Structure of the Skin

- 3 layers
n Superficial layer = epidermis
n Mid layer = dermis, cutis propria
u Papillary
u Reticulate
n Hypodermis
u Subcutaneous fatty tissue

Epidermis
- Stratums basale (innermost)
n Consists of 1 row, a series of prismatic cells disjoined with
intracellular canaliculi
n Keratinocytes—synthesis of keratin
n Melanocytes—synthesis of pigments
n Merkel cells—tactile sensation
n Reproduction of epidermal cells
- Stratum spinosum (spiky)
n 3-8 rows of keratinocytes—irregular polygonal shape—
Langerhans cells
n Special tonofibrils pressure in cytoplasm, not moving from
cell to cell
n Ending in cytoplasmic structures
- Stratum granulosum
n 1-2 cell row
n Located parallel to skin surface
n Keratohyalin grains—lamellar granules (similar to DNA)
- Stratum lucideum (brilliant)
n Flattened, poorly contoured non-nuclear homogenous
keratinocytes—on palms and soles
n Contains glycogen, fatty substances and eleidin
- Stratum corneum (horny)
n Outermost layer
n 10-20 rows of flattened cells with no nuclei and cell
organelles
n Corneocytes causes permanent physiological exfoliation of
epithelial cells
n Vit. A involves in formation
Dermis
- Papillary layer
n Consisting of loose connective tissue containing capillaries,
elastic fibers, bundles of collagen, reticular an argyrophil
fibers, fibroblasts, histiocytes, melanophages, blood
vessels, nerve endings
- Reticular layers
n Collagen and elastin fibers
n Strength of the skin depends on this laer

Hypodermis
- Subcutaneous fat
- Coarse-meshed network of collagen fibers with fat
- Absent on eyelids

Skin attachments
- Sebaceous glands
n Located in dermis
n Connected with hair follicle
n One hair follicle has 1 or 2 sebaceous glands
n Function
u Secretion of sebum composed of TG, fatty acid
breakdown products, was esters, squalene, cholesterol
esters, cholesterol
u Sebum lubricates the skin to protect against friction and
impervious to moisture
n It is no on palms and soles
n On the border of lips, glans penis, inner layer of prepuce,
labia minora, nipple, areola of breast, eyelids—open
directly into the surface of the skin
n Large gland—on face (T-zone), chest, back
- Sweat glands
n Secretion the sweat glands are divided into eccrine and
apocrine
n Eccrine
 u Secretion is excreted through exocytosis and no part of
glands is lost or damaged
u Located throughout the skin
n Apocrine
u Secretion occurs by destroying the apical part of the
gland, secretory cell located deep in the dermis
u Located in the armpits, pubic region, inguinal folds,
genital organs, anus circumference, nipple of mammary
glands
u No glans penis, inner layer of the prepuce and outer
surface of the labia minora

Hair
- Vellus-skin hair
- Bristly-eyebrows, eyelashes, beard, mustache, genital area
- Long- on scalp
Nail
- Free edge
n Extends past the skin
- Nail body
n Visible nail area
- Nail wall
n Skin on both sides of nail
- Lunula
n Whitened half-moon
- Eponychium
n Lies at the base of nail, live skin
- Mantle
n Holds root and matrix
Nerve-receptor skin
- Tactile sensation
n Meissner’s bodies are located inside the papillae of dermis
n Many are present in fingers, lips, genitals
- Thermal sensation
n End-bulbs of Krause are localized in dermis
n Lips, eyelids, external genitalia-cold
n Ruffini-heat—lower body of dermis and upper part of
hypoderm
- Body position and pressure
n Deep layers of dermis, hypodermis—mainly in palms, soles,
nipples of mammary glands, genitals-Fatera-Pacini bodies
- Dogel’s genital bodies
n In skin of genital organs, providing increasing sensitivity of
these zones
- Pain, itching, burning—free nerve endings in epidermis

Functions of the skin

- Immune organs
n Contribute to the maturation of T-lymphocytes
- Protection
n Mechanical from microbes and sun rays
- Secretory
- Sensory
- Respiratory
- Thermoregulatory (dilate and constrict of blood vessels)
- Metabolic
Pathological changes of the skin
- Parakeratosis
n Presence of cells in stratum corneum of the epidermis with
rod-shaped colored nuclei (granular and eleidin layers are
absent)
- Hyperkeratosis
n Thickening of stratum corneum without structural changes
in cells
- Acanthosis
n Increased multiplication of the cells of stratum spinosum
(up to 20-30 layers) with elongation of intrapapillary
outgrowth of the epidermis
- Acantholysis
n Melting of intracellular epithelia bridges, disruption of a
strong bond between epithelial cells, cells easily separate
from each other and form bullas in stratum spinosum
- Granulosis
n Increasing the number of granular layer
n Form epidermal papules (warts) and epiderma-dermal
papules (lichen planus)
- Papillomatosis
n Proliferation of the cellular elements of dermal papilla
n Psoriasis, atopic dermatitis

