Skin and skin appendage

Summary

The skin is the largest organ of the body, covering an area of approximately 2 m2. The skin is
composed of the cutis (including the dermis and epidermis), subcutaneous tissue, and skin
appendages. The epidermis, which is derived from ectoderm, is the outermost layer of the skin
and is mainly composed of keratinocytes. The dermis, which is derived from mesoderm, is
located underneath the epidermis and is mainly composed of elastic fibers, type I collagen,
and connective tissue. It is formed by the papillary dermis and the reticular dermis.
The subcutaneous tissue, which is derived from the mesoderm, is the innermost layer of the skin
and is mainly composed of fat and connective tissue. Skin appendages are derived from the skin
and include hair, nails, and glands. The main functions of the skin are protection (barrier against
ultraviolet radiation, microorganisms, and water loss), the synthesis of vitamin D, detection of
sensation (e.g., touch, temperature, pain), and the regulation of body temperature.
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Structure of the skin

The skin is composed of several layers, which are categorized as follows (from superficial to
deep):
Cutis 

Epidermis 

 Derived from ectoderm
 Primarily composed of keratinocytes, which constantly regenerate approximately every 30 days

 The outermost and nonvascularized layer of the skin that maintains the skin's barrier
function
 There are 5 layers of the epidermis, which are categorized as follows (from superficial to deep):
o Stratum corneum: outer layer of the epidermis 
 Consists of dead (anuclear), keratin-filled cells
 This layer is constantly being sloughed off.
o Stratum lucidum: thin, translucent layer
  Located only on thick skin (palms and soles)
 Composed of a homogeneous layer of keratinocytes with no nuclei or organelles
o Stratum granulosum: also called the granular layer
 Contains keratohyalin
 This layer has waterproof properties.
o Stratum spinosum
 Composed of actively dividing keratinocytes with spinous-like projections
(prickle cells)
 This layer produces keratin and induces keratinization.

 Langerhans cells are also located in this layer.

o Stratum basale (also called the basal cell layer of the epidermis)
 Stem cells of the epidermis (their daughter cells migrate upwards and
differentiate into other cells)

 Melanocytes and Merkel cells are also located in this layer.

 The stratum basale is regenerative and it proliferates to fill skin defects.

“Come on, Let's Get Some Beers”: Corneum, Lucidum, Granulosum, Spinosum, and Basalis are

the 5 layers of the epidermis.

Dermal-epidermal junction

 Basement membrane

o Anchors the epidermis to the dermis

o Consists of two layers:

 Lamina lucida (superficial)

 Lamina densa (deeper)
  Hemidesmosomes: connect the epidermis to the basement membrane

 Collagen fibrils: connect stratum basale to the papillary layer

Dermis

Derived from mesoderm; contains blood vessels and provides structural integrity to the skin  

 Papillary dermis
o Consists of fine, loosely arranged collagen fibers
o Supplies the epidermis with nutrients

o Plays an important role in temperature regulation 

o Forms dermal ridges, which connect dermal papillae (extension of the papillary
dermis into the epidermis) to epidermal downgrowths known as epidermal ridges or
rete ridges
o Contains Meissner corpuscles (for fine-touch and two-point discrimination) and free
nerve endings

o Contains immune cells (mast cells and macrophages)

 Reticular dermis
o Consists of thick, densely packed fibers (e.g., reticular, elastic, and collagenous) that
provide structure and support to the skin and its components 
o Contains Ruffini corpuscles (mechanoreceptors): responsible for mechanical pressure
and the sensation of distortion
o Contains sweat glands, sebaceous glands, and the roots of hair follicles

o Langer lines

 Topographic lines that correlate with the natural orientation of the reticular

fibers of the reticular dermis

 Important for wound healing and guiding surgical incisions 

Subcutis (also called hypodermis)

 Derived from mesoderm
  Consists mainly of subcutaneous fat that protects from cold and trauma

 Contains superficial veins and free nerve endings

 Contains Pacinian corpuscles (mechanoreceptors) that are responsible for the sensations of
vibration and pressure

 Collagenous and elastic fibers in this area anchor the skin (epidermis, dermis) to the
deep fascia.

