Integumentary system

Sta mina

Skin
 Also called the integument, integumentum, cutis or cutaneous layer
 largest single organ of the body accounting for 15 percent to 20 percent of total body weight
and in adults, presenting 1.5 to 2 m2 of surface area to the external environment

I. Skin functions:
a. Protection
 It provides a physical barrier against thermal and mechanical insults such as
friction and against invasion of pathogens
 It prevents tissue damage by toxic chemicals and ultraviolet radiation
 Fluid loss
b. Containment
 For the body structure
 Vital substances
 Preventing dehydration, which may be severe when extensive skin injuries
c. Fluid and electrolyte imbalance
 Prevents dehydration and loss of body fluids. Excess electrolytes can be
removed in sweat
 The subcutaneous layer stores a significant amount of energy in the form of fat
d. Heat regulation
 A constant body temperature is normally easily maintained thanks to the skin’s
insulating components and its mechanism for accelerating heat loss
e. Sensation
 Touch pain temperature, pressure and vibration, which are important for
communication, dexterity, and injury prevention
f. Synthesis and storage of Vit D
g. Immunological function
 Microorganism that penetrate skin alert resident and antigen-presenting cells
such as Langerhans cells in skin and an immune response is mounted
 Maintain the normal flora
h. Metabolism
 Vit Dis produced from precursors under the effects of steroids and sunlight. Vit
D3 is needed in calcium metabolism and proper bone formation
i. Pharmacologic func.
 The skin selective permeability allows some lipophilic drugs such as certain
steroid hormones and medications to be administered via skin patches
J. sexual signaling

II. Skin Parts

a. Epidermis
i. Keratinized stratified (multi layered) epithelium non-living cells composed of
keratinocytes
ii. Horny superficial layer that provides a protective outer surface overlying its
regenerative and pigmented deep or basal layer
iii. Avascular epidermis is nourished by the under lying vascularized dermis
 iv. Supplied by arteries that enter its deep surface to form a cutaneous plexus
anastomosing arteries
v. Afferent nerve endings that are sensitive to touch, irritation and temperature
vi. Epidermis have depression since the dermis has projections
vii. 3 less abundant cells in epidermal cell
1. Melanocytes- pigment producing
2. Langerhans cells- Antigen-presenting
3. Merkel cells- tactile epithelial cells
viii. Layers of epidermis
1. Stratum corneum
o Top most layer of the epidermis
o Subject to friction and any mechanical insult and abrasion
o Consist of 15 to 20 layers of squamous, keratinized cells
2. Stratum lucidum
o Very thin, translucent
o 2- 3 layers of anucleate, dead cells
o Densely packed with eleidin- immediate synthesis of keratin
3. Stratum granulosum
o 3 to 5 layers of flat keratinocytes- more thick in skin than thin
skin
o Keratinocytes of this layer contains course and dark staining
granules that give its name
o Keratinization- for synthesis of keratin
o Keratinohyaline granules- cytoplasm filled with intensely
basophilic masses
o Lamellar granules
 golgi derived ultrastructural features in cells of the
granular layer
 Undergo exocytosis, producing lipid rich, impermeable
layer around the cells
 Major part of the skins barrier against water loss
o melanocytes are found in this area
o Langerhans cells are found in this area
4. Stratum spinosum
o Thickest layer
o Stratum germinativum –zone where cells divide and combine
o Tonofibrils-keratin filaments that converge and terminate at
numerous desmosomes holding the cells layers together
5. Stratum basale
a. Lower most layer of the epidermis
b. Cytoskeletal Keratins – during differentiation, the cells move
upward and the amount and types of keratin filaments increase

