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Skin is the largest organ of the human body

Accounts for 16-20% of body weightit weighs twice
as much as your brain
For the average adult human, the skin has a surface
area of between 1.5-2.0 sq.mtrs
The skin is composed of two basic layers (regions)..
Epidermis outermost layer
Dermis underlying connective tissue
Subcutaneous fat (Hypodermis),inspite of its close
anatomic relationship and tendency to respond
jointly to pathologic processes,is not a part of skin
basic structure


Primarily made up of keratinized stratified squamous


Gives strength to the skin.

Varies in thickness from thick skin to thin skin

Eyelids- 0.04 mm,Palms- 1.6 mm,average 0.1 mm

It does not have any vascularization, so it relies on

the connective tissues deep to it.

Also contain melanocytes, merkels cells and

Langerhans cell

Layers of epidermis

Stratum basale (the deepest layer)

Stratum spinosum
Stratum granulosum
Stratum lucidum (only in thick skin)
Stratum corneum (most superficial layer of

Stratum Basale

The stratum germinativum (or basal layer,

stratum basale) Consists of single layer of

basophilic columnar or cuboidal cells.

Along with S. spinosum, it is a component of

Malpighian layer

Cells are bound to each other by desmosomes

and to basal lamina by hemidesmosomes.

All cells contain intermediate keratin filaments,

number of which increases as cells progress

Stratum Spinosum

Also contain the dividing cells as in basale.

Cells contain bundles of intermediate filament
(tonofilaments) projecting into the processses of
cells which give attachment to the desmosomes, so
giving spined appearance.
Tonofilaments provide resistant to the abrasion so
this layer is thicker in the areas prone to abrasion
(thick skin) .
Keratinization begins in the stratum spinosum.

stratum granulosum

Consists of polygonal cells , cytoplasm of which

is filled with the basophilic granule ,

keratohyaline granules. It is rich in
phosphorylated histidine and cystine.

Cells contain, lamellated bodies, made up of

lipid. It fuses with the cell membrane and it
come out of cells and function as a intercellular
cement or sealing agent.

This sealing effect is first evolutionary

adaptation to terrestrial life

Stratum Lucidum

More prominent in thick skin .Cellular

organells and nuclei are not prominent.

It is composed of clear non-nucleated


In the palms and soles, the stratum

lucidum is present. The tan colored

protein blocks the underlying

melanocytes from view

Stratum corneum

The main difference between thick skin and thin

skin relates to the thickness of the Stratum
These are the dead cells, flaking off. The cells lose
their nucleus and fuse to form squamous sheets,
which are eventually shed from the surface
The mean turnover or renewal time of epidermis is
39 days(13+12+14) i.e.,time for a cell to move
from the stratum basale to the distal edge of the
stratum corneum and shed
13 days for proliferative compartment( lower two
rows),12 days for differentiated compartment,14
days for cornified layer


It is connective tissue that support the epidermis and

attaches the epidermis to the hypodermis.

Dermis is 15-40 times thicker than the epidermis

Its surface consists of many ridges (dermal papillae)

which interdigitate with epidermal ridges.

The dermis is also the area where all the glands of the
body are located.

Has 2 layers/compartments


A thin zone immediately beneath the epidermis (the

papillary dermis) and around adnexa ( the periadnexal
dermis).The combination of papillary and periadnexal
dermis is called Adventitial dermis


A thick zone of Reticular dermis that extends from the

base of the papillary dermis to the surface of the
subcutaneous fat

papillary dermis
Papillary layer The papillary dermis is the uppermost
layer of the dermis,composed of thin haphazardly
arranged collagen bundles,delicate branching elastic
fibers,numerous fibrocytes,abundant ground
substance.A highly developed microcirculation composed
of arterioles,capillaries and venules
Its superior surface is uneven (fingerlike projections)
which forms the characteristic fingerprint of the finger.
This layer provides the epidermis with nutrients. Pain
and touch receptors are found here
Together,the papillary dermis and epidermis form a
morphologic and functional unit whose intimacy is
reflected in their alteration jointly in various
inflammatory processes
A similar interrelationship exists b/w periadnexal layer
and its adjacent epithelium

Reticular dermis

Dense irregular Connective Tissue

Has thick bundles of Collagen and coarse Elastic

fibers.Proportionally, there are fewer fibrocytes and
blood vessels and less ground substance compared to
papillary dermis

Arrangement of bundle in the direction of mechanical

force give rise to the cleavage lines of Langer.

