STRUKTUR KULIT

DAN JARINGAN PENUNJANG

BAGIAN 1

Disusun oleh:
Fajar Cristianta Ginting
H1A022014

MODUL KULIT DAN JARINGAN PENUNJANG

FAKULTAS KEDOKTERAN DAN ILMU KESEHATAN
UNIVERSITAS BENGKULU
2023
The skin consists of morphologically and functionally dis- tinct subunits: epidermis, dermo-
epidermal junction zone (basement membrane), dermis, and subcutis (Fig. 1).

2.1 Embryonic Development of the Skin

The vascular-free epidermis, the outer layer of the skin, is of ectodermal origin; the dermis
and subcutis, including their vessels, are of mesodermal origin. During the embryonic period,
the sweat glands and the hair follicles with the seba- ceous glands arise from the epidermal
stem cells by invagi- nation. In approximately the second month the ectoderm differentiates
into the cuboid basal layer and the outer flat periderm. As the embryo stretches in length, the
cells divide and the epidermal cells migrate caudally into the vertebrae, corresponding to
Blaschko’s lines. At birth, all cell layers of the epidermis are present. Detached scales and
sebum com- bine to form the protective vernix caseosa.
The primitive dermis is richer in cells than that of the adult, but relatively amorphous. At
around the second month of embryonic life, the fibroblasts begin to produce collagen. Fatty
tissue forms and islands of primitive endothe- lial cells develop, creating vessels with lumina.
Nerves sprout into the dermis from about the fourth month onward.
Intense interaction occurs between the epidermal and mesodermal parts: the
dermoepidermal junction zone (basement membrane) appears in the first trimester; at the
end of this period, all its elements are present. This is important for the prenatal diagnosis of
genetic defects that manifest in this zone (hereditary epidermolysis).
The skin appendages also develop in a close relationship between the invaginations of the
epidermis and the dermal elements. Hair, sebaceous glands, and apocrine sweat glands are
formed by the interaction of a sprouting epidermal cor- nice and a dermal papilla of
specialized mesenchymal cells. Although apocrine glands are still widely distributed in fetal
skin, their later occurrence is limited to smaller areas, such as the axillae and the genitoanal
region. The hair follicle muscles between the hair follicle and the dermal connective tissue are
of mesodermal origin. The nail units are apparent at around the third month, first at the
fingertips, then at the toes.
In addition to keratinocytes, the epidermis contains three other cell types:
In addition to keratinocytes, the epidermis contains three other cell types:
• The immunologically active dendritic Langerhans cells originate from the bone marrow.
• The melanocytes responsible for pigment formation migrate from the neural crest into the
epidermis.
• The neuroendocrine (Merkel) cells probably also originate in the neural crest.

2.2 Epidermis and Skin Appendages (Adnexa)

The epidermis is constantly renewed; the mitotic dividing basal cells differentiate within 28
days to corneocytes, which consist mainly of keratin. Therefore, the epidermal cells are called
keratinocytes. Histomorphologically, an even stratification exists, which leads from the
stratum basale (stratum germinativum) via the stratum spinosum and the stratum granulosum
to the stratum corneum. The control mechanisms of cell division in the basal cell layer and in
the hair follicle that ensure a balance between the remaining divisive stem cells and
differentiating cells are largely unclear. Epidermal adhesion is mediated primarily by
desmosomes, which connect to the cyto- skeleton via transmembrane plaque proteins.
The skin’s surface shows fine and coarse wrinkles, which are coarsened by chronic
inflammation and rubbing, as well as light-related aging (lichenification). The lines on the
palms of the hands and soles of the feet are genetically determined individually, and the
fingerprints can be used for identification.
The hair follicles develop complex epithelial mesenchymal structures. The fetal lanugo hairs
develop into vellus and terminal hairs, whose cyclic growth is controlled by genetic and
hormonal influences.
The sebaceous glands are relatively large at birth owing to the effect of maternal hormones;
after temporary involution, they increase again during puberty.
The role of the apocrine glands is unclear. In some mammals, they secrete pheromones,
which can influence social behavior via the olfactory system. In humans, apocrine glands are
found in the axillae and in the genitoanal region.
The eccrine sweat glands are mainly used for temperature regulation, whereby they are
under neural control. Sweat secretion is triggered by heat, physical exertion, and emotional
stress. Moist palms of the hands and soles of the feet increase the adhesion of the skin.
The nails have a gripping function, protect the fingertips, and have a considerable aesthetic
effect. Keratin is more densely packed than in hair and in the horny layer and therefore very
resistant.
The closest mucous membranes are also of dermatological interest, such as the oral
mucosa, the genital mucosa, and the anal mucosa. They are nonhorny and have a damp,
slimecovered surface.
The skin color is essentially determined by the melanin of the epidermis, whereby a
distinction is made between skin types I–VI according to skin color – and thus also sensitivity
to light. Melanin is produced by the melanocytes and released into the surrounding
keratinocytes via their dendrites. The quantity and distribution of melanin granules determine
the skin color more than the number of melanocytes.

2.3 Dermo-epidermal Junction Zone

The connection between the dermis and the epidermis is extremely complex, as it must have
high mechanical strength and elasticity on the one hand and guarantee the exchange of cells,
metabolic products, and cytokines on the other. The components of the dermo-epidermal
junction zone are pro- duced both by the fibroblasts of the dermis and by the basal
keratinocytes.
Dermis The dermal connective tissue consists mainly of bundles of collagen fibers and a
network of elastic fibers, both formed by fibroblasts interspersed between them. The dermal
connective tissue is loosely structured (stratum papillare) below the epidermis, in the
interlocking zone between the epidermal rete pegs and the connective tissue papillae, and
the coarser network of the stratum reticulare. From this mechanically very firm layer, leather
is produced – from animal skins – hence the German term Lederhaut. The
dermis is supplied by a complex arterial, venous, and lym- phatic vascular system, which
serves to exchange water, metabolic products, messenger substances, and cells, and can
react in an inflammatory manner to the defense of foreign organisms and antigens.
Subcutis The subcutaneous fat serves as a protective cush- ion and energy reserve and
prevents the loss of body heat. Subcutaneous fat tissue is also an important aesthetic factor
owing to its contribution to the modeling of the body shape.
Cartilage Cartilage occurs very close to the skin as supporting tissue in the auricle and in the
nose. It is avascular; therefore, it heals badly after inflammation and injury.