ANATOMY AND PHYSIOLOGY WITH
PATHOPHYSIOLOGY
Integumentary System
Ingumentary (in=inward; -tegere= to cover)
composed of the skin, hair, oil & sweat glands, nails
& sensory receptors.
Consist of Skin & accessory structures.
One of the most familiar system of the body
Dermatology is the medical specialty that deals with
the diagnosis and treatment of integumentary
system disorders.
Skin (wt. 8-10 pounds/17 kg & 22 sq. feet).
Integumentary System and Homeostasis
The IS contributes to Homeostasis by protecting and
helping regulate body temperature. It also allows you
to sense pleasurable, painful, and other stimuli in
your external environment.
Anatomy
Epidermis
Dermis Skin
Subcutaneous layer or hypodermis.
Epidermis
Dermis
Sub-Q Layer
Epidermal
appendages (hair,
glands, & nails)
Major Functions of IS
1. PROTECTION = abrasion & UV light, prevent MO
entering body & reduce water loss, preventing
dehydration.
2. SENSATION = has sensory receptors that can
detect heat, cold, touch, pressure, & pain.
3. VIT. D PRODUCTION = when exposed to UV light,
skin produces molecule that can be transformed into
Vitamin D, important regulator of CALCIUM
homeostasis.
4. TEMPERATURE REGULATION = the amount of
blood flow beneath skin’s surface & activity of sweat
glands in skin both regulate body temperature.
5. EXCRETION = small amount of waste products lost
through skin & in gland secretions.
Functions of IS
1. regulates body temperature.
2. stores blood.
3. protects body from external environment.
4. detects cutaneous sensations.
5. excretes and absorb substances.
6. synthesizes vitamin D.
 SKIN
Made-up of 2 major tissue layers :
1. EPIDERMIS
2. DERMIS

EPIDERMIS :

Most superficial layer.

Stratified squamous epithelium; in its deepest layer,
new cell are produced by mitosis.
During movement, cells change shape & chemical
composition.
This process is called KERATINIZATION because
cells become filled with protein (Keratin), which
makes them hard. EPIDERMIS
Although Keratinization is a continuous process,
distinct layers called STRATA can be seen in
epidermis.

SKIN

The deepest stratum, the STRATUM BASALE,

consists of cuboidal or
columnar cells that undergo mitotic division about
every 19 days.
Stratum corneum is most superficial stratum of
the epidermis consists of
dead squamous cells filled keratin. Keratin gives
S. corneum its structural
strength. S. corneum are also coated &
surrounded by lipids which help
prevent fluid loss through the skin.
S. corneum is composed of 25 or more layers of
dead sq. cells joined by
desmosomes.
Excessive sloughing of S. corneum cells from the
surface of the scalp is
called “DANDRUFF”.
Skin subjected to friction. No. of layers in S.
corneum greatly increases
producing a thickened area called “CALLUS” abdomen & breast
(hard skin). during pregnancy or skin of athletes due to
Over bony prominence, S. corneum thicken to increase muscle size by
form cone-shaped structure intense weight training.
called “CORN”. DERMAL PAPILLAE = upper part of dermis
(projections), contain
many blood vessels that supply overlying dermis
DERMIS with nutrients,
Composed of dense collagenous CT containing remove waste products & regulate body
fibroblast, adipocytes & temperature. D. papillae in
macrophages. palms, sole & tip of finger are arranged in parallel.
Nerves, hair follicles, smooth m, glands &
lymphatic vessels extend into
dermis.
Collagen & elastic fibers responsible for structural
strength of the dermis.
Dermis part of animal hide from which leather is
made.
Collagen fibers of dermis are oriented in many
direction & resist stretch.
However, more collagen fibers are oriented in
some directions than in
others. This produces “Cleavage Lines” or tension
lines in the skin.
It is important for surgeons to be aware of
cleavage lines.
Ex. Incision made across CL, likely to Gap =
produce Scar tissue.
Incision made parallel CL, tends to gap less = less SKIN COLOR
Scar.
Factors determine include PIGMENTS in the skin,
blood circulating though the skin % thickness of
Dermis S. corneum.
MELANIN = black pigments primarily responsible
for skin, hair & eye color, mostly brown to black
pigments, some yellow or reddish.
Is produced by melanocytes, which are irregularly
shaped cells with many long processes that
extend bet. epithelial cells of deep part of
epidermis.
Golgi apparatus of melanocytes package melanin
into vesicles called “MELANOSOMES” which
move into the cell processes of melanocytes.
Large amount of melanin form freckles or moles in
some regions of skin, darkened area in genitalia,
nipples, circular area of nipples.
Lips. Palms & Soles contain less melanin.

