SKIN

Introduction
Human skin is considered to be the largest organ of the body.
The surface area of the skin on an average adult is 1.8 m2, and
represents 16% of the total body weight. The thickness of the
skin varies throughout the body. It depends on how much use we
make of that area.
It both provides protection and receives sensory stimuli from
the external environment.
The skin is a multifunctional organ. It is divided into two main
layers, the dermis and epidermis.

Functions
Protection:
Protection of the body from environmental effects, such as
abrasions, fluid loss, harmful substances, ultraviolet radiation, and
invading microorganisms.
Containment:
Containment for the body’s structures (e.g., tissues and organs) and
vital substances (especially extracellular fluids), preventing dehydration,
which may be severe when extensive skin injuries (e.g., burns) are
experienced.
Thermal Regulation:
Heat regulation through the evaporation of sweat and/or the dilation
or constriction of superficial blood vessels.
Sensation:
Sensation(e.g., pain) by way of superficial nerves and their sensory
endings.
Synthesis and Storage:
Synthesis and storageof vitamin D.

Classification of Skin
Skin has two types thick skin and thin skin
Their differences are given below:

Thick SKin Thin SKin

1. Covers Palm, Palmar surface 1. Covers all parts of the

and soles. body except Palms, Palmar

2. About 0.6 to 4.5 mm thick
3. Has Thick Stratum Lucidum,
Spinosum and Corneum
4. Possess evident Epidermal
Ridges due to well
developed and more
numerous dermal papillae
organized in parallel rows
5. Does not have Hair follicles,
Arrector Pili muscles, and
Sebaceous glands
surfaces of digits and
soles
2. About 0.10 to 0.15 mm thick
3. Lacks Stratum Lucidum. Has
Thinner Stratum Spinosum
and Corneum
4. Lacks Epidermal Ridges due
to poorly developed and
fewer and less well
organized dermal papillae
5. Has Hair follicles, Arrector
Pili muscles and Sebaceous
glands
 6. Contains more numerous 6. Contains fewer
Sudoriferous glands and Sudoriferous glands and
denser Sensory receptors sparser Sensory receptors

Layers of Skin
The skin is divided into two main regions, the epidermis, and the
dermis, each providing a distinct role in the overall function of the
skin. The dermis is attached to an underlying hypodermis, also called
subcutaneous connective tissue, which stores adipose tissue and is
recognized as the superficial fascia of gross anatomy.

Epidermis
The epidermis is the most superficial layer of the skin and provides
the first barrier of protection from the invasion of foreign substances
into the body. The principal cell of the epidermis is called a
keratinocyte.

Composition of Epidermis:
The keratinocytes: these form epidermal keratin. As the predominant
cell type, they constitute 80% of the cellular population found in the
epidermis.
The melanocytes: these produce melanin, the pigment that provides
the skin with its colour and protects it from the sun's rays.
The Langerhans cells: acting as veritable gatekeepers, they provide
immune defence, particularly in capturing allergens.
The Merkel cells: originating from nerve cells, they are highly sensitive
receptors involved in the sense of touch.
Layers of Epidermis
The epidermis is sub-divided into 5 layers.
Stratum corneum:
The outermost layer of the epidermis. There are many cells which
are tightly packed together, This allows the skin to be tough and
waterproof. This layer is important in the prevention of invasion from
foreign things, such as bugs and bacteria.
Stratum lucidum:
This layer contains several clear and flat dead cells. It is a tough
layer and is found in thickened skin, including the palms of the hand
and soles of the feet.
Stratum granulosum:
The stratum granulosum is composed of 3 to 4 layers of cells. Here,
keratin is formed, which is a colourless protein important for skin
strength.
Stratum spinosum:
This layer contains cells that change shape from columnar to
polygonal. Keratin is also produced here.
Stratum basale:
This layer is the deepest layer of the epidermis, in which many cells
are active and dividing. The stratum basale is separated from the
next layer – the dermis – by a basement membrane, which is a layer
made of collagen and proteins.
 Dermis

The dermis is the thick layer of connective tissue to which the

epidermis is attached. Its deepest part continues into the
subcutaneous tissue without a sharply defined boundary. Its thickness
is for this reason difficult to determine but 1-2 mm is a good
guestimate for "average" skin. The dermis may be divided into two
sublayers:

The papillary layer : consists of loose, comparatively cell-rich

connective tissue, which fills the hollows at the deep surface ( dermal
papillae) of the epidermis. Capillaries are frequent. Collagen fibres
appear finer than in the reticular layer.

