CHAPTER 1 – INTEGUMENTARY SYSTEM

OUTLINE LAYERS OF THE SKIN

I. FUNCTIONS
II. LAYERS OF THE SKIN EPIDERMIS
• EPIDERMIS • Superficial protective layer of the skin.
• LAYERS OF EPIDERMIS • Composed of Stratified Squamous Keratrinized
• DERMIS Epithelium that varies in thickness.
• LAYERS OF DERMIS
III. COLORATION OF THE SKIN
• All but the deepest layers of epidermis are composed of
• MELANIN dead cells.
• CAROTENE • Composed of 4-5 layers, depending on its location
• HEMOGLOBIN within the body.
IV. SURFACE PATTERNS • Palms and soles have five layers because these areas
• CONGENITAL PATTERNS are exposed to most friction.
• ACQUIRED LINES
• FURROWS IN THE FOREHEAD AND FACE
(WRINKLES)
LAYERS OF EPIDERMIS
• LANGER LINES (from deep to superficial)
V. CUTANEOUS GLANDS • Stratum Basale
• SEBACEOUS GLANDS ◦ Composed of single layer of cells in contact with
• SWEAT GLANDS dermis.
• MEROCRINE ◦ 4 Types of Cells:
• APOCRINE ▪ Keratinocytes
• CERUMINOUS GLANDS
• MAMMARY GLAND
• Produce keratin which toughens and
VI. HAIR waterproofs skin.
• PARTS OF HAIR ▪ Melanocytes
• 3 LAYERS OF HAIR IN CROSS SECTION • Synthesize the pigment melanin providing
VII. NAILS a protective barrier to UV radiation in
VIII. SKIN HOMEOSTATIC IMBALANCES sunlight.
• INFECTIONS ▪ Tactile Cells (Merkel Cells)
• INFECTIONS & ALLERGIES • Aid in tactile (touch) reception.
• BURNS
▪ Non Pigmented Granular Dendrocytes
• RULES OF NINES
• SEVERITY OF BURNS (Langerhans Cells)
• CRITICAL BURNS • Protective macrophagic cells that ingest
• COMPLICATION OF BURNS bacteria and other foreign debris.
IX. SKIN CANCER • Stratum Spinosum (Spiny Layer)
• TYPES ◦ Contains several stratified layer of cells.
• ABCD RULE ◦ Spiny appearance due to changed shaped of
X. DEVELOPMENTAL ASPECTS OF SKIN AND BODY keratinocytes.
MEMBRANES ◦ With limited mitosis.
• SKIN DEVELOPMENT
◦ This layer plus stratum basale are collectively called
Stratum Germinativum.
FUNCTIONS • Stratum Granulosum (Granular Layer)
• Keeps water and other precious molecules in the body. ◦ Consist of only 3-4 flattened rows of cells.
• Keeps water out (so one can swim for hours without ◦ Cells here appear granular due to the presence of
becoming waterlogged). keratohyaline granules.
• Protects the body from external agents. • Stratum Lucidum (Clear Layer)
• Insulates and cushions deeper organs. ◦ Nuclei, organelles and cell membranes are no
• Protects body from mechanical damage (bumps and longer visible so this layer appear clear.
cuts), chemical damage (from acids and bases), thermal ◦ Exist only in the lips and the thickened skin and
damage (heat and cold), ultraviolet radiation and soles and palms.
bacteria. ◦ Contains a translucent substance called eleidin.
• Regulates heat loss from the body surface. • Stratum Corneum (Hornlike Layer)
• Acts as a mini excretory system; urea, salt, water are ◦ Composed of 25-30 layers of flattened, scale like
loss when we sweat. anucleated cells, which are continuously shed as
• Manufactures several proteins important to immunity. flake like residues of cells.
• Storage of vitamin D precursor. ◦ This surface layer is cornified and is the real
• Contains cutaneous receptor that serve as sensors for protective layer of the skin.
touch, pressure, temperature, and pain. ◦ Cornification is brought on by keratinization and the
hardening, flattening process that takes places as
the cells die and are pushed to the surface.