 Allows for the subcutaneous administration of medication

Skin appendages

 Hair, nails, glands (e.g., sweat glands, sebaceous glands)

 See “Skin appendages” below for more information.

References:[ref][ref][ref]
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Sensory receptors of the skin  [ref]

Sensory receptors of the skin

Recepto Types of fiber Function

r

 Encapsulated  Changes
Ruffini
dendritic endings in joint angl
corpuscl
 Large myelinated es
es fibers that are coiled  Pressure
together with  Slippage
bundles of collagen detection
fiber  Stretch
 Adapt slowly to
stimuli
 Location:
fingertips, joints

Meissne  Large myelinated  Dynamic,

r fibers fine, and
 Sensory receptors of the skin

Recepto Types of fiber Function

r

corpuscl  Adapt quickly to light

es stimuli touch (e.g.,
 Location: glabrous stretching,
skin (an area of skin tugging,
that does not folding,
contain hair follicles, twisting,
e.g., over the palms striking,
and soles) squeezing)
 Vibration (l
ow-
frequency)
 Position
sense

Pacinian  Large myelinated  Vibration (

corpuscl fibers high-
es  Adapt quickly to frequency)
stimuli  Deep touch
 Location: ligaments, j and
oints, deep layers of pressure
the skin

 Large myelinated  Deep static

Merkel
fibers touch (e.g.,
discs
 Adapt slowly to edges,
stimuli corners,
 Location: shapes)
fingertips, superficial   Pressure
skin  Position
sense

Free  C fibers: slow  Pain

nerve unmyelinated fibers  Temperatu
endings  Aδ (A-delta): fast re
myelinated fibers
 Location: all skin
areas, epidermis,
some viscera
MeiSsner corpuscles are located on Smooth, hairleSs skin and detect Smooth (fine) touch.
MerKel discs are located on folliKles (hairy skin) and detect Krude touch.
“A Delta plane is fast, but a Cab is slow”: A-delta fibers have fast conduction velocity and C
fibers have slow conduction velocity.

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Skin appendage
Overview  [ref]
Skin appendage includes:

 Nails
 Hair follicles
 Glands
o Sebaceous glands
o Sweat glands (apocrine sweat glands and eccrine sweat glands)

Nails 

 Perionychium: epidermal tissue surrounding the root and base of the nail

 Eponychium: proximal layer of epidermis extending over the nail base
 Hyponychium: epidermal tissue immediately underlying the free distal edge of the nail 
 Nail plate (nail body)
o Covers the nail bed
o Proximally: consists of the matrix unguis or onychostroma (responsible for
new nail growth) and the lunula (the white, crescent-shaped, poorly vascularized
portion of the nail)
o Distally: sterile matrix (provides the nail with bulk and strength)
 Nail fold: depression proximal to the nail plate from which the nail grows
 Vascular supply
o Arterial: two terminal branches of the volar digital artery
o Venous: drains into a network in the proximal nail bed and the skin proximal to the nail
fold
  Innervation: trifurcation of the dorsal volar digital nerve (supplying the nail fold, pulp,
and distal tip of the finger)

Hair follicles
Invaginations of the epidermis into the deep dermis, forming a cavity where the hair grows and
develops. Hair follicles are composed of the following:

 Hair
o A skin appendage that grows from follicles in the dermis
o Contains medulla, cortex, and cuticle
o Functions include conservation of body heat, sensation, and protection of the skin
o Most prominent on the scalp, pubis, axilla, extremities, and face
o See also “Phases of hair growth”.
 Hair shaft
o Extends above the epidermis
o Connects to the hair root in the deep dermis
 Hair bulb
o Root of the hair follicle; located deep in the dermal papilla
o Receives blood and nutrients from a capillary network of vessels to sustain hair growth
 Arrector pili muscle
o Description: obliquely directed smooth muscle fibers that attach to the dermal sheath
surrounding hair follicles
o Function
 Contraction, which is responsible for piloerection (goosebumps)
 Conservation of body heat
 Innervated by the sympathetic autonomic nervous system
Glands
Sebaceous glands  Sweat glands

Eccrine sweat glands  Apocrine sweat glands 

 Exocrine (holocrine)  Composed of a secretory unit called glomerulum or

Descrip
branched glands acrosyringium; surrounded by myoepithelial cells
tion
 The combination of sebaceous gland, arrector pili
muscle, and hair follicle is known as the pilosebaceous
unit.