Strongest layer of the Dermis.Gives the area

strength.Contains sweat,sebaceous glands and

pressure receptors

Leather is made of this layer.

Consists of loose connective tissue which helps in sliding
the skin over the deep structure.
Consists of layer of fat according to the nutritional status of
the person.
Also called as superficial fascia or panniculus adiposus

Arteries form the 2 plexuses. One at the junction of
papillary and reticular layer( sub- papillary plexus) and
another at junction of dermis and hypodermis (cutaneous
Veins form the three plexuses 2 in same position as for
arterial and another in the middle of the dermis

Cutaneous Glands
1. Sebaceous (oil) glands-Sebaceous glands are microscopic
glands in the skin which secrete an oily matter, called sebum,
in the hair follicles to lubricate the skin and hair. In humans,
they are found in greatest abundance on the face and scalp,
though they are distributed throughout all skin sites except
the palms and soles. An infection causes acne
2. Sweat (sudoriferous) glands - Sweat glands are exocrine
glands, found in the skin , that are used for body temperature
a) Eccrine glands -Eccrine glands (or merocrine glands) are
found at virtually all sites on the human body. They produce
clear liquid (perspiration), consisting of water, salts, and urea.

b) Apocrine glands- Apocrine glands are found in axillary and

genital areas, secrete a milky protein and fat substance. This
mixture is an excellent source of nutrients for bacteria which
produce body odour.


Follicle- A hair follicle is a part of the skin that grows hair by

packing old cells together.
Hair bulb

Arrector pili -Arrectores pilorum (singular Arrector pili)

are tiny muscle fibers attached to each hair follicle, which
contract to make the hairs stand on end, causing goose
bumps. Arrectores pilorum are smooth muscle, not skeletal
muscle, which explains why humans cannot voluntarily give
themselves goose bumps.


Fingernails and toenails are made of a tough protein

called keratin. Along with hair and teeth they are an
appendage of the skin.

Free edge- The part of the nail that extends past the
finger, beyond the nail plate. There should always be a
free edge present to prevent infections.
Nail folds (cuticle)- A fold of hard skin overlapping the
base and sides of a fingernail or toenail
Nail Matrix- This is the only living part of the nail. It is
situated behind and underneath the Nail Fold and
produces protein keratin which makes up the Nail Plate.

Embryology of skin


The skin of the embryo begins to form during the first

20 to 30 days of embryonic life, the period of active
organogenesis in human development.
The skin arises by the juxtaposition of two major
embryological elements:

The prospective epidermis, originates from a

surface area of the early gastrula; ectoderm.

The prospective mesoderm, which is brought into

contact with the inner surface of the epidermis.

The neural crest also makes contribution to the skin

Derivates of germinal layers

Epithelial structures like
Folliculo-sebaceous-apocrine units
Eccrine units
Nail units
& Merkel Cells ( From Primitive Ectodermal Cells From
Embryonic Epidermis)


Nerves &
Specialised sensory receptors


Langerhans cells


Mast cells


Blood vessels

Lymph vessels



Development of epidermis

In about the third week of fetal life, the

epidermis consists of a single layer of

undifferentiated, glycogen-filled, a single layer of


Present only in prekeratinized, developing skin

sloughed to amniotic fluid.

