Mucous membrane slightly pale

Introduction Mucosal damage occurs in the oral cavity, the genital gland and the anal membrane and the ocular membrane. It can be associated with skin diseases and systemic diseases. The oral membrane disease is extensive, and it has actually been related to dentistry. Department of dermatology, otolaryngology, internal medicine and many other disciplines. The genital area is not only a common predilection site for sexually transmitted diseases, but also a prone to some skin diseases. With the increasing sexually transmitted diseases, vulvar diseases are receiving more and more attention.

Cause

Caused by insufficient capillary filling of the skin or insufficient blood, and a decrease in the amount of red blood in the blood (anemia), it can be seen in cold, panic, collapse, aortic insufficiency, anemia, visceral bleeding, and the like.

(1) medical history

The etiology of mucosal diseases is complex and manifests in a variety of ways. A deep understanding of the medical history is helpful for diagnosis. The medical history includes the patient's age, occupation, gender, sexual contact history, and systemic disease history.

(2) Physical examination

Mucosal damage is not a symptom. It is a variety of symptoms or signs at a certain site of the disease. Disease diagnosis can be considered according to the location of the disease. Each disease site has a common set of diseases, and the diagnosis is determined by the nature of the damage. In addition, the new membrane site is not as intuitive as the skin. It should be noted that the lesion should be fully exposed, and the light should be sufficient, especially in the vulva and vagina. It should also pay attention to other parts with or without skin lesions.

(3) Laboratory inspection

There are many kinds of laboratory tests for mucosal diseases, which should be considered in combination with etiology. For example, infectious diseases can be diagnosed by bacteriology, viral diseases can be identified by virus culture, histopathology can provide a basis for diagnosis of tumors, and sexually transmitted diseases can also be examined in many aspects. For example, syphilis serological tests, PCR tests can be used for the diagnosis of a variety of diseases, and mycological examinations contribute to the diagnosis of fungal diseases.

an examination

Related inspection

Nasal mucosa and nasal secretions gastric mucosa biopsy

First, genital ulcer disease

1. Behcet's disease: This disease is also called eye, mouth, genital syndrome, the cause is unknown, and the basic pathological changes are small vasculitis. The clinical features are characterized by a homogenous reaction of recurrent oral genital ulcer external lesions and nodular erythema, folliculitis and acupuncture. Systemic symptoms can have low fever, joint pain, rapid blood sedimentation, and can affect the digestive tract, heart, brain tissue and so on.

The diseased membrane ulcer is often characterized by multiple, painful, recurrent, ulcers are generally small, miliary to soybean size, border clearing around red, soft and yellowish white secretions, often accompanied by symptoms other than vulva. The above characteristics can be distinguished from hard under-sex and soft under-cancerous, as detailed in the relevant diseases. The disease is effective for hormone therapy and immunosuppressive therapy.

2. Acute female genital ulcer: For acute painful ulcers that occur in female yin, unmarried women are more common. There are three types of ulcers: gangrene, sexually transmitted diseases, and miliary. The gangrenous type often has high-heat and other systemic symptoms, sexually transmitted diseases and miliary types, and no systemic symptoms. The subjective symptoms of ulcers are burning and pain, which may be associated with erythema of the lower extremities and oral ulcers. Therefore, some people think that it is the female genital manifestation of self-suppression. The course of the disease is usually several weeks and often recurs. The disease has no history of sexual intercourse, ulcer pain, soft and repeated attacks can be distinguished from sexually transmitted diseases such as hard lower waves and soft under cancer. See the relevant diseases for details.

3. Genital pityriasis: This disease is a simple sputum disease type II (HSV-November, attribute-borne disease, in male pityriasis occurs in the penis, glans, coronary sulcus, etc., rarely involving the scrotum. Women are common in the labia, Clitoris, perianal and vaginal and even the cervix. Often there is a burning sensation, and soon clusters of small leeches occur, rupture and erosion after a few days, the formation of shallow ulcers, soft base. Short course of disease, easy to relapse, pregnant women with genital herpes easily lead Abortion, premature delivery, can also infect newborns. The formation of ulcers after the sore rash, soft, short course and other characteristics can be distinguished from self-suppression, hard underlying sore, acute female yin ulcer. Laboratory examination with the fourth section of recurrence Simple pityriasis.

4. Soft sputum is one of the sexually transmitted diseases of this disease, caused by Haemophilus ducrei, multiple painful soft ulcers in the genital area, round or oval, with a diameter of 0.l-1cm or larger, irregular edges It can be jagged, the base is not flat, and the surface has a pale yellow purulent secretion, which is easy to bleed and has seizures. Some patients with 2-3 weeks after the onset of ulcers with inguinal lymphadenitis, known as transverse fatigue, often unilateral, local redness and heat pain, the final suppuration and ulceration, leaving the original trace. Gram-negative Haemophilus ducrei can be found in the ulcer. The disease is ulcerated, soft, and painful. There are purulent secretions on the surface of the ulcer that can be distinguished from the hard measures. The disease has a horizontal control should be distinguished from sexually transmitted lymphogranuloma, the latter without pain ulcers, see later.

