SKIN ANATOMY

The human skin (cutis) is the outer covering of the

body and is continuous with the mucous
membrane in the region of the mouth, nose,
urogenital organs, and the anus.
The mass of the skin an adult accounts for
approximately 5 per cent while together with the
subcutaneous fat for about 16 to 18 per cent of the
total body mass.
The skin has a mat tinge and a peculiar colour
due to the colour of its component tissues, the
thickness of the granular and horny layers, the
blood vessels visible through the skin, and the
presence of the pigment melanin. The colour of
the skin may change because the amount of the
pigment in it varies under the effect of external
and internal factors.
The skin surface is covered with hairs over a
great area. The areas devoid of hairs are the lips
(vermilion border), the palms and soles, the
palmar surface of the fingers and the plantar
surface of the toes, the glans penis, the inner
surface of the prepuce, and the inner surface of
the large and small pudendal lips.
In ontogenesis the skin develops from two
germinative zones: the ectoderm (the
outermost embryonal layer) which is
represented by the epidermis (the most
superficial skin layer) and the mesoderm (the
middle embryonal layer) represented by two-
layers, namely the true skin, or dermis (the
middle layer) and the subcutaneous fat, or
hypoderm (the deepest skin layer).
Skin consists of the following layers:

Epidermis (I)
Dermis (II,III)
Hypodermis (IV)
 Epidermis includes the following layers:

1. Germinative layer (2)

(1-basement membrane).
2. Prickle cell layer (3).
3. Granular layer (4).
4. Lucid layer (5).
5. Horny layer (6).
Germinative layer
(stratum basale or stratum germinativum)
It consists of a single layer of prismatic (columnar)
cells arranged like a palisade; between these cells
there are slit-like spaces called intercellular bridges.
Among the cells of germinative layer localaze
melanocytes, which produce melanin.
Skin color straightly depends on the amount of
melanin.
Prickle cell layer (stratum spinosum)
Consists of five to ten rows of cells which are
cuboid in the deep parts of the layer but become
flatter gradually as they approach the next layer, the
granular layer
The cells of the prickle-cell layer are marked by the
presence of specific tonofibrils in their cytoplasm.
Special Langhan's cells are demonstrated in this
layer, which carry imunalogical function.
Granular layer (stratum granulosum)

Contains one to two or four rows of cells elongated parallel

to the epidermis
It was considered previously that they were formed of a
special substance called keratohyalin
The presence of the keratohyalin granules is the first visible
stage, of the beginning of the process of keratinization of the
epidermal cells.
The epidermal germinative, prickle-
cell, and granular layers are sometimes
embraced under the name of
Malpighian layer.
 Lucid layer (stratum lucidum)

Composed of elongated cells containing a special protein

substance which refracts light strongly
This substance resembles drops of oil and is called eleidin
Besides its main component, eleidin, the stratum lucidum
contains glycogen and fatty substances (lipoids, oleic acid)
 Horny layer (stratum corneum)
It is composed of fine, anuclear keratinized elongated cells
They are firmly attached to one another and are filled with a
horny substance (keratin) the chemical structure of which has
still not been finally determined
It is believed that this is an albunoid substance poor in water
and rich in sulphur and contains fats and polysaccharides.
The outer part of stratum corneum is less compact and
occasional lamina separate from the main bulk, i.e. the process
of physiological desquamation occurs
 Dermis
Papillary layer - consists of thin bundles of astructural
amorphous interstitial substance, collagen fibres and many fine
elastic and argyrophil fibres
Reticular layer - consists of collagen bundles are more
compact and thick and intertwine into a thick network of loops
The reticular and particularly the papillary layer of normal skin
have a small number of various cell elements: fibroblasts,
histiocytes, lymphocytes, mast and plasma cells, and peculiar
pigment cells
Hairs, glands (epithelial appendages of the skin), muscles,
vessels, nerves and nerve endings are located in the dermis
 Hypoderm
consists of thick bundles of collagen and elastic fibres
stretching from the reticular dermal layer and forming a
wide-loop reticulum in which accumulations of large fat
cells, lobules of fatty tissue, are lodged
The thickness of the hypoderm varies from 2mm till 10cm
and more, and in some areas there is no hypoderm at all
(eyelids, prepuce, small pudendal lips, scrotum)
Functions of the Skin
Immunological function
Metabolic function
Secretory function
Thermoregulation function
Receptory function
Excretory function
Protective function
Neuroreceptors of the Skin
Vater Pacini corpuscles - the receptors of the sense of deep
pressure and proprioceptive sensations, usually located in the
subcutaneous fatty tissue.
Free nervous endings –non specific receptors.
Meissner’s corpuscles - are situated in the papillae receptors
for the sensation of tactile sensation.
Krause’s bulbs - the receptors for the sensation of cold situat-
ed in and under the papillae.
Ruffini’s bodies - receptors for the sensation of warmth
located much deeper, in the deep parts of the dermis and in the
upper parts of the subcutaneous fat.
Pathohistological Process
Serous inflammation
Acanthosis
Acantholysis
Dyskeratosis
Granulosis
Papilomatousis
Hyperkeratosis
Classification of Morphological Lesions

Primary
Secondary
 Classification of Primary
Morphological Lesions
Infiltrative Exudative Cavitary Non Cavitary

Spot Vesicle Vesicle Spot

Papule Bulla Bulla Papule
Tuber Pustule Pustule Tuber

Nodule Wheal Nodus

Wheal
 Spot
It is a circumscribed alteration in the colour of the skin or mucous
membrane. It is not elevated on the skin.
According to cause of their formation :
1. Vascular : Roseola
Erythema
Eryhthrodermia