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◦ Friction at the surface of skin stimulates additional

mitotic activity of stratum basale, resulting in the
formation of a callus for additional protection.

DERMIS
• Deeper and thicker than epidermis.
• A strong and stretchy envelop that helps to hold the
body together.
• Blood vessels within the dermis nourish the living
portion of the epidermis.
• With numerous collagenous, elastic, and reticular fibers
that gives support to the skin. • Vitiligo
• Highly vascular and glandular. ◦ Lack of melanocytes in localized areas of the skin
• Contains many nerve endings and hair follicles. causing distinct white spots.
◦ White skin patches.
LAYERS OF DERMIS
(from deep to superficial)
• Reticular Layer
◦ Deepest skin layer.
◦ Contains blood vessels, sweat and oil glands, and
deep pressure receptors (Pacinian Corpuscles).
◦ Many phagocytes are found here; they engulf
bacteria that have managed to get through the
epidermis.
• Papillary Layer
◦ In contact with the epidermis. CAROTENE
◦ Accounts for about 1/5 of the entire dermis. • A yellowish pigment found in epidermal cells and fatty
◦ With numerous projections called Dermal Papillae, parts of dermis.
that extend from the upper portion of the dermis into • Abundant in skin of Asians.
the epidermis. • Together with melanin, accounts for the yellowish-tan
▪ Dermal Papillae color in Asians.
• Contain capillary loops, which furnish
nutrients to the epidermis. HEMOGLOBIN
• Form the base for the friction ridges on the • Not a pigment of the skin, rather it is the oxygen binding
fingers and toes. pigment found in RBC.
▪ Some papillae house pain receptors (free • Oxygenated blood flowing through the dermis gives its
nerve endings) and touch receptors pinkish tones.
(Meissner’s Corpuscles).
SURFACE PATTERS

CONGENITAL PATTERNS
• Positive fingerprints or friction ridges.
• Present on palms and soles.
• Formed by the pull of elastic fibers within the dermis.
• Function to prevent slippage when grasping objects.

COLORATION OF THE SKIN ACQUIRED LINES

• Caused by expression of a combination of 3 pigments: • Deep Flexion Creases
◦ Found on the palms.
MELANIN • Shallow Flexion Lines
• Brown-black pigment produced by the melanocytes of ◦ Seen on knuckles and surface of other joints.
stratum basale.
• Guard skin against damaging effect of ultraviolet rays of
sunlight.
• Gradual exposure to sunlight promotes increased
production of melanin; hence tanning of the skin.
• In albino, there is a normal number of melanocytes but
lacks enzymes tyrosinase, that converts the amino acid
thyrosine to melanin.
• Freckles
◦ Caused by aggregated patch of melanin

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 CHAPTER 1 – INTEGUMENTARY SYSTEM

FURROWS IN THE FOREHEAD AND FACE
(WRINKLES)
• Acquired from continual contraction of facial muscles,
such as from smiling or squinting in bright light or
against the wind; facial lines become more strongly
delineated as person ages.
LANGER LINES
• Lines of tension in the skin produced by the orientation
of collagen and elastic fibers in nonrandom pattern of
arrangement.
• Surgical incision should be made parallel to langer lines
to promote better wound healing.
• Secretion reaches skin surface via a duct that opens
directly on surface of skin through sweat pores.
• Secretion is mostly water with few salts.
• Function is to cool the body
APOCRINE
• Much larger, localized gland found in axillary and pubic
regions where they secrete into hair follicles.
• Not functional until puberty.
• Secretion is thick and rich in organic substance which is
odorless when released but quickly broken down by
bacteria into substances responsible for body odor.
• More viscous – fatty acids and proteins, empties into
hair follicles.

