or erythema. This lesion is most commonly associated with superficial pyoderma.

图4 表皮环。表皮环是一种常见的边缘有结痂和/或红斑的圆形病变。这种病变最常与浅表脓皮病有关。

FIGURE 5 Stria/striae. Striae are lines or stripes associated with abnormal stretching of the skin as a result of thinning. Striae are most often associated with an excess of corticosteroids (iatrogenic or natural)

图5 条纹/条痕。条痕是由于皮肤变薄导致的异常拉伸形成的线条或条纹。条痕最常与皮质类固醇过量有关（医源性或自发性）

FIGURE 6 Excoriation. Excoriation represents injury to the skin, typically from scratching, and is often linear in appearance.

图6 抓痕。抓痕意味着皮肤损伤，通常是由抓伤造成的，且外观上通常呈线性

FIGURE 7 Lichenification. Associated with chronic irritation of and friction applied to the skin by scratching, lichenification is a thickening of the skin, often with accentuation of normal skin lines.

图7 苔藓化。苔藓化是一种皮肤增厚，与搔抓引起的皮肤慢性刺激和摩擦有关，常伴有正常皮肤线条的加重

FIGURE 8 Erosion. Erosion is an incomplete loss of epidermis; erosions do not penetrate the epidermal– dermal junction.

图8 糜烂。糜烂是表皮的不完全缺失；糜烂不穿透表皮-真皮交界处。

FIGURE 9 Ulceration. Ulceration is a defect in the skin that penetrates completely through and with resultant loss of the epidermis.

图9 溃疡。溃疡是一种完全穿透皮肤的皮肤缺失，可导致表皮的缺失

FIGURE 10 Fissure. A fissure is a linear cleft or tear that extends through the epidermis.

图10 开裂。开裂一种延伸并贯穿表皮的线状裂缝或撕裂。

FIGURE 11 Scar. A scar develops as a result of trauma or damage through to the dermis or subcutaneous tissue. It is a visible defect that may be palpably depressed and composed of fibrous tissue that has replaced normal skin.

图11瘢痕。瘢痕是由真皮或皮下组织的创伤或损伤而形成的。它是一种可见的缺损，明显凹陷，纤维组织替代了正常皮肤。

FIGURE 12 Pigmentation change. Pigmentation change refers to an alteration in the normal color of the skin and/or hair coat. Endocrinopathy and chronic inflammation are common causes of pigmentation change.

图12色素改变。色素改变是指皮肤和/或被毛正常颜色的改变。内分泌病和慢性炎症是色素改变的常见原因。

SUGGESTED READING 参考文献

Mueller RS. Dermatology for the Small Animal Practitioner. Jackson WY: Teton NewMedia; 2000.

Rhodes KH, Werner AH, eds. Blackwell’s Five-Minute Veterinary Consult Clinical Companion: Small Animal Dermatology. 3rd ed.

West Sussex, UK: John Wiley & Sons; 2018.

AUTHOR 作者简介

VMD, DACVD Animal Dermatology Center Alexander Werner Resnick, VMD, DACVD, is the editor of the dermatology section of the 5-Minute Veterinary Consult textbook and coauthor of the second and third editions of Small Animal Dermatology Clinical Companion. He practices at the Animal Dermatology Center in Studio City and Westlake Village, California, and Reno, Nevada.

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