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THE INTEGUMENTARY SYSTEM

Ahmad Aulia Jusuf, MD, PhD
Department of Histology Faculty of Medicine University of Indonesia
2008

INTRODUCTION
Like Borobudur temple the skin (Fig-1) is the largest organ in our body, both in weight
and surface area. The skin shows variation in structure at different sites in the body surface. The
thickness of skin varies in any place in our body. The skin is thick on the upper back while the
thinnest skin is on the upper and lower eyelids.

Fig-1 Skin is the largest organ in the body

The general aim of this module is to study the histological structure of the skin and its
accessories in the correlation with their functions. In this module we study:
1. Histological structure and its relation to skin function
2. Role of 4 types epidermal cells in skin function
3. Melanocyte structure
4. Melanogenesis
5. Vascularization of the skin and skin immune cells
6. Histological structure of the skin in aging process
7. Histological structure of thick and thin skin
The integumentary (inte=whole, -gument=body covering) is the largest organ in our
body. It constitutes 15-20% of total body mass. The integumentary system consists of skin (cutis,
integument) and its derivates, such hair, nails and multicellular exocrine glands. The function of
skin are
1. Protection
The skin provides protection against a wide variety of external damaging stimuli, including
ultra violet light, chemical, thermal, and mechanical insult. The skin also provides a barrier
against the excessive wetting (Waterproof) and also against bacterial and fungal invasion.
Some of bacteria and fungi are present normally in the surface of skin, but they can not
penetrate into underlying tissue.

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2. Sensation
Skin contains many different receptors for touch, pressure, pain and temperature. These
sensory receptors present in most numerous in the skin which has most physical contact with
solid objects in the enviroment, such as in the soles and palm and in the ventral surface of
finger and toes
3. Thermoregulation
Skin has an important role in heat conservation through the thick pelt of hairs on the surface
and subcutaneous adipose tissue. There are several mechanisms for heat to be lost :
a. increasing the blood flow through the rich vascular network in the skin
b. secreation of sweat from the eccrine glands to the surface of skin
c. evaporation
4. Metabolic function
The most important metabolic function of skin is the synthesis of vitamin D3
(cholecalciferol) by the action of ultraviolet light on he precursor 7-dehydrocholesterol. The
cholecalciferol is further processed in liver and kidney to produce the active 1,25-
dihydroxycholecalciferol which is important in calcium metabolism and bone formation.
5. Sexual Attractant
This greatly underestimated function has spawned an enormous industry in products claiming
to improve the texture and appearance of skin, hair, and nails and other products which hide
or minimise defects.

Histological structure and its relation to skin function as body protector

Integument (Fig-2) (Inte=whole; gument= body weight) composed of skin and its
accessoriy structure: hair, nails and exocrine glands such as sweat glands and sebaceous glands.

Fig-2 The integument system : skin,

Skin consists of two layers (Fig-3) ; an outer epidermis and a deeper connective tissue
layer, the dermis.

Fig-3 Epidermis and dermis

The epidermis, the surface layer of skin, is derived from ectoderm and is composed of
stratified squamous keratinized epithelium. The thickness of epidermis varies over most of body.
The thick skin is present on the palm of the hands and soles of the feet, while the thin skin covers
most of the remainder of the body. Epidermis makes invagination into its underlying connective

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tissue (dermis) called as epidermal ridge which interdigitate with the dermal ridges (papillae), the
ridges of the dermis.
The dermis, the layer of skin immediately deep to the epidermis, is derived from
mesoderm and it consists of a loose papillary layer and a deeper denser reticular layer. Except of
connective tissue, this mesoderm derived tissue contains sweat glands, sebaceous glands and hair
follicles. The dermis forms the ridges, called as dermal ridges (papillae) which interdigitate with
epidermal ridges.

Fig-4 The Epidermis

The hypodermis is a loose connective tissue containing varying amounts of fat , underlies
the skin. The hypodermis is not part of the skin but is the superficial fascia of gross anatomical
dissection that covers the entire body, immediately deep to the skin. Individuals who live in cold
climates posses a large amount of fat deposited in the superficial fascia named panniculus
adiposus.