DERMIS

Overstretched of skin, dermis can be damaged,

leaving lines that
are visible through the epidermis, these lines called
“STRETCH MARKS”.
EX. Stretch marks often form on the skin of
 SKIN COLOR

Production is determined by genetic factor,

exposure to light & hormones.
Genetic factor are responsible for the amt. of
melanin produced in different races.
Since all races have the same no. of melanocytes,
racial variations in skin color are determined by
the amt. , kind & distribution of melanin.
Although many genes are responsible for skin
color, a single mutation can prevent melanin
production.
Ex. Albinism = recessive genetic trait that causes
def. or absence of melanin. Albino = fair skin,
white hair, unpigmented irises in the eyes.
SKIN COLOR

Exposure = to UVL = sunlight stimulate

melanocytes to increase melanin production.
Hormones = Estrogen & MSH cause increase
melanin production during pregnancy, darkened
nipples, areola & genitalia.
Increased blood flow in skin = blushing & redness
due inflammatory response.
Decreased blood oxygen = bluish color of skin.
Birthmarks = congenital disorders of bld. v
(capillaries) in the dermis.
Carotene = yellow pigments found in plants. As a
source of Vit. A
Carotene are lipid soluble, accumulate in S.
corneum & adipocytes of dermis & SQ, large
amount consumed skin become yellowish.

SUBCUTANEOUS TISSUE

Attaches to underlying bone & muscles &

supplies it with blood v. & nerves.
Not part of skin called “HYPODERMIS” (under
the dermis).
Loose CT, adipose T that contain about half of
the body’s stored lipids, although amount &
location vary with age, sex & diet.
Adipose T in SQ function as padding &
insulation, & responsible for some differences in
appearance bet. Men & Women as well as
bet. individual of same sex.
Used to estimate Total Body Fat.
Skin & SQT are pinched at selected locations &
thickness of fold is measured. The thicker the
fold the greater amt. of total body fat.
% of body fat varies in population but on ave.
women have higher total body fat than men.
F = 21-30%
M =13-25%
Acceptable % of body fat above the range is
indicator of OBESITY.

Subcutaneous Tissue

HAIR

HAIR

Found everywhere on the skin except ?