5. Hard sputum: for the first-stage syphilis, attribute-borne diseases, usually 18-21 after infection, characterized by a single or a few painless hard ulcers in the genital area, no purulent, clear borders, and swollen lymph nodes nearby . Healed in 2-3 weeks. Generally occur in male glans, coronary sulcus, penis, female size lips, vagina, etc., lips, tongue, anus, fingers are also good hair parts. Dark-field microscopy at the lower jaw reveals Treponema pallidum, and serological tests for syphilis are often negative in the early stages and positive in the late stage. The ulcer of the disease is hard and the purulent secretion of the border clearing element can be found to be different from the soft chancre.

6. Sexually transmitted lymphogranuloma: caused by Chlamydia trachomatis type I, II, III infection, sexually transmitted diseases, incubation period 3-21d, damage characterized by painless shallow ulcers, soft, round border clear, surface may have A little secretion, often single hair, more in the glans, men and women genital. Other parts are rare. Two weeks after the disease, unilateral inguinal lymphadenopathy and pain occurred, which formed irregular plaques, which adhered to the skin and surface unevenness, and finally caused the formation of most thin tubes by suppuration and ulceration. Female patients with ulcers often occur in the vagina, and drainage to the iliac and anorectal lymph nodes, to the end of the anus proctitis and peripheral inflammation, resulting in rectal stenosis, common perianal thin tube. The initial rash of the disease is not hard, the surface of the syphilis is not found, and the lymphadenitis is broken and can be distinguished from the hard colonization. The disease is not painful at the beginning of the disease, and the lymphoid inflammation breaks out of the serous pus instead of the pus and blood, and the identification of Haemophilus ducrei and the soft lower Luo.

7. Inguinal granulomatosis: This disease is a Donovan infection, a sexually transmitted disease characterized by painless soft ulcers in the vulva, groin, anus, etc., and proliferate, easy to bleed, beef red, with a serous slurry Sexual pus secretions, most satellite-like lesions can occur around the ulcer. The lymph nodes are not swollen, and some patients have ulcers progressing deep, which may cause damage to tissues such as the penis, labia or vagina. Pathology showed pseudoepithelial neoplasia, dermal tissue cells, plasma cells, lymphocytes and neutrophils infiltrated, and several oval Donovan bodies were seen in macrophages. The characteristics of the ulcer, the lymph nodes are not swollen, and the pathological features are different from other ulcerative diseases, which are different from hard and soft.

Second, other diseases of the external genitalia

1. Penile pearl-like rash disease: The cause is related to the stimulation of excessive secretion of the foreskin. The damage is small papules, which occurs in the male coronal sulcus near the edge of the glans. The shape of the round papule is around the glans and has no symptoms. Pathology shows that dense connective tissue surrounds a rich network of blood vessels, peripheral lymphocytes infiltrate, and the top epidermis becomes thin. The symptoms of this disease are particularly easy to diagnose. Note that it is different from sebaceous gland ectopic disease. The latter has a cluster of papules, which are yellow-white and do not surround the glans.

2. Condyloma acuminata: For human papillomavirus type 6, type II infection, occurs in the skin membrane junction area such as coronary sulcus, foreskin. The labia, perineum, anus, etc., are papillary-like bio-enhancement, the surface is uneven, and the surface is soft and bulging, and the larger is cauliflower-like. Localized moisture and rash grow rapidly. The pathology showed pseudoepithelial neoplasia, the cells were arranged neatly, and the granular layer cells were vacuolar degeneration. A PCR check can help with the diagnosis. It should be distinguished from flat wet warts. The latter rash has a flat surface to detect Treponema pallidum, and serological response to syphilis is positive. It should also be distinguished from pseudo-wet phlegm, please see later.

: 3. Pseudocondyloma: may be related to inflammation, vaginal discharge stimulation, damage often occurs in the inner side of the female labia minora, symmetrically distributed, clustered fish-like small papules, redness around the surrounding membrane. The disease should be differentiated from condyloma acuminata. The former is symmetrical, the skin lesions are evenly distributed in parallel, and the high-lifting skin surface is not significant. After reaching a certain level, it basically no longer grows, and the condyloma acuminata grows fast and can be distinguished.

Third, oral mucosal diseases

1. Exfoliative cheilitis: the cause is related to local irritation, the skin is more than the lower lip, but the upper and lower lips can be affected, the lip membrane is congested, edema, saddle crack, smashed, etc., the surface is repeatedly peeled off, and soon A new skin is formed with pain and burning sensation. Should be identified with discoid lupus erythematosus, the latter lesions are limited to a certain location, increased after sun exposure, pathology can distinguish between the two, exfoliative cheilitis is general inflammation, and discoid lupus erythematosus has its own typical pathological features Not difficult to identify, please refer to the relevant section.