EPIDERMIS
Epidermis (Fig-4) is composed of stratified squamous keratinizied epithelium. This layer
has no blood vessel and lymph vessel. The nutrient is received by diffusion process in which the
nutrient pass through the extracellular fluid from the blood capillaries in the dermis to the
epidermis layer. Because of the cytomorphogenesis of keratinocytes during their migration from
the basal layer of the epidermis to its surface, epidermis divided into 5 morphologically distinct
zones:
1. stratum basale (germinativum)
2. stratum spinosum
3. stratum granulosum
4. stratum lucidum
5. startum corneum.

Skin is classified into thick and thin skin (Fig-5) according to the thickness of epidermis.
However these two classification are also distinguished by the presence or absence of certain
epidermal layers and the presence or absence of hair.

Fig-5 The Thick Skin (left side) and Thin Skin (right side)

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The thick skin is characterized by the presence of all five layers. Thick skin lacks hair
follicles, arrector pili muscles and sebaceous glands but has the sweat glands. The thick skin covers
the palms and soles.
The thin skin is characterized by the presence of thin stratum corneum and lacks the
defined stratum lucidum and stratum granulosum, although individual cells of these layers are
present in their proper locations. Thin skin has hair follicles, arrector pili muscles, sebaceous glands
and sweat glands. The thin skin covers most of the remainder of the body.

KERATINOCYTES
Keratinocytes (Fig-6 and 7A) which are derivated from surface ectoderm of embrionic
layers form the largest population of the cells (85-95% of cell population) and are arranged in all
five recognizable layers while the remaining 3 other cell types are interspersed among keratinocytes
in their specific location.
Keratinocytes undergo mitosis actively (Fig-7B) at night in the basal layers of epidermis.
As the new cells are forming the cells above continue to be pushed toward the surface. Along their
way to the surface, the cells differentiate and begin to accumulate keratin filaments in their
cytoplasm. When they near to the surface, the cells die and are sloughed off (desquamation). This
process takes 20-30 days.

Figure-6 The types of cells in the Epidermis

STRATUM BASALE
Stratum basale (Fig-6 and 7A), also known as the germinal layer is the deepest layer of
the epidermis. It is supported by a basement membrane and sits on the dermis. The stratum basale
consists of single layer of mitotically active, cuboidal to low columnar cells containing basophilic
cytoplasm and a large nucleus. Many desmosomes are located on the lateral cell membrane
attaching stratum basale cells to each other and to cells of the stratum spinosum.
Hemidesmosomes attachs the cells to the basal lamina. Mitotic figures should be common in this
layer because it is partially responsible for cell renewalin the epithelium. When new cells are
formed via mitosis, the previous layer of cells is pushed surfaceward to join the startum
spinosum.

Fig-7A. Keratinocytes in stratum basale Fig-7B. The process of keratinization

and stratum spinosum

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STRATUM SPINOSUM
The thickest layer of the epidermis is the stratum spinosum (Fig-7A) which is composed
by polyhedral to flattened cells. The basally located keratinocytes in the stratum spinosum also
are mitotically active, thus the stratum germinativum and stratum spinosum are responsible for
the turnover of epidermal keratinocytes. The stratum spinosum and stratum germinativum are
known as Malpighian layer. The cells in the stratum spinosum are richer in bundles of
intermediate filaments (tonofilament) representing cytokeratin than in cells in stratum basale.
These bundles radiate outward from perinuclear region toward highly interdigitated cellular
processus. These cellular processes attach adjacent cells to each other by desmosomes. These
processes, also called as intercellular bridges give cells of the stratum spinosum a“ prickle cell”
appearance (Fig-8)

Figure-8 The prickle cell appearance in the keratinocyte cells in stratum spinosum

STRATUM GRANULOSUM

Fig-9 Stratum Granulosum

The stratum granulosum (Fig-9) consists of three to five layers of flattened keratinocytes
which still have nuclei. The cytoplasm of these keratinocytes contains the keratohyalin granules,
the large irregularly shaped and basophilic granules. Cells of stratum granulosum contain
membrane-coating granules, which are released by exocytosis into extracellular space, forming
sheets of lipid-rich substance that acts as a waterproof barrier, one of the functions of skin.
STRATUM LUCIDUM
Stratum lucidum (Fig-9) is a thin layer of cells immediately superficial to the stratum
granulosum and is present only in the thick skin (i.e. palms of the hands and soles of the feet).
Although the flattened cells of stratum lucidum lack organelles and nuclei, they contain densely
packed keratin filament.
STRATUM CORNEUM
The stratum corneum (Fig-9) is composed of numerous layers of flattened, keratinized
cells with a thickened plasmalemma. These cells lack nuclei and organelles but are filled with
keratin filaments embedded in an amorphous matrix. The cells near the surface of the skin called
squames or horny cells, lose their desmosomes and become desquamated (sloughed off).