2. Hemorrhagic : Petechiae
Purpura
Vibrces
Ecchymoses
Hematoma

3. Dischromic : Depigmentation
Hyperpigmentation
 Papula
It is a solid, more or less hard lesion, elevated above the skin surface.
Size is until 5mm.
According to the localisation :
• Epidermal
• Dermal
• Epidermodermal

According to the form :

• Semispherical
• Acuminated
• Flat
• Polygonal
• Oval
• Round
 Tubercle
Infiltrative solid skin elevation
of a non-acute inflammatory
character
Tubercles occur on restricted
areas of the skin as a rule,
either in groups or they
coalesce forming a compact
infiltration
The inflammatory cellular
infiltration in tubercles
spreads not only in the
papillary but mainly in the
reticular layers of the dermis
Histologically, it is an
infectious granuloma which
either ulcerates with the
eventual formation of a scar,
or resorbs leaving cicatricial
atrophy
 Nodule
It is a primary infiltrative
morphological lesion without
acute inflammation.
It is large (the size of a pea to
that of a walnut or larger) and is
situated in the subcutaneous fat.
The nodules ulcerate and
eventually cicatrize. Their
consistency varies from soft to
firm elastic
 Vesicle
It is a primary morphological lesion of an exudative character; it has a
fluid-containing cavity and is slightly elevated.

Size is until 5mm

They can be unicamerate

or multicamerate.

According to contents,
they can be serous or hemorrhagic.
 Bulla
It is a cavitary lesion with size more than 5mm. It consists of a
covering, a cavity with serous contents, and a floor.

According to localisation in skin :

a) subcorneal
b) intraepidermal
c) subepidermal

Contents can be either serous

or hemorrhagic
Pustula
It is an exudative cavitary lesion containing pus.

May be :
• Superficial
• Deep
 Wheal
It is an exudative non-cavitary lesion which forms as a result of
circumscribed acute-inflammatory oedema of the papillary skin layer.
It is a rather hard cushion-like elevation, spherical, or less frequently
oval in shape, which is attended with strong itching.
It usually disappears rapidly (from several scores of minutes to a few
hours) leaving no trace.
Secondary Morphological Lesions
1. Erosion
2. Ulcer
3. Squama
4. Crust
5. Scar
6. Fissura
7. Excoriation
8. Spot
9. Vegetation
10. Lichenization
 Erosion
Superficial morphological lesion within
the epidermis only.

Appear after rupture of vesicles, bullae

and pustules and are of the same shape
and size as the primary morphological
cavitary lesions in whose place they
had formed.

Are usually pink or red and have a

moist, weeping surface

Heal without leaving scars

 Ulcers
Skin defect with involvement of the
epidermis, dermis, and sometimes the
deeper lying tissues.
Develop from tubercles, nodules, and
after rupture of deep pustules.
Can be spherical, oval or an irregular
shape. Colour can vary from bright-red
to cyanotic congestive.
Heals always leaving a scar from the
character of which the previous
pathological process may be
determined
 Squama
Are pathologically detached
horny laminae.

According to size of squama,

can be furfuraceous (small and
fine) or lamellar (large).

Colour of the squamae may be

white, grey, yellowish or
brownish.
 Crust
Forms when a serous exudate, pus or
blood, dries on the skin.
According to contents, can be:
a) serous
b) purulent
c) hemorrhagic
d) mixed
According to colour, can be :
a) transparent or yellowish in serous
secretion.
b) yellow or greenish-yellow in a
purulent secretion.
c) red or brownish in a hemorrhagic
secretion
 Spot
Develops in the process of
evolution of primary
morphological lesions.

Dischromic spot

• Depigmentatic
• Hyperpigmentatic
 Scar
Forms in place of deep defects in the skin which had been replaced by
coarse, fibrous connective tissue.

Can be divided into the following :

• Atrophic
• Hypertrophic
• Primatrophic
• Keloid
Fissura
Superficial (epidermis only)
- does not penetrate beyond the epidermis and heals without a
trace

Deep (epidermis and dermis)

- forms in the epidermis and the dermis, sometimes with
involvement of the deeper tissues, and leaves a scar after
healing
 Excoriation
Skin defect resulting from
scratches or some other
traumatic damage.

If only epidermis and dermis

involved, then no scar. If
deeper penetration, then scar
forms.

It is objective sign of
excruciating itching.
 Vegetation
Form in the region of a persistent
inflammatory process as the
result of intensified proliferation
of the epidermal prickle-cell
layer.

Have appearance of villi, dermal

papillae which lend them an
uneven nodular character
resembling a cock's comb.

Colour can differ based on the

presence of discharge from
bleeding or secondary infections
from grey to red or yellow. Can
be hard or tender.
 Lichenization
It is thickening and hardening of the
skin marked by exaggeration of its
normal pattern, hyperpigmentation,
dryness, roughness, and shagreen-like
appearance.

Can be primary (due to long term

irritation of the skin) or secondary (in
confluence of papullary lesions)
Evolution of Morphological Lesions
Spot, Papule

Squama

Pigmentation
Vesicula, Bulla,Superficial Pustula

Erosion

Crust

Squama

Pigmentation
Tuber, Nodule, Deep Pustula

Ulcer

Crust

Squama

Scar
 Wheal

Disappears rapidly without any traces

or
may become squama
 Eruption
Monomorphic eruption
- single type of primary morphological
lesions eg. papules in psoriasis warts.

Polymorphic eruption
- True polymorphism
- False polymorphism
Polymorphic Eruption
True Polymorphism
- consists of several types of primary morphological lesions eg.
in eczema, leprosy, Duhring's dermatitis herpetiformis.

False Polymorphism
- primary and a few secondary morphological lesions are found
at the same time.