The reticular layer : appears denser and contains fewer cells. Thick
collagen fibres (5-10 µm) often aggregate into bundles (up to 100 µm
thick). The fibres form an interlacing network, although their
predominant direction is parallel to the surface of the skin. A
preferred orientation of the collagen fibres is not visible in the
sections, but the main orientation of the fibres differs in skin
from different parts of the body.
Diagrams
 Clinicals:
ECZEMA
Eczema is an allergic reaction that manifests as dry, itchy patches of
skin that resemble rashes. It may be accompanied by swelling of the
skin, flaking, and in severe cases, bleeding. Many who suffer from
eczema have antibodies against dust mites in their blood, but the link
between eczema and allergy to dust mites has not been proven.
Symptoms are usually managed with moisturizers, corticosteroid
creams, and immune suppressants.
ACNE
Acne is a skin disturbance that typically occurs on areas of the skin
that are rich in sebaceous glands (face and back). It is most common
along with the onset of puberty due to associated hormonal changes,
but can also occur in infants and continue into adulthood. Hormones,
such as androgens, stimulate the release of sebum. An overproduction
and accumulation of sebum along with keratin can block hair follicles.
This plug is initially white. The sebum, when oxidized by exposure to air,
turns black. Acne results from infection by acne-causing bacteria
(Propionibacterium and Staphylococcus), which can lead to redness and
potential scarring due to the natural wound healing process.
Callosities
Callosities are greatly thickened areas of waxy keratin on which the
animal may sit for extended periods of time without damage to the
underlying soft tissue.
 Skin Incisions and Scarring
The skin is always under tension. In general, lacerations or incisions
that parallel the tension lines usually heal well with little scarring
because there is minimal disruption of fibers. The uninterrupted fibers
tend to retain the cut edges in place. However, a laceration or
incision across the tension lines disrupts more collagen fibers. The
disrupted lines of force cause the wound to gape and it may heal
with excessive (keloid) scarring. When other considerations, such as
adequate exposure and access or avoidance of nerves, are not of
greater importance, surgeons attempting to minimize scarring for
cosmetic reasons may use surgical incisions that parallel the tension
lines.
Skin Injuries and Wounds
Lacerations:
Accidental cuts and skin tears are superficial or deep. Superficial
lacerations violate the epidermis and perhaps the superficial layer of
the dermis; they bleed but do not interrupt the continuity of the
dermis. Deep lacerations penetrate the deep layer of the dermis,
extending into the subcutaneous tissue or beyond; they gape and
require approximation of the cut edges of the dermis (by suturing, or
stitches) to minimize scarring.
Burns.
Burns are caused by thermal trauma, ultraviolet or ionizing radiation, or
chemical agents. Burns are classified, in increasing order of severity,
based on the depth of skin injury.
1. 1st-degree (superficial) burn (e.g., sunburn): damage is limited to
the epidermis; symptoms are erythema (hot red skin), pain, and
edema(swelling); desquamation(peeling) of the superficial layer
 usually occurs several days later, but the layer is quickly
replaced from the basal layer of the epidermis without
significant scarring.
2. 2nd-degree (partial-thickness) burn:epidermis and superficial
dermis are damaged with blistering (superficial 2nd degree) or
loss (deep 2nd degree); nerve endings are damaged, making this
variety the most painful; except for their most superficial parts,
the sweat glands and hair follicles are not damaged and can
provide the source of replacement cells for the basal layer of
the epidermis along with cells from the edges of the wound;
healing will occur slowly (3 weeks to several months), leaving
scarring and some contracture, but it is usually complete. •
3. 3rd-degree (full-thickness) burn the entire thickness of the skin
is damaged and perhaps underlying muscle. There is marked
edema and the burned area is numb since sensory endings are
destroyed. A minor degree of healing may occur at the edges,
but the open, ulcerated portions require skin grafting: dead
material (eschar) is removed and replaced (grafted) over the
burned area with skin harvested (taken) from a non-burned
location (autograft) or using skin from human cadavers or pigs,
or cultured or artificial skin.
Factors increase death risk from injuries:
Age older than 60 years
Partial and full thickness burn of over 40% area
Presence of inhalation injury
Rule of Nines: The rule of nines is a method doctors and emergency
medical providers use to easily calculate the treatment needs for a
person who’s been burned.
The rule of nines assigns a percentage that’s either nine or a multiple
of nine to determine how much body surface area is damaged. For
adults, the rule of nines is:

Body part Percentage

Arm (including the hand) 9 percent each

Anterior trunk (front of the body) 18 percent

Genitalia 1 percent
Head and neck 9 percent

Legs (including the feet) 18 percent each

Posterior trunk (back of the body) 18 percent