Each hair arises from hair follicle, shaft protrude
above surface of skin, root & hair bulb below the
surface. Hair bulb site of hair cell formation.
Has a hard CORTEX which surrounds a softer
center, MEDULLA.
The Cortex is covered by the CUTICLE, a single
layer of overlapping cells that holds hair in the
hair follicle.
Hair follicle plays an important role in repair of the
skin.
Ex. If surface of epidermis damaged, epithelial
cells within the hair follicle can divide & serve as
source of new epithelial cells.
Is produced in cycles : growth phase & resting
phase.
Growth stage = formed by epithelial cells within
the hairbulb. Cells undergo division &
keratinization (like skin).
Regression stage = when the cells of the hair
matrix stop dividing, the hair follicle atrophies
(shrinks), & the hair stops growing.
Resting stage = growth stops & hair is held in hair
follicle.
HAIRS
 When next growth stage begins, a new hair is • During childhood, vellus hairs cover most of the
formed & old hair falls out. body except for the hairs of the eyebrows,
Duration of @ stage depends on individual hair. eyelashes, & scalp, which are terminal hairs.
Ex. Eyelashes = grow about 30 days & rest 105 • In response to hormones (androgens) secreted at
days. Scalp hair = grow for 3 yrs. & rest 1-2 yrs. puberty, terminal hairs replace vellus hairs in the
Loss of hair normally means that hair is being axillae & pubic regions of the boys & girls & they
replaced because old hair fall out of hair follicle boys & girls & they replace vellus hairs on the face,
when new hair begins to grow. limbs, & chest of boys which leads to the formation
Some men, permanent loss of hair results in of a mustache, beard & hairy arms & legs & a hairy
“pattern baldness”, change occur due to male sex chest.
hormones act on hair follicle of men who have • During adulthood, about 95% of body hair on
genetic predisposition for pattern baldness. males is terminal hair & 5% is vellus hair; on
Hair color determined by the amt. & types of females, about 35% of body hair is terminal hair &
melanin production & distribution by melanocytes 65% is vellus hair
occur in hairbulb same as skin.
With age, amt. of melanin in hair decreases,
causing hair color become faded or hair contain
no melanin (white).
Gray hair usually mixture of unfaded, faded &
white hair.
Contraction of the ARRECTOR PILI, which are
smooth muscles, causes hair to “stand on end” &
produce “GOOSE BUMP”.
Normal hair loss in the adult scalp is about 70-100
hairs / day.
Both the rate of growth & the replacement cycle
may be altered by illness, radiation therapy,
chemotherapy, age, genetics, gender, &
severe emotional stress.
GLANDS
Rapid wt. loss diets that severely restrict calories
or protein increase hair loss.
Major glands of the skin :
The rate of shedding also increases for 3-
4 months after childbirth.
1. SEBACEOUS GLANDS
Alopecia, the partial or complete lack of hair, may
2. SWEAT GLANDS
result from genetic factors, aging, endocrine
disorders, chemotherapy or skin disease.
SEBACEOUS GLANDS = simple, branched acinar
glands, produce sebum which oils the hair & the
TYPES OF HAIR surface of the skin. Sebum released by Holocrine
secretions.
• Hair follicle develop at 12th weeks after
fertilization. TWO KINDS OF SWEAT GLANDS
• Usually by the 5th month of development, the
follicles produce very fine, nonpigmented, downy 1. Eccrine Sweat Glands
hairs called Lanugo (wool or down) that cover the 2. Apocrine Sweat Glands
body of the fetus.
• Prior to birth, the lanugo of the eyebrows,
eyelashes, & scalp are shed & replaced by long,
coarse, heavily pigmented hairs called terminal
hairs.
• The lanugo of the rest of the body are replaced by
vellus hairs (fleece), commonly called “peach fuzz”,
which are short, fine, pale hairs that are barely
visible to the naked eye.
 NAILS

Thin plate, consisting layers of dead S. corneum

cells that contain very hard type of keratin.
Consist of nail body & nail root.
Cuticle (EPONYCHIUM) = is S. corneum that
extends onto nail body. Nail root extends distally
to the nail matrix.
Also attaches to underlying nail bed, located
distal to the nail matrix.
Nail matrix & bed are epithelial tissue with S. basale
that give rise to the cells that form the nail.
LUNULA (half moon) = small part of nail matrix,
seen through nail body as whitish, crescent
Sweat Glands
shaped area at the base of the nail.
Cell production within the nail matrix causes nail
to grow.
Unlike hair, Nail grow continuously without resting
stage.

ECCRINE SG = simple, coiled, tubular glands &

release sweat by Merocrine secretion. Located
most part of skin but more on Palms & Soles.
Produce secretion mostly water with few salts.
Produce sweat, which cools the body.
EMOTIONAL SWEATING = used in lie detector
(Polygraph) test bec. SG activity increases when
person is nervous, such as when person tells a lie.
Tests can detect small amts. of sweat bec. the salt
sol. conducts electricity & lowers electrical
resistance of the skin.
APPOCRINE SG = simple, coiled, tubular glands
that produce thick secretion rich on organic subs.
Subs. released by Merocrine secretion & some by
Holocrine . They open into hair follicles, but only
in armpits & genitalia. Active during puberty
because of the influence of sex hormones.
Produce organic secretion that causes body odor
when broken down by bacteria.
 Physiology of Integumentary System Integumentary System as a Diagnostic Aid