 Exocrine  Exocrine
glands with a spir glands with a secretory unit
al duct (glomerulum) and excretory
(acrosyringium) ducts that open into hair
and secretory follicles
ducts that open
into sweat pores

Location  Dermis  Deep in the dermis and hypodermis

and  Predominantly
distribu located on the face
and scalp  Most areas of the  Mostly axilla, perineum, areo
tion body la of the nipple, and external
 Absent on palms and
soles  Absent in lips, ear
ear
canal, clitoris, lab
ia minora,
and glans penis

Function  Secretion of sebum  Secretion of  Modified apocrine cells

o An oily, waxy sweat (thermore produce ear wax or breast
substance gulation) milk.
which  No significant role
is a lubricant in thermoregulation
and a waterp
roof layer for
the skin
and hair 
o Has
photoprotec
tive,
antimicrobial
, and
 Sebaceous glands  Sweat glands

Eccrine sweat glands  Apocrine sweat glands 

antioxidant
properties

Regulati  Stimulated  Stimulated  Stimulated

on of by androgens, by acetylcholine by epinephrine and norepine
secretio especially dihydrotes via muscarinic phrine from adrenergic nerve
n tosterone receptors  fibers
 Inhibited
by estrogens
 Circulating hormones may also affect the secretion of
sweat:
o Growth hormone: ↑ size of sweat glands
o Thyroid hormone: ↑ secretion of sweat
(i.e., hyperthyroidism is characterized by moist
and warm skin)

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Functions of the skin

The main functions of the skin include: [ref]

 Barrier and protection against the external environment 

 Thermoregulation (e.g., perspiration, regulation of blood circulation)  
 Sensory function: sensations of pressure, vibration, touch, pain, and temperature
 Hormone synthesis of vitamin D 
 Melanin synthesis: provides protection against ultraviolet (UV) radiation and determines the
color of the skin and iris (see “Synthetic pathway of melanin” above)

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Clinical significance
Common skin disorders

 Acne
 Allergic contact dermatitis
 Atopic dermatitis
 Psoriasis
 Rosacea
 Seborrheic keratosis
 Urticaria

Vascular tumors of the skin

 Angiosarcoma
 Bacillary angiomatosis
 Kaposi sarcoma
 Pyogenic granuloma
 Strawberry hemangioma

Viral infections of the skin

 Herpes
 Human papillomavirus
 Molluscum contagiosum
 Varicella-zoster virus
 Hairy leukoplakia

Bacterial infections of the skin

 Cellulitis
 Erysipelas
 Impetigo
 Necrotizing fasciitis
 Staphylococcal scalded skin syndrome
Fungal infections of the skin

 Tinea
 Cutaneous candidiasis
 Sporotrichosis

Bullous skin disorders

 Bullous pemphigoid
 Dermatitis herpetiformis
 Pemphigus vulgaris
 Stevens-Johnson syndrome
 Toxic epidermal necrolysis

Malignant and premalignant skin lesions

 Actinic keratosis
 Melanoma
 Cutaneous squamous cell carcinoma
 Basal cell carcinoma

Disorders of pigmentation

 Albinism
 Melasma (chloasma)
 Vitiligo
 Seborrheic dermatitis

Other skin disorders

 Acanthosis nigricans
 Erythema nodosum
 Lichen planus
 Ichthyosis

Nail disorders

 Finger infections
  Psoriasis

Hair disorders

 Alopecia
 Menkes disease
 Vitamin C deficiency
 Folliculitis
 Trichotillomania

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Sources
last updated 05/15/2021