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MELANOCYTES
Melanocytes (Fig-10), derivated from neural crest are located among the cells of stratum basale
and in the superficial portions of dermis. These cells are responsible for producing the pigment
melanin which is responsibel for skin coloration. The pigment exists in various forms from
yellowish brown to black. This skin pigment is thought to have protective function against
damage from excessive ultraviolet light.

Fig-10 The melanocytes (indicated by arrow)

Fig-11 The synthesis of melanin pigment

Melanocytes are round to columnar cells whose long undulating processus extend from
superficial surface of the cells and penetrate the intercellular spaces of the stratum spinosum.
Under light microscope melanocytes is pale stainned with their cytoplasm contains scanty tiny
round or oval dark staining bodies known as melanosomes which are responsible for the synthesis
of melanin.
Melanocyte are present as scatter cells in the basal layer and are more numerous in areas
which are exposed to light , for example they are more numerous on the face than on buttocks.
There is no great difference in numbers of melanocytes between white and dark-skinned races,
but they are considerably more synthetically active in darker skinned people. In pale skinned
people the melanocytes can be stimulated into producing more melanin by gradually increasing
exposure to UV light.

Fig-12 Cytocrine secretion of melanosomes

Tyrosinase produced by the RER of melanocytes (Fig-11) is packed by Golgi apapratus
into oval granules known as melanosom. The amino acid tyrosine is transported into melanosom.
The tyrosinase coverts tyrosine into melanin by a series of reactions through 3,4-
dihydroxyphenylalanine (dopa, methyldopa) and dopaquinone. The enzyme tyrosinase is
activated by ultraviolet light.
Melanosomes leave the cell body of the melanocytes (Fig-12) and travel to the tips of
their processes penetrate the cytoplasm of keratinocytes and become pinched off via a special
secretory process called as cytocrine secretion. Melanosomes are transported to the supranuclear
region. So the melanosomes forms a protective barrier between the nucleus and the impinging

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ultraviolet rays from the sun. The melanin pigment is attacked and degraded by lysosome of the
keratinocytes. This process occures over a period of several days.

LANGERHANS CELLS
Langerhans cells (Fig-13 ) are antigen presenting cells located among the cells of the
stratum spinosum. This cell originate from precursor in the bone marrow and are a part of the
mononuclear phagocyte system. Normally the Langerhnas cells represent 2% to 4% of the
epidermal cell population. Langerhans cells also known as dendritic cells because of their
numerous long processes.
Histologically these cells are pale stainned (Fig-13) with irregularly lobulated nuclei and
almost clear cytoplasm. Cytoplasmic processes extend from the cell and insinuate between
keratinocytes of all layers. Under electron microscope the Langerhans cells show the present of
unique feature of granules known as Birbeck granules which in section resemble Pingpong
paddles; however theire function is not known.

Figure-13 Langerhans cells, indicated by L and its processus indicated by CP, HE

staining (left side) and immunohistochemical stainning (right side)

These cells function in the immune response that will phagocytose and process foreign
antigens. Then they migrate to lymph nodes in where they present epitopes of processed foreign
antigen to T lymphocytes, thus Langerhans cells are antigen presenting cells.

MERKEL CELLS

Figure-14
Merkel cells (Fig- 14) are intra epidermal touch receptors and contain neuroendocrine
type membrane-bound vesicles in their cytoplasm, particularly near theis base where they make
synaptic junctions with unmyelinated sensory nerve twigs in upper dermis. They are very scanty
in adult skin and are difficult to find.

DERMIS

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Dermis (Fig-15) is the layer of skin immediately deep to the epidermis is derived from
mesoder and composed of dense irregular collagenous connective tissue containing mostly type I
collagen fibers and networks of elastic fibers which support the epidermis and bind the skin to the
underlying hypodermis (superficial fascia).
Dermis is responsible the tone and texture of the skin. In the young the skin is tight and
firm because of the quality of the collagen and elastin, but with increasing of age and particulary
exposure to sunlight the collagen and elastin in upper dermis progressively degenerate, and the
skin loses much of its texture and wrinkle.