CUTANEOUS GLANDS
• All exocrine glands (they release secretions to skin
surface via ducts).
CERUMINOUS GLANDS
SEBACEOUS (OIL) GLANDS • Modified sudoriferous glands.
• Found all over the skin, except on palms and soles. • Secrete cerumen (ear wax).
• Ducts usually empty into a hair follicle but some open • Empties into the ear canal.
directly onto skin surface. •
• Secretion is called Sebum, a mixture of oily substance
and fragmented cells that keeps skin soft and moist and
prevents hair from becoming brittle.
◦ If the drainage pathway for sebaceous gland
becomes blocked for some reason, the glands
become infected, resulting in acne.
◦ Sebum also contains chemicals that kills bacteria.
◦ Become very active when sex hormones are
produced in increased amounts during
adolescence, thus skin is oilier during this period of
life.
• If the drainage pathway becomes blocked for some
reason, the glands may become infected, resulting in
ACNE formation.

MAMMARY GLANDS
• Specialized sweat gland.
• Found within the breast tissue.
• Undergoes cell hypertrophy (size increase) and cell
hyperplasia (increase in number) under pituitary
influence in pregnancy.
• Secrete milk during lactation.

SWEAT GLANDS
• Also called Sudoriferous Glands.
• Widely distributed in the skin; numerous in palms, sole,
axillary and pubic regions.
• Secretion evaporates and cools the body.
• 2 Types:

MEROCRINE
• Eccrine Sweat Glands
• More numerous and found all over body especially in
forehead, back, palms and soles.

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 CHAPTER 1 – INTEGUMENTARY SYSTEM

HAIR NAILS
• Characteristic of all mammals, but its distribution, • Nail Body
function, density and texture varies across mammalian ◦ Visible attached portion.
species. • Hyponychium
• Humans are relatively hairless, with only the scalp, face, ◦ Beneath free edge.
pubis and axilla being densely haired. • Nail Matrix
• Men with more obvious hair because of the male ◦ Growth area of the nail, proximal portion of nail bed.
hormone. • Lunula
• Certain regions of the body are hairless, like the palms, ◦ White crescent shape.
soles, lips, nipples, penis, labia minora. • Free Edge
• Lifespan 3-4 months for eyelash, 3-4 years in scalp hair. ◦ Distal exposed portion.
• Primary Function of Hair: Protection • Nail Root
◦ e.g. Scalp hair, eyebrows are protection from the ◦ Covered by skin.
sunlight. • Eponychium (Cuticle)
• Lanugo ◦ Covers the nail root.
◦ Fine, silky fetal (immature) hair.

• Vellus
◦ Short, fine hairs.
◦ Fine vellus hairs grow all over the body except the
palms and soles. SKIN HOMEOSTATIC IMBALANCES

INFECTIONS
• Athlete’s Foot
◦ Caused by fungal infection.
◦ Tinea Pedis
◦ Itchy, red peeling condition of the skin between the
toes due to fungal infection.

• Definitive Hair
◦ Grows up to a certain length only, most dominant
type of hair; eyelashes, eyebrow, pubic and axillary
hair.

PARTS OF HAIR
• Shaft
◦ The visible but dead portion of hair projecting above • Boils and Carbuncles
surface of the skin. ◦ Caused by bacterial infection.
• Root ◦ Inflammation of hair follicles and sebaceous glands,
◦ Enclosed in the follicle. found on the dorsal neck.
• Hair Bulb Matrix ◦ Staphylococcus Aureus
◦ The growth zone; contains melanocytes that give
color to the hair.

3 LAYERS OF HAIR IN CROSS SECTION

• Medulla
◦ Inner part.
• Cortex
◦ Thick middle part. • Cold Sores
• Cuticle ◦ Caused by virus.
◦ Covers cortex and forms toughened outer portion. ◦ Fever blisters.
◦ Small-fluid filled blisters that itch and sting, caused
by herpes simplex infection.
◦ The virus localizes in a cutaneous nerves, where it
remains dormant until activated by emotional upset,
fever, or UVR.
◦ Commonly occurs around the lips and in the oral
mucosa of the mouth.