b. Dermis
i. Is a dense layer of interlacing collagen and elastic fiber
ii. The predominant pattern of collagen fibers determines the char tension and
wrinkle lines in the skin (tension lines or Langer lines)
 iii. Nutritive vessels form 2 major plexuses
1. Subpapillary plexus
a. Between the papillary and reticular dermal layers
b. Capillary branches extend into the dermal papillae and form a
rich, nutritive capillary network
2. A deep plexus with larger blood and lymphatic vessels lies near the
interface of the dermis and subcutaneous later
iv. Arteriovenous anatomoses or shunts
 Located between the 2 major plexuses
 Thermoregularotry function- decreases blood flow in the papillary layer
to minimize heat loss in cold conditions
v. Deep layers of the dermis contains hair follicles with associated smooth arrector
muscles and sebaceous glands. (arrector muscles of hairs causing the hair to
stand up and cause goosebumps)
 Arrector pili hair muscle contraction > causing the compression of
sebaceous gland to contract > secrete oil
vi. 2 main layers of the dermis
1. Papillary layer
 Multiple projection and each projection are called papilla that is
upward tower
 More superficial layer of dermis; composed of areolar connective
tissue; loose connective tissue
 Contains fibroblasts, scattered mast cells, macrophages and other
leukocytes
a. Free nerve endings
i. Respond primarily into high and low temp, pain , and
itching but also func at as tactile receptors
b. Meissner corpuscles- slight touch found in the dermis of the
skin
2. Reticular layer
 Composition of all reticulating structures such as sweat glands,
many free nerve endings and Blood vessels
 Dense irregular connective tissue
 A network of elastic fibers is also present
 More fibers few cells
 Lamellated pacinian corpuscles- onion skin; sensing coarse touch,
pressure (sustained touch) and vibrations

*reason why there are more locking of the sole of the feet and palms of the hand is because they are
more used

c. Hypodermis/ Subcutaneous layer/ superficial fascia

i. Components:
1. Loose connective tissue
2. Adipose tissue
3. Lamellated Pacinian corpuscles- onion skin; sensing coarse touch,
pressure (sustained touch) and vibrations
 4. Arteries and veins
5. nerves
ii. Composed of mostly loose connective tissue and stored fat , contains sweat
glands, superficial blood vessels, lymphatic vessels and cutaneous nerves
iii. Contains fat for storage
iv. Participate in thermoregulation as insulation (retaining heat in the body core )
v. Provides protection for padding
vi. Promotes rapid uptake of insulin or drugs injected into this tissue because of
highly vasculated
d. Skin ligaments
i. Numerous small fibrous bands through the subcutaneous tissues and attached
to the deep surface of the dermis to the underlying deep fascia.
ii. The longer and sparse it is the skin is more mobile while the short and abundant
it is more attached to the underlying deep fascia of the skin such as the palm
and the soles

III. Accessory structures of the skin

a. Glands
i. Sebaceous glands-
1. Embedded in the dermis except palms and soles
2. Branched acinar cells
3. Hair follicle + sebaceous gland = pilosebaceous unit
ii. Eccrine sweat glands-
1. Most numerous in the foot soles
2. The secretory part (stratified cuboidal epi)has 3 cell types :
a. Clear cells
i. Produce the sweat
b. Dark cells
i. Strongly eosinophilic granules
ii. Granules undergo merocrine secretion to release a
poorly understood mixture of glycoproteins with
bactericidal activity
c. Myoepithellal cells
i. Basal lamina
ii. Contract to move the watery secretion into the duct
iii. Apocrine sweat glands-
1. Axillary and perineal regions
2. Not completely function until puberty
3. Consist of simple cuboidal, eosinophilic cels with numerous secretory
granules that also undergo exocytosis
b. Hair- elongated keratinized structures
i. Hair bulb- terminal dilation for the growing hair follicle
ii. Hair shaft- hair extending beyond the skin surface
iii. Hair follicles
c. Nail
i. Same process of keratinization that produces the hair and skin
ii. Nail root- proximal part of the nail; covered by a fold of skin
iii. Nail bed- contains only the basal and spinous epidermal layers
 iv. Eponychium/ cuticle- epidermal stratum corneum extends
v. Hyponychium- distal end of the plate becomes free of the bail bed at the
epidermal fold
d. Sensory receptors
i. Unencapsulated- no schwann cell or collagenous coverings and more complex
structures with sensory fibers
1. Merkel cells (merkel cell neurite complexes or merkel disk)
a. Sensitive mechanoreceptors essential for light touch sensation
b. Expanded nerve endings which func as tonic receptors
2. Free nerve endings
a. Respond to high and low temp, pain, and itching but also
function as tactile receptors
3. Root hair plexuses
a. A web of sensory fibers surrounding the bases of hair follicles in
the reticular dermis that detect movements of the hairs
ii. Encapsulated- phasic mechano receptors responding rapidly to stimuli on the
skin
1. Meissner corpuscles
a. elliptical structures
b. consisting of sensory axons winding among flattened schwann
cells
c. initiate impuleses when light touch or low frequency stimuli
against skin temporarily deform their shape
d. numerous in the fingertips, palms and soles but decline slowly
in number during aging after puberty
2. Lamellated pacinian corpuscles-
a. onion skin;
b. sensing coarse touch,
c. pressure (sustained touch) and vibrations
d. Hot and cold
3. Krause end bulbs
a. simpler encapsulated, ovoid structures
b. found primarily in the skin of the penis and clitoris where they
sense low frequency vibrations
4. Ruffini corpuscles
a. Collagenous, fusiform capsules anchored firmly to the
surrounding connective tissue
b. Stimulated by stretch (tension) or twisting in the skin
*Thick skin vs thin skin
-what layer is thick and what layer is thin and where it is located

