Chapter II - Dermatology

Appendages of the skin:
Appendages of the skin are nails, hair, sebaceous glands and sweat glands.
Hairs and nails are modified epidermal cells composed of keratin. Hairs grow from a cavity called hair follicle, which
is located in the dermis as seen in the figure. Hair follicle is lined with epidermal cells.
At the base of the hair follicle is an enlarged hair bulb. At the bottom of it is the papilla, which contains connective
tissues and blood vessels to provide nourishment to the hair. It is from these cells in this region that the hair
grows. The hair projects above the body surface as hair shaft. The portion that penetrates in the dermis (in the
hair follicle) is called the root. Associated with the hair follicles are minute specialized smooth involuntary muscles
called arrector pilus, which contract during stress and raise the hair and pull it in an upright position. Also
sebaceous glands are connected to the hair follicles, which secrete a fatty or oily substance called sebum. It keeps
the skin soft, smooth and gives a glossy feeling to the hair. Hairs grow in two phases; anagen or growing phase
and telogen or resting phase.
Nails are also composed of keratin. They are present on the distal ends of fingers and toes. The nail lies on the
nailbed in which dermis is arranged in longitudinal ridges. The nailbed is supplied with nerve endings and blood
vessels. Nail grows from root of the nail, which lies in the groove of the skin called the nail grooves. Nail is thinnest
in this region. The body of a nail is the uncovered part, which is firmly attached to the nailbed. Its distal end is free
and called free border.
Sweat glands:
Sweat secretes from the sweat glands. It is essentially a saline solution comprising about one-third of the
concentration of plasma. Its secretion is under the control of the sympathetic nervous system. Body temperature
can be lowered by means of sweat glands. Sweating varies from 0 to 2000 ml per day, depending upon
requirements of body temperature regulation.
During physical assessment of a patient, it is imperative for the examining physician to take note of the skin
condition. The physician has to look for skin texture, moistness or dryness, tenderness, skin turgor, and most

erythema, jaundice, etc., and sees the pigmentation pattern of the skin. The examiner also inspects the skin
for any hemorrhagic lesions like petechiae, purpura, and ecchymosis, or structural changes on the skin
like macule, vesicles, bullae, wheals, pustules, papules, plaque, nodules, scales,
excoriations, fissures, scars, ulcers, or lichenifications . A variety of skin conditions and diseases
importantly temperature. The physician also evaluates the skin color for any abnormality like

can be properly diagnosed by a proper assessment of skin condition. Not only that, even systemic condition can be
reflected many times to the skin surface, like jaundice and cystic fibrosis, in which skin is the primary indicator of
the underlying disease.