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INFECTIONS & ALLERGIES

• Contact Dermatitis
◦ Exposures cause allergic reaction.
◦ Itching, redness, and swelling of the skin,
progressing to blisters.
◦ Caused by exposure of the skin to chemicals
(poison ivy) that provoke allergic responses in
sensitive individuals.
• Impetigo
◦ Caused by bacterial infection. • Second-Degree Burns
◦ Pink water-filled, raised lesions that develop a ◦ Epidermis and upper dermis are damaged.
yellow crust and eventually rupture. ◦ Skin is red and painful and blisters appear.
◦ Caused by a highly contagious staphylococcal ◦ Partial thickness burn.
infection. ◦ Regeneration of the epithelium (healing) can still
◦ Commonly affects elementary school-aged children. occur because of sufficient number of epithelial
◦ Commonly occurs around the mouth and nose. cells still present.

• Third-Degree Burns
◦ Destroys entire skin layer.
◦ Burn is gray-white or black.
• Psoriasis ◦ Full thickness burn.
◦ Cause is unknown. ◦ Painless because the nerve endings in the area are
◦ Triggered by trauma, infection, stress. destroyed.
◦ Chronic condition characterized by reddened ◦ Regeneration (healing) is no longer possible.
epidermal lesions covered with dry, silvery scales. ◦ Skin grafting must be done to cover the underlying
◦ Triggering Factors: exposed tissue (due to absence of regeneration).
▪ Trauma
▪ Infection
▪ Hormonal Changes
▪ Stress

BURNS
• Tissue damage and cell death caused by heat,
electricity, UV radiation, or chemicals.
• Associated dangers:
◦ Dehydration
◦ Electrolyte Imbalance CRITICAL BURNS
◦ Circulatory Shock • Over 25% TBSA has 2nd degree burns.
• Over 10% TBSA has 3rd degree burns.
• 3rd degree burns of the face, hands or feet.
RULES OF NINES
• Way to determine the extent of burns.
◦ Facial burns are dangerous because of the
possibility of the burned respiratory passageways to
• Body is divided into 11 areas for quick estimation.
swell and cause suffocation joint burns are
• Each area represents about 9%.
Adults Children
troublesome because scar tissue formation can
Head – 9% Head – 18% severely limit joint mobility.
Arms – 9% each Arms – 9% each
Legs – 18% each Legs – 13.5% each COMPLICATIONS OF BURNS
Chest – 18% Chest – 18% • Circulatory Shock
Back – 18% Back – 18% ◦ Due to extravassation of fluids containing proteins
Groin – 1% Groin – 1% and electrolytes from the burned surface –
dehydration & electrolyte imbalance – decrease
SEVERITY OF BURNS volume – circulatory shock.
• First-Degree Burns • Renal Failure
◦ Only epidermis is damaged. ◦ Due to extravassation of fluids containing proteins
◦ Skin is red and swollen. electrolytes from the burned surface – dehydration
◦ Partial thickness burn. & electrolyte imbalance – renal failure.
◦ Generally heal in 2-3 days without any special • Infection
attention. ◦ Leading cause of death after burns.
◦ Sunburn. ◦ Burned skin is sterile for about 24 hours.
◦ After 24 hours, bacteria and fungi easily invade
areas where the skin has been destroyed and

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 CHAPTER 1 – INTEGUMENTARY SYSTEM

multiply rapidly in the nutrient rich environment of

dead tissues.
• Depression of the Immune System
◦ Occurs in severe burn cases.

