INTRODUCTION

The skin is the most superficial and also the largest organ in the body. It has a dual origin:
1. A superficial layer, the epidermis which develops from the surface ectoderm.
2. A deep layer, the dermis which evelops from the underlying mesenchyme.
The skin functions as a barrier against infection, serves in thermoregulation, and protects
the
body against dehydration.
Epidermis
The epidermis is derived from the surface ectoderm. This is at first single-layered. At the
end of the fourth month, the epidermis acquires its definitive arrangement, and four layers
can be distinguished: (1) The basal layer which is responsible for production of new cells.
This layer later forms ridges and hollows, which are reflected on the surface of the skin
in the fingerprint. (2) A thick spinous layer which consists of large polyhedral cells
containing fine tonofibrils. (3) The granular layer which contains small keratohyalin
granules in its cells. (4) The horny layer which forms the tough scalelike surface of the
epidermis and is made up of closely packed dead cells containing keratin.
Many of the superficial layers are shed off. These get mixed up with secretions of
sebaceous glands to form a whitish sticky substance (vernix caseosa) which covers the
skin of the newborn infant. The vernix caseosa has a protective function.
The melanoblasts of the epidermis are derived from the neural crest. These cells
synthesize melanin pigments responsible for skin and hair colour. Cells of Merkel and of
Langerhans appear in the epidermis between 8 and 12 weeks of intrauterine life.
Dermis
The dermis is formed by condensation and differentiation of mesenchyme underlying the
surface ectoderm. They are believed to be derived from many different sources and
includes:
1. Neural crest cells which supply the mesenchymal cells for the dermis of face and
neck
2. Paraxial mesoderm which supply the mesenchymal cells for the dermis of the
back
3. Lateral plate mesoderm supplying mesenchymal cells for the dermis of the body
wall and limbs.
The line of junction between dermis and epidermis is at first straight. Subsequently, the
epidermis shows regularly spaced thickenings that project into the dermis. The portions
of dermis intervening between these projections form the dermal papillae. Still later,
surface elevations (epidermal ridges) are formed by further thickening of the epidermis
in the same situation.

DEVELOPMENT OF SKIN APPENDAGES

Hair
The hair are also derived from surface ectoderm. At the site where a hair follicle is to
form, the germinal layer of the epidermis proliferates to form a cylindrical mass that
grows down into the dermis. The lower end of this downgrowth becomes expanded and
is invaginated by a condensation of mesoderm, which forms the hair papilla which is
soon filled with mesenchymal cells that develop into blood vessel and nerve endings.
Soon, cells in the center of the hair buds become spindle-shaped and keratinized, forming
the hair shaft, while peripheral cells become cuboidal, giving rise to the epithelial hair
sheath. As the hair grows to the surface, the cells forming the wall of the downgrowth
surround it and form the epithelial root sheath. An additional dermal root sheath is formed
from the surrounding mesenchymal cells. A thin band of smooth muscle (arrector pili) is
formed by mesodermal cells and gets attached to the dermal root sheath. A typical hair
follicle is thus formed
Lanugo hair is the first set of hairs to appear and it is shed at about the time of birth and
is later replaced by coarser hairs arising from new hair follicles.
Sebaceous glands develop from the epithelial wall of the hair follicle and elaborate sebum
into the hair follicle.
Sweat glands
Sweat gland develops as a downgrowth from the epidermis. The downgrowth is at first
solid but is later canalized. The lower end of the downgrowth becomes coiled and forms
the secretory part of the gland.
There are two types of sweat glands namely the eccrine and apocrine glands. The eccrine
glands develop over most of the body and function in temperature control and exocytosis.
The apocrine glands develop during puberty in parts of the body there are hair such as
the face, pubic region and axilla. The sweat produced by these apocrine glands contains
lipids, proteins and pheromones. The odor associated with this sweat is as a result of
bacterial decomposition of this substances.
Mammary glands
Mammary glands develop from the mammary ridge. These ridge appearing on the left
and right sides of the body extends from the base of the forelimb to the region of the hind
limb. Although a major part of these ridges disappear shortly after being formed, a portion
persists in the pectoral region and penetrate into the underlying mesenchymal.
Canalization of these epithelial downgrowths results in formation of alveoli and
lactiferous ducts. The lactiferous ducts drain into an epithelial pit, the future nipple.
The Tanner stages of breast development are guidelines in assessing whether a female
adolescent is developing normally:
Stage I: Breasts have papillae elevations only
Stage II: Breasts have palpable buds, and areolae enlarge
Stage III: Breasts show elevation of contours, and areolae enlarge
Stage IV: Breasts form secondary areolar mounds
Stage V: Breasts show adult breast contour, areolae recess to the general contour of the
breast, and the nipples project.

CLINICAL CORRELATES
Ichthyosis refers to a group of cutaneous disorders characterized by increased or aberrant
keratinization of the skin resulting in noninflammatory scaling, dryness, and cracks in the
skin that may form deep fissures. Types include:
a. Ichthyosis vulgaris is an autosomal dominant genetic disorder caused by a mutation
in the FLG gene on chromosome 1q21, which encodes for the filaggrin protein (a major
component of keratohyalin). Clinical features include the mildest form of ichthyosis. It
presents during childhood after 3 months of age, and appearance consists of fine white
scales on the extensor surfaces of the extremities.
b. Harlequin fetus is an autosomal recessive genetic disorder caused by a mutation in
the ABCA12 gene on chromosome 2q34, which encodes for the adenosine triphosphate-
binding cassette transporter (subfamily A, member 12), which functions as a lipid
transporter in keratinocytes. These
mutations lead to impaired lipid secretion from lamellar granules in keratinocytes.
Clinical features include the most severe form of ichthyosis. The fetus is encased by
massive, armor-like plates of scale with deep fissures; the diamond-like configuration of
the scales results in the appearance of a harlequin clown. Many such infants are stillborn
or die shortly after birth.
Psoriasis is a skin disease characterized by excess cell proliferation in the stratum basale
and in the stratum spinosum. This results in thickening of the epidermis and shorter
regeneration time of the epidermis.
Hypertrichosis is an overgrowth of hair. It is frequently associated with spina bifida
occulta, which is seen as a patch of hair overlying the defect.
Polythelia is a condition in which supernumerary nipples occur along the mammary
ridge.
Polymastia is a condition in which supernumerary breasts occur along the mammary
ridge.
Breast hypoplasia: this generally occurs asymmetrically when one breast fails to
develop completely.