Figure-15
Dermis contains the vascular supply and innervation of the skin and has two layer, a
superficial papillary dermis benetah the epidermis and a deeper reticular dermis which borders
the subcutis.
The superficial papillary layer of dermis interdigitates with the epidermis forming the
dermal ridges (papillae). It is composed of a loose connective tissue containing type III collagen
fibers, elastic fibers, and type VII collagen fibers which extend from the basal lamina into
papillary layer, binding the epidermis to the dermis. This layer also contains fibroblast,
macrophages, plasma cells, mast cells, and other cells common to connective tissue. The papillary
layer (Fig 16) posses

Figure-16
1. the capillary loops, called as vascular papillae which are rich with capillar vessel.
These capillaries regulate the body temperature and nourish the cells of avascular
epidermis
2. the nerve ending receptor loops, also called as nerve papillae which are rich with
nerve ending receptor such as Meissner corpuscle, the mechanoreceptor specialized
to slight deformations of the epidermis. This receptor are most common in area of the
skin that are sensitive to tactile stimulation (eg. Lips, external genitalia and nipples).
Another mechanoreceptor present in the papillary layer is the Krauseend bulb, which
once thought to respond to cold, but its actual function is currently unclear.
The reticular layer of dermis (Fig-15) is composed of dense irregular collagenous
connective tissue (type I collagen fibers), elastic fibers, proteoglycan, fibroblast, macrophage,
mast cells, lymphocytes, and fat cells in the deeper aspect of the reticular layer. The other
structures present in this layer are sweat glands, sebaceous glands, hair follicle, smooth muscle

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(eg. arrector pili muscles) and 2 mechanoreceptor, the paccinian corpuscle which respond to
pressure and vibrations and Ruffni corpuscles which functions still unclear.

SKIN CIRCULATION

Figure-17
The circulation of the skin (Fig-17) has an unusual arrangement which has correlation
with its function :
1. Nutrition of skin and appendages
2. increased the blood flow to facilitate heat loss in hot condition
3. decreased blood flow to minimise heat loss in cold condition
The artery supplying the skin are located deep in the subcutis from which they give rise to
branches passing upwards to form two plexuses of anastomosing vessels. The deeper plexus lies
at the junction of the subcutis and dermis, known as the cutaneous plexus. The more superficial
plexus lies at the junction between papillary and reticular dermis, knowns as subpapillary plexus.
This subpapillary plexus also gives rise to a capillary loop in each dermal papilla.
The venous drainage of the skin is arranged into plexuses broadly corresponding to the
arterial supply. The skin has a rich lymphatic drainage which forms plexus corresponding to those
of the blood vascular system.

HAIR FOLICLE
Hair (Fig-15, 17, 18 and 19) are filamentous, keratinized structures that project from the
epidermal surface of the skin. Hair grows over most of the body except on the vermilion

Figure-18 The part of Hair

zone of the lips, palms and side of palms, sole and sides of feet, dorsum of of the distal phalanges
of the fingers and toes, glands penis, glands clitoris labia minora and vestibulum aspect of the
labia mayora. There are two types of hairs on the human body:
1. vellus hairs are soft, fine, short and pale (e.g hairs covering the eyelids)
2. terminal hairs are hard, large, coarse, long and dark (e.g. scalp and eyebrows)
Additionally very fine hair called lanugo is present on the fetus.

Figure-19 The Hair

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Hair follicles, the organs from which hair develop, arise from the invagination of the
epidermis that invade the dermis, hypodermis or both. Hair follicles are surrounded by dense
accumulations of fibrous conncetive tissue, belonging the dermis. A thickened basement
membrane, the glassy membrane separates the dermis from the epithelium of hair follicle.
The terminus of hair follicle, the hair root (Fig-20) extend to the base and make the bulb,
known as hair bulb (Bulbus pili). The bulbus pili is invaginated by the connective tissue of
dermis containing the capillaries known as dermal papilla (papil pili). The bulk of the cells
composing the hair root is called the matrix. Proliferation of these matrix cells accounts for the
growth of hair.