SKIN CANCER
• Cancer – abnormal cell mass.
• Two Types:
◦ Benign
▪ Does not spread (encapsulated).
◦ Malignant ABCD RULE
▪ Metastasized (moves) to other parts of the • A = Asymmetry
body. ◦ Two sides of pigmented mole do not match.
• Skin cancer is the most common type of cancer. • B = Border Irregularity
◦ Borders of mole are not smooth
SKIN CANCER TYPES • C = Color
◦ Different colors in pigmented area.
• Basal Cell Carcinoma
• D = Diameter
◦ Least malignant.
◦ Spot is larger then 6mm in diameter.
◦ Most common type.
◦ Arises from stratum basale.
◦ Alteration of the cells of stratum basale – inablity to DEVELOPMENTAL ASPECTS OF SKIN AND
distinguish the boundary between the dermis and BODY MEMBRANES
epidermis – invasion of the cancer cells in the • Lanugo
dermis and subcutaneous tissues. ◦ Down type of hair covering the soon-to born infant
◦ Most commonly occurs on exposed areas of the during 5th – 6th months of fetal development (shed
skin. by birth).
◦ Slow growing and metastasis seldom occurs before • Vermix Caseosa
it is noticed. ◦ Accumulations of small white spots in the
◦ Grows rapidly and metastasizes to adjacent lymph sebaceous glands on the baby’s nose and
nodes if not removed. forehead.
◦ Believed to be sun-induced. ◦ Normally disappear by the 3rd week after birth .
◦ Good prognosticating factors:
▪ Early detection. SKIN DEVELOPMENT
▪ Early removal through surgery. • Fetal
▪ Early chemotherapy. ◦ Lanugo
• Squamous Cell Carcinoma • Neonatal
◦ Arises from stratum spinosum. ◦ Vermis caseosa and millia.
◦ Metastasizes to lymph nodes. ◦ Very thin and blood vessels can easily be seen
◦ Early removal allows a good chance of cure. through it.
◦ Scaly reddened papule (small rounded elevation) • Infancy
that gradually forms a shallow ulcer with a firm, ◦ Thicker and moist, and more deposition of
raised border. subcutaneous fats.
◦ Common sites: • Adolescence
▪ Scalp ◦ Skin and hair become oilier due to activation of
▪ Ears sebaceous glands, causing acne.
▪ Dorsum of the Hands ◦ Acne subsides in early adulthood.
▪ Lower Lip • Adulthood – 20-30
◦ Skin reaches its optimal appearance.
• Geriatric Period
◦ Reduction of subcutaneous fats.
▪ Causes cold intolerance.
◦ Dry skin.
▪ Due to decrease oil production and reduction of
collagen fibers.
▪ Causes itchiness and discomfort.
◦ Thinning of the skin.
• Malignant Melanoma ▪ Increases the risk for bruising and other types
◦ Most deadly of skin cancers. of injuries.
◦ Cancer of melanocytes. ◦ Decrease skin elasticity.
◦ Metastasizes rapidly to lymph and blood vessels. ▪ Along with the loss of subcutaneous fat causes
◦ Detection uses ABCD rule. eyebags and sagging of jowls.
◦ Accounts for 5% of skin cancers. ◦ Baldness
◦ Occurs spontaneously in pigmented areas but ▪ Alopecia
some develop from pigmented moles. ▪ Occurs in 5th decade of life.
◦ Usually appears as a spreading brown to black ▪ Due to reduced number of degeneration of hair
patch that metastasize rapidly to surrounding lymph follicles.
and blood vessels. ▪ “Male pattern baldness” = obvious balding/ hair
◦ 50% chances of survival with early detection. loss with aging.
◦ Vellus hair.

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▪ Very tiny and colorless hairs ion the bald area

due to degeneration of the hair follicles.
◦ Premature graying of hair.
▪ Causes:
• Emotional crisis (problems).
• Anxiety
• Protein deficient diets.
• Chemotherapy
• Radiation
• Excessive vitamin A.
• Fungal diseases (ringworm).
▪ These conditions are not genetically
determined.

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