2. Actinic cheilitis: acute or chronic inflammation of the lips caused by long-term or intense sunlight. Occurred in the lower lip, acute cheilitis manifested as edema in the lip red area, congestion, water sores. Chronic damage is dryness, thickening, scaling, and cracking of the labia, and atrophy, leukoplakia, or cancer can occur in the advanced stage. The disease has no erythema infiltration, no pore enlargement, no horny plug, etc. Reference tissue pathological diagnosis can be distinguished from discoid lupus erythematosus.

3. Granulomatous cheilitis: the cause is unknown, more common in young adults between the ages of 20 and 40, generally starting from the upper lip gradually affecting the lower lip, showing diffuse swelling J thick. After a slow, recurrent episode, eventually develop into a permanent lip. Pathological changes can be seen in the structure of inflammatory granuloma or tuberculous granuloma.

4. Glandular cheilitis: characterized by ectopic salivary glands of the lip film and excessive secretion of semen, most patients occur in the lower lip, see the swelling of the red lips and the lip membrane on the lip can be seen scattered needle size The new liquid gland tube mouth, the hand squeezing the tube mouth out of my liquid, the liquid often forms a gel film in the lip. Pathology shows that there are many ectopic salivary glands in the deep part of the membrane.

5. Riboflavin deficiency: The body may suffer from cheilitis, glossitis, angular cheilitis, cystitis, conjunctivitis, keratitis and seborrheic dermatitis due to riboflavin deficiency. Among them, the most common form of angular keratitis is more than 90%. See the whiteness of the mouth, impregnation, erosion, linear cracking and keratosis. Glossitis is also a common symptom, and scrotal inflammation can manifest as erythema, scaling or exudation. Keratosis, facial skin lesions can be similar to seborrheic dermatitis, often blepharitis, conjunctivitis, corneal vascular hyperplasia, turbidity, ulcers, can have photophobia and tears. Oral riboflavin can be cured, and should be distinguished from eczema seborrheic dermatitis.

6. Oral simple sore rash: more common in infants and young children, good for hair, cheeks, lips and soft, hard cross-section membrane, beginning with erythema, followed by clustered small water sores, ulceration or ulceration after ulceration . For laboratory examination, see section IV of the simple pityriasis.

7. Oral mask candidiasis: also known as goose sore, mostly caused by Candida infection, found in infants and young children, often associated with chronic diseases and long-term use of antibiotics or hormones. There is a flaky white or gray-white film on the oral membrane, which is relatively tightly fixed. After peeling, the base is bright red, and the film is positive for microscopic examination.

Fourth, other Dun membrane diseases

Differential diagnosis

1. The cause of urethritis, arthritis and conjunctival syndrome is unknown. The skin lesions are used in the palm, road joints and genital areas. The basic damage is needle-like or slightly larger water sores. The substrate is wet. Aseptic urethritis often occurs, which may include hematuria and pyuria. Conjunctivitis, iritis and keratitis occur in the eye. Arthritis is characterized by redness, swelling, heat and pain in the joints. Can be expressed in stomatitis, enteritis, myocarditis, pleurisy and phlebitis. The blood sedimentation bacteria culture was negative. Can be relieved by itself.

2. Membrane dryness syndrome: Most women who are seen in middle-aged women have dry and desquamative skin, dry and sparse hair, and telangiectasia. The eye-bound membrane and the oral throat are dry and can be atrophied. Gastric membrane secretion is low, the secretion of gastric juice is low. Can be combined with rheumatoid arthritis, may be associated with mumps, lymphadenopathy, hepatosplenomegaly.

3. Facial swelling, scrotal tongue syndrome Sudden occurrence of non-sinking edema in the mouth or cheeks, can also subside at the beginning, relapsed due to repeated attacks and swelling, after the skin becomes hard, no symptoms. Nerve paralysis, mostly unilateral. The tongue is swollen with deep, wide grooves. Histopathology is tuberculous granuloma.

4. syphilitic membrane damage: conjunctivitis, keratitis, iridocyclitis can occur in the eye, may have interstitial glossitis, atrophic glossitis, pebbles-like tongue, facial leukoplakia, severe cases may be Causes hard toe and perforation of the nasal septum. Congenital syphilis can occur in the early stage of rhinitis, late congenital syphilis can occur corneal parenchyma, neurological deafness and wedge-shaped teeth also known as Hu's teeth. Secondly, it can cause choroiditis and iritis. Periostitis, bone gum, optic atrophy, etc. Diagnosis should be based on medical history, systemic symptoms, syphilis serology and histopathology.

5. Leprosy damage caused by leprosy: more common with tumor-type leprosy, occurs in the nasal pig membrane, oral membrane and eyelids, cornea. Early inflammatory infiltration nodules, advanced formation of erosion, ulcers, nasal septum perforation, saddle nose, root atrophy, tooth loss, interstitial keratitis, iridocyclitis, throat damage.

6. Nasal induration: caused by Rhizoctonia solani, began to increase the symptoms of nasal catarrh or nasal secretions, followed by gray-purple, ivory hard subcutaneous active nodules, gradually increased into a hard plaque It can form a ulcer and cause nasal deformation, and the pathology is chronic granuloma.

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