Acute inflammation in the epidermis

- Spongiosis
n Formation of bubbles in the stratum spinosum due to the
accumulation of intermittent edema fluid
- Vacuolar degeneration
n Fluid accumulation in the basal and spinosum layers due to
degenerative processes in the nucleus, cytoplasm of the
cells
n D: dyshidrotic eczema, epidermophytosis of feet
- Ballooning degeneration
 n Cells of stratum spinosum increase in size due to
accumulation of fluid, become spherical, then cells are
separated resulting in the formation of cavities filled with
exudate
n D: herpes simplex and zoster

Primary morphological elements

- appear on unchanged skin and characterize the onset of the
disease
n Proliferative
n Exudate
- Macula
n Limited change in skin color without disturbing its relief
and consistency
n The spots on the skin are “exanthema”
n On mucous membrane “enanthema”

- Types
n Inflammatory
u As result of expansion of surface blood vessels in skin
 l Roseola up to 25mm
l Erythema more than 25mm
n Non-inflammatory
u Result of improper development of blood vessels—
hemangiomas
u Due to hemorrhage—purpura
n Hyperpigmented
u nervous
n Depigmented
u Vitiligo
- Nodule (knot)
n Large infiltrative dense element of globular or ovoid form
n Located in deep layers of the dermis and subcutaneous
fatty tissue
n Knot has dimensions from pea to walnut
n Knot can be mobile or welded to the skin

- Blister (urtica)
n Inflammatory, rise above the surface of the skin
n Lies the derma of upper layers of the dermis
n Differs in density, pink-red, pearly-white color and intense
itching
- Wheel (urticaria/hives)
 n
- Papula
n Infiltrative, elevations of the skin
n Arise from epidermis and upper dermis
n Epidermal, dermal and epidermal-dermal
n Miliary (1-2mm)
n Lenticular (1cm)
n Nummular (2-2.5cm)
n Plaques (>2,5cm)
n By shape
u Conical, polygonal, flat, oval
n Pink, red, purple
 n Surface: smooth, covered with scales

- Tuberculum
n Infiltrative
n Rise above the surface of skin
n Resolved by scar or scarring atrophy
n Result of limited foci of productive inflammation of the
type of infectious granuloma with the phenomena of
necrosis, ulceration and scarring
n Diameter from grains to hazelnut
- Vesicle
n Intraepidermal cavity surface element filled with serous
transparent contents
n Erosion, crust
 n Diameter up to 5mm

- Bubble (bulla)
n Large cavity element of round or oval shape with a clear,
cloudy or hemorrhagic content
n Diameter > 5mm
n It is tense or flabby, easily opening and forming erosive
wetting surface
- Pustula
n Cavity filled with pus
n Surrounded by halo of inflammation
n Formed in epidermis as a result of necrosis of epithelial
cells under the influence of various pyogenic
microorganisms
n Big form—abscess—associated with hair follicle-furuncle
n With apocrine sweat glands—hydradentitis
Secondary morphological elements
- Appear as result of changes in primary lesion
- Scales (Squamae)
n Loosened, detaches horny plates that have lost contact
with the underlying cells
- Crust
n Dried out exudate of the contents of vesicles, blisters,
decay of skin tissue,
n Separated erosion and ulcers
n Color of the crusts depends on the type of exudate
- Abrasion (excoriation)
n Skin defect caused by mechanical damage to the skin
n Bruises, scratches,
n Epidermal or deep dermis abrasion
- Crack
n Skin defect that results from its linear rupture with
prolonged inflammatory infiltration, dryness and lose of
skin elasticity
Secondary macules
- Appear after the primary lesions (nodules, vesicles, pustules)
as hypopigmented, de or hyper spots
- Erosion
n Superficial defect of the epidermis
n Formed after the opening of exudative primary elements
(vesicle, bladder, abscess)
n Dimension is related to previous primary elements
- Ulcer
n Deep defect in the skin within the dermis and hypodermis
n Result of pathological changes that have caused necrosis of
the deep layers of the dermis
n It always heals by scar, by nature of which it is possible to
judge a previously transferred pathological process
- Cicatrix (scar)
n Newly formed skin tissue that arises in the places of its
deep injuries when defect is replaced with a coarse fibrous
connective tissue
n Scar contains no hair, sebaceous, sweat glands, vessels and
elastic fibers
n Hypertrophic scar
u Rise above the surface of the skin

n Atrophic scar
u Thinned surface, located below the level of surface of
normal skin

- Lichenification
n Thickening of skin due to various inflammatory infiltrates
 n At the center, it has form of compacted skin with
underlined, diamond pattern, rough, dry and
hyperpigmented (shagreen skin)

- Vegetation
n Proliferation of papillary layer and thickened epidermal
horny cell layers
n Ex) genital warts
- Crack (fissure)
n Vertical loss of epidermis and dermis with sharply defined
walls, crack in skin
n Chapped lips or hands

- Excoriation
n Partial damage to the epidermis by injury or rubbing
 n Epidermis is missing, and dermis is exposed

- Crust
n Solified keratin and exudate that forms on an erosion or on
ulcerous skin
n Color demands on nature of exudate