1. PROTECTION = IS performs many protective IS is useful in Dx because it is observed easily &

functions
a) The intact skin plays an important role in
reducing water loss because its lipid act as barrier
to diffusion of water.
b) The skin prevents MO & other foreign subs. from
entering the body. Secretions from SG also
produce an environment unsuitable for some MO.
c) Stratified sq. epithelium of skin protects
underlying structures against abrasion.
d) Melanin absorbs UVL & protects underlying
structure from its damaging effects.
e) Hair provides protection in sev. ways : hair on
head act as heat insulator, eyebrows keep sweat
out of the eyes, eyelashes protect eyes from
foreign objects, hair in the nose & ears prevents the
entry of dust & other materials.
f) The nail protect the ends of the finger & toes from
damage & can be used in defense.
2. SENSATION = skin (epi. & dermis) contains
sensory receptors for pain, heat, cold & pressure.
3. VIT. D PRODUCTION = UVL stimulate
production of a precursor molec. in the skin that is
modified by the Liver, Kidneys into Vit. D. fatty fish
(fish oil) & Vit D –fortified milk are best source of
Vit. D. Eggs, Butter, & Liver contain small amts. of
Vit. D. Adequate levels Vit. D necessary bec. active
Vit. D stimulate SI to absorb Calcium & Phosphate,
which are necessary for normal bone growth &
muscle formation. Vit. D increases calcium uptake
in the SI.
often reflect events occurring in other parts of the
body.
Ex. Cyanosis = caused by decreased blood
oxygen, indication of impaired circulatory &
respiratory function.
Jaundice = occurs when liver secretes bile
pigments which are products of breakdown of
worn-out RBC’s into SI. Bile pigments are
yellow & their buildup in the blood & tissue can
indicate impaired Liver function.
Rashes = Ex. Scarlet fever, results when
bacteria infecting throat release toxin into
blood that cause reddish rash on the skin.
Also indicate allergic rxn. to food, drugs.
Condition of skin, hair, & nail is affected by
nutritional status.
Ex. Vit A def. = skin produces excess keratin
& assumes sandpaper texture.
Iron def. Anemia = nail loss normal contour
become flat or concave (Spoon-shaped). Lead
poisoning results in high lead in hair
Koilonychia (Spoon Nails)

4. TEMPERATURE REGULATION = Normal Body

Temp. 37 oC (98.6oF).
 Regulation is impt. bec. rate of chemical
reaction within the body can be increase or
decrease by changes in body temp.
Exercise, fever & increase in environmental Clubbing of Nails
temp. tend to raise body temp.

 In order to maintain Homeostasis, body

must rid itself of excess heat. Through
dilation & constriction of blood v. , skin
controls heat loss from the body.
5. EXCRETION = IS plays minor role in excretion,
the removal of waste products from the body. In
addition, water, salts, sweats contain small amount
of waste products such as Urea, UA & Ammonia.
SG do not play a significant role in the excretion of
waste products.
BURNS
- Injury to tissue caused by heat, cold,
friction, chemicals, electricity or radiation.
Classified according to their depth.
1. Partial-thickness burns = part of S. basale
remains viable & regeneration epidermis
occurs within the burn area & edges of the
burn.
a) First-degree burns = involves only epidermis,
red & painful slight edema.
Ex. Sunburn or brief exposure to very hot or very
cold objects, heal without scarring in about a week.
b) Second-degree burns = damage both
epidermis & dermis. If thermal damage is
minimal, symptoms include redness, pain,
edema & blisters. Healing takes about 2 wks. &
no scarring results.
However, if burn goes deep into the dermis, wound
appear red, tan, or white, take several months to
heal & might scar.
3rd Degree Burn
In all 2nd-degree burns, epidermis regenerates
from epithelial tissue in hair follicles & SG as well
as from edges of the wound.
2. Full-thickness burns (3rd-degree burns) =
epidermis & dermis completely destroyed &
recovery occurs from the edges of burn wound.
Often are surrounded by areas of 1st & 2nd DB
areas are painful, region of 3rd DB is usually
painless bec. sensory receptors in epidermis &
dermis have been destroyed. 3rd DB appear
white, tan brown, black or deep cherry red.
Deep partial thickness & Full-thickness burns takes
long time to heal & form scar tissue with disfiguring
& debilitating wound contracture. Skin Grafting
performed to prevent Cx & to speed healing.
RULE OF NINES = method for determining
extent of burn, a quick way or means of
estimating the surface area affected by a burn
in an adult.
o 1. 9% for both ant. & post. surface of the
head & neck.
o 2. 9% for both ant. & post surface of each
upper limb (18% both UL)
o 3. 4x9 or 36% for both ant. & post. Surface
of the trunk including buttocks.
o 4. 9% for ant. & 9% for the post. Surfaces of
@ lower limb as far up as the buttocks
(36% both LL)
o 5. 1% for perineum
o Total = 100%
 Deep Lesion

1st Level of Healing

Major Problems of Burns

• Infection
• Maintaining fluid
• Maintaining electrolyte balance which requires
food and fluid intake
• Contractures of skin and underlying CT and
muscle (all soft tissue) due to intense scarring