Figure-20 The Root of Hair

The outer layers of follicular epithelium form the external root sheath which is composed
of a single layer of cells at the hair bulb and several layers of cells near the surface of the skin.
This external root sheath surrounds several layers of epidermally derived cells known as internal
root sheath, which is consistes of three components (Fig-20): (1) an outer single row of cuboidal
cells which contacts the innermost layer of external root sheath known as Henle layer; (2) one or
two layers of flattened cells forming Huxley layer; (3) cuticle of the internal root sheath formed
by overlapping scale like cells.
The hair shaft is a long slender filament that extends to and through the surface of the
epidermis. It consists of three regions (Fig-21): medula, cortex, and cuticle of the hair. As the
cells of the matrix within the hair root proliferate and differentiate, they move toward the surface
of the skin, eventually developing into the hair shaft. As the cells of the cortex are displaced
surfaceward, they synthesize abundant keratin filaments and trichohyalin granules.

Figure-21.The cross section of the hair shaft

Attach to the connective tissue sheath surrounding the hair follicles and to the papillary
layer of the dermis are arrector pili (Fig-15). Contraction of this smooth muscle depress the skin
over their attachment and elevate the hair shaft and the skin around the hair shaft, forming tiny “
goose bumps” on the surface of the skin. These are easily observed when a person is chilled or
suddenly frightened.

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SEBACEOUS GLANDS
Sebaceous glands (Fig-22) secrete an oily substance known as sebum., which maintains
the suppleness of the skin. Sebum is a wax-like oily mixture of cholesterol, triglycerides and
secretory cellular debris.This sebaceous glands arebelongs to holocrin type glands, found
throughout the body, embedded in the dermis and hypodermis, except of palms of the hands,
soles of te feet and sides of the feet inferior to the hairline. Sebaceou glands are under the
influence of sex hormones and increase their activity greatly after puberty.

Figure-22
Each sebaceous gland has a branched acinar form, the acini converging upon a short duct
which empties into the hair follicle beside the maturing hair. Each acini consists of a mass of
rounded cells which are packed with lipid filled vacuoles. During tissue preparation the lipid
content of the acinar cells increases greatly and the distended cells degenerate, releasing their
content.
ECCRINE SWEAT GLANDS
Eccrine sewat glands (Fig-23) are simple coiled tubular glands located deep in the dermis
or in the underlying hypodermis. Passing from the secretory portion of each gland is a slender,
coiled duct that traverses the dermis and epidermis to open on the surface of the skin at sewat
pore. Eccrine sweat glands are mrocrine in their method of releasing their secretory product. The
eccrine glands are innervated by postganglionic fibers of the sympathetic nervous system.

Figure-23 The Eccrine glands

APOCRINE SWEAT GLANDS

The apocrine sweat gland (Fig-24) are found only in the certainlocations: the axilla (arm
pit), the areola of the nipple, and the anal region. Apocrine glands do not become functional until
puberty.
The secretory cells of apocrine glands are simple cuboidal to low columnar in profile.
When the lumen of the gland is filled with secretory product, these cells may become squamous.
The lumina of these glands are much larger than those of eccrine glands. The secretory cells
contain granules located in the apical membrane. When this secretory cells secreted their product,
they are also lost a part of their cytoplasm. The viscous secretory product of apocrine glands is
odorless on secretion, but when metabolized by bacteria, it presents a distinctive odor.

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Myoepithelial cells surround the secretory portion of the apocrine sewat glands and asist
in expressing the secretory product into the duct of the glands.

Figure-24 The acinar and secretory duct of apocrine glands

NAILS
Nails (Fig-25) located in the distal phalanx of each finger and toe are composed of plates
of heavy compacted, highly keratinized cells that form the nail plate, lying on the epidermis,
known as the nail bed. The nail develope from cells of the nail matrix that proliferate and become
keratinized. The nail matrix, a region of the nail root, is located beneath the proximal nail fold
forms the eponychium which extends from the proximal end up on the nail for about 0.5-1mm.
Laterally the skin turns under as lateral nail folds, forming the lateral nail grooves; the epidermis
continues beneath the nail plate as the nail bed, and the nail plate occupies the position of the
stratum corneum.
The white crescent observed at the proximal end of the nail is called the lunula. The distal
end of the nail plate is not attached to the nail bed, which becomes contiuous with the skin of the
fingertip. Near this junction is an accumulation of startum corneum called hyponychium.

Figure-25 The Nail

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