IV. Clinical correlation

a. Wound healing
i. Stages of wound healing:
1. Cut blood vessels bleed into the wound
2. Blood clot forms and leukocytes wound
a. Fibroblast- it forms like a net to st
b. Macrophages
 c. Neutrophils
3. Blood vessels regrow and granulation tissue forms
4. Granulation tissue formation- group of cells ahat ???
5. Epithelium regenerates and connective tissue fibrosis occurs
a. Regenerative epidermis
b. Scar tissue
c. Fibroblast
b. Friction blisters -lymph filled spaces created between the epidermis and dermis of thick
skin by excessive rubbing; formation of corns and calluses if continued
c. Skin cancer-
i. 1/3 of all cancers originate in the skin
ii. Derive from cells of the basal cell carcinomas and squamous cell carcinomas
iii. Increased incidence rate in regions with high amounts of solar radiation
d. Psoriarsis-
i. Chronic skin condition
ii. Keratocytes are produced at accelerated rates causing thickening of the
epidermal layers and increased keratinization and desquamation
iii. Caused by over active t lymphocytes that trigger an auto immune reaction in the
skin which also lead to inflammation with redness, irritation , itching and scaling
e. Albinism- congenital disorder producing skin hypopigmentation due to defect in
tyrosinase or some component of the melanin producing pathway
f. Vitiligo- an acquired condition that involves skin depigmentation, often only in affected
patches due to the loss or decreased activity of melanocytes
g. Benign melanocytic Nevi(mole)-
i. proliferation of melanocytes
ii. changes in size or appearance of moles are sometime indicate of dysplasia that
causes malignant melanoma
h. Pemphigus and bullous pemphigoid
i. Collagen- more collagen you have the more the skin elastic
j. 2 point discrimination-
i. neurology test where the doctors apply 2 point 2 stimuli
ii. to determine the number of tactile corpuscles in skin
iii. loss of tactile corpuscles or reduction in their activity can also be detected in
scleroderma or other connective tissue disorder such that lead to sclerosis of
the dermis and tightening of the skin
k. Alopecia
i. Baldness results from a complex combination of genetic and hormonal factors
l. Acne-
i. Inflammatory disorder of the pilosebaceous unit which can be expected to occur
during adolescene.
ii. Excessive keratinization and excess sebum production both of which contribute
to the blockage of ducts in the follicle
iii. Anaerobic bacteria (propionibacterium acnes) grow in the accumulated sebum
iv. Comedone- enlarged follicle
m. Cystic fibrosis- defect in a transmembrane conductance regulator of epithelial cells that
lead to disruptive accumulations of thick mucus in the respiratory and digestive tract
n. Molluscum contagiosum
V.
*who are more prone to have scars and keloid former?