Other Common Problems with Skin

Decubitus Ulcers – AKA bed or pressure sores

– Caused by constant deficiency of blood to
tissues overlying a bony prominence subjected to
prolonged pressure – especially if CNS or PNS not
functioning fully.
– Tissue breakdown leads to infection, necrosis,
etc.
Heel Decubitus ulcer Healing

Further Healing
 Basal Cell

SKIN CANCER
Most common type of cancer Squamous Cell
• Although chemicals & radiation (x-rays) known to
induce cancer.
• The development of skin CA most often is asstd.
with exposure to UVL from sun.
• Most skin CA develop on face, neck or hands.
• Group of people most likely to have skin CA are
fair-skinned (have less protection) or older than 50
(have long exposure to the sun).
3 Main Types of Skin Cancer
1. Basal Cell CA = most frequent type, involves
cells of the S. basale & extends into dermis to
produce an open ulcer. Tx. Surgical removal or
radiation therapy (treatable). Little danger to
spread or metastasize.
2. Squamous Cell CA = involves cell
immediately superficial to the S. basale & can
metastasize & cause death.
3. Malignant Melanoma = rare form arises from
melanocytes, can metastasize & often fatal.
Large, flat, spreading lesion or as deeply
pigmented nodule.

• Limiting exposure to sun & using sunscreens that

block the UVL reduce skin CA. Melanoma

UVL classified into 2 types based on

wavelength
1. UVA = has longer WL than UVB, exposure to
UVA causes most tanning of skin but asstd.
with development of Malignant Melanoma.
2. UVB = causes most burning of skin & asstd.
with development of Basal Cell CA & Squamous
Cell CA.

•Advisable to use sunscreen that effectively block

both UVA & UVB.
EFFECTS OF AGING ON THE IS
 As body ages, skin more easily damaged because
epidermis thins & amount of collagen in dermis
decreases.
Skin infection more likely, repair occurs more
slowly.
Blood flow to the skin is reduced, skin becomes
thinner & elasticity is lost.
Decrease no. of elastic fibers in dermis & loss of
adipose T fr. SQ cause skin to sag & wrinkle.
SG & Seb. G are less active, & no. of
melanocytes decreases but some areas, the
melanocytes increases to produce “AGE
SPOTS”
Freckles = caused by increase production of
melanin.
Gray & White hair = also results because of
decrease in or lack of melanin production.
Skin exposed to sunlight shows sign of aging more
rapidly than non-exposed, so avoid over exposure
& use sunscreen.
Skin Changes in the Aging Adult
• Lentigines - “liver
spots”
• Keratosis -crusted
lesions
• Xerosis – dry skin
• Skin thickness changes
• Hair growth changes
• Brittle nails, thickened
toenails
Cont.
• Several cosmetic anti-aging txs are available to
diminish the effects of aging or sun-damaged
skin.
These include the ff:
• 1. Topical products = bleach the skin to tone
down blotches & blemishes (hydroquinone) or
dec. fine wrinkles & roughness (retinoic acid)
• 2. Microdermabrasion = (mikros=small;
derm=skin; -abrasion= to wear away) , the use
of tiny crystals under pressure to remove &
vacuum the skin’s surface cells to improve skin
texture & reduce blemishes.
• 3. Chemical peel = application of a mild acid
(glycolic acid) to the skin to remove surface cells to
improve skin texture & reduce blemishes.
• 4. Laser resurfacing = use of laser to clear up
blood vessels near the skin surface, even out
blotches & blemishes, & decrease fine wrinkles. Ex.
IPL Photofacial
• 5. Dermal fillers = injections of human collagen
(Cosmoderm), hyaluronic acid (Restylane &
Juvaderm) , or poly-L-lactic acid (Sculptra) that
plums up the skin to smooth out wrinkles & fill in
furrows, such as those around the nose & mouth
and between the eyebrows.
• 6. Fat transplantation = in which fat from one
part of the body is injected into another location
such as round the eyes.
• 7. Botulinum toxin or Botox = a diluted version
of a toxin that is injected into the skin to paralyze
skeletal muscles that cause the skin to wrinkle.
• 8. Radio frequency nonsurgical facelift = use
of radio frequency emissions to tighten the deeper
layers of the skin of the jowls, neck sagging
eyebrows & eyelids.
• 9. Facelift, browlift, or necklift = invasive
surgery in which loose skin & fat are removed
surgically & the underlying connective tissue &
muscle are tightened.