EPIDERMIS AND ADNEXA During the first weeks of life, the fetus is covered by a layer of nonkeratinizing

cuboidal cells called the periderm (Fig. 1-2). Later, the periderm is replaced by a multilayered epidermis.
Adnexal structures, particularly follicles and eccrine sweat units, originate during the third month of
fetal life as downgrowths from the developing epidermis. Later, apocrine sweat units develop from the
upper portion of the follicular epithelium and sebaceous glands from the midregion of the follicle.
Adnexal structures appear first in the cephalic portion of the fetus and later in the caudal portions. The
adult epidermis is composed of three basic cell types: keratinocytes, melanocytes, and Langerhans cells.
An additional cell, the Merkel cell, can be found in the basal layer of the palms and soles, oral and
genital mucosa, nail bed, and follicular infundibula. Located directly above the basement membrane
zone, Merkel cells contain intracytoplasmic densecore neurosecretory-like granules and, through their
association with neurites, act as slow-adapting touch receptors. They have direct connections with
adjacent keratinocytes by desmosomes and contain a paranuclear whorl of intermediate keratin
filaments. Both polyclonal keratin immunostains and monoclonal immunostaining for keratin 20 stain
this whorl of keratin filaments in a characteristic paranuclear dot pattern. Merkel cells also label for
neuroendocrine markers such as chromogranin and synaptophysin.