The periderm:
In a 4- to 6-week-old fetus, two layers of cells can

be distinguished, the periderm or epitrichial

layer and a stratum germinativum ( basal
germinative epithelium)

Development of epidermis


3 Weeks

Single Layer Of Flattened

Epithelial Cells

4 Weeks

Basal Germinative Layer &


3 Months

Intermediate Cells

5 Months

Keratohyaline Granules, signs

Of Cornification Starts

6 Months

Cornification Completed


Increase In Thickness Of
Cornified Layers

Development of cells in epidermis


Derived from Neural Crest cells

8 weeks - Reach epidermis
4-6 Months - Become dendritic, synthesize &
transfer melanosomes

Langerhans cells :

Derived from Bone marrow ( Mesoderm)

In fetal life : yolk sac and/or Liver
6-7 weeks Appear
12-14 wks - mature

Merkel cells :

Derived from neural crest ??

Evidence points towards origin from primitive
ectodermal cells within embryonic epidermis
12 wks appear in plantar skin
16 wks palmar skin
( as early as 9th week in Hair )

Development of dej



Flat Interface

1st Trimester

Basal Lamina

12 Wks

Interface Undulated

End Of 12 Wks

Mature DEJ ( As Viewed

Through An Electron

6 Months

Dermal Papillae

development of dermis

Intially, embryonic dermis comsists of stellate

mesenchymal cells suspended in acid muco substance


12 weeks

fibrocyte produce delicate collagen


16 weeks

i. Mature collagen bundles

ii. Dermis with papillary (thin
collagen bundles) and Reticular
(thicker collagen bundles)
becomes recognizable

24 weeks

Fibrocyte derived elastic fibres

appear interspread among collagen

Devp. Of blood vessels,cells of dermis and

sub cutaneous fat


1st Trimester

Dermal network of blood & lymph vessels

1st appears

2nd Trimester Mast cells and macrophages appear in

the dermis
Late 2nd

Beneath the dermis, mesenchymal cells

surrounding BV begin to differentiate into
lipid filled primitive adipocytes,as a
consequence subcutaneous fat comes
into being

3rd Trimester

Arborizing arterial and Venous plexuses

Develeopment of neural network

Origin-ectoderm of neural crest

5th week detectable in the embryonic dermis

In succeeding weeks, elaborate neural network develop

consisting of autonomic motor nerves that innervate


Blood vessels


Hair erector muscles


Eccrine & apocrine glands


Somatic sensory nerves


Specialised sensory end organs ( pacini corpuscle,

meissner corpuscle,mucocutaneous end organs)

Development of adnexa
Folliculo-sebaceous-apocrine unit
Hair follicle
The earliest development of the hair rudiments occurs
at about 9 weeks in the regions of the eyebrow, upper
lip and chin.
The bulk of the remaining follicles begin to develop at
approximately 4 to 5 months gestation in a cephaladto-caudad direction.
By 17th week-first fine wisps of hair emerge from
ostia on the eyebrows and forehead and cover the
entire scalp by 18 weeks
By 20 weeks,these lanugo hairs cover the whole
cutaneous surface,except for the palms,soles,terminal
phalanges of the digits,glans penis and labia minora

Follicular germ stage

condensation of mesenchymal cells just beneath the slight downgrowth or
bud of fetal basal keratinocytes.

Follicular peg stage, organization of keratinocytes

in the follicle and the mesenchyme of the follicular
sheath and follicular papilla located at the tip of
the follicle.

Bulbous hair peg stage,(near 16th week). Two prominent bulge

the uppermost becoms the sebaceous gland and the lowermost is
the insertion site of the arrector pili muscle as well as the
presumptive site of the hair follicle stem cells.
In many follicles, a third bud later appears above the sebaceous
gland; this is the rudiment of the apocrine gland.

Sebaceous glands
The sebaceous glands become differentiated at 13-15
weeks, and are then large and functional.
These are, at first, solid, hemispherical protuberances on
the posterior surfaces of the hair pegs.
The cells contain moderate amounts of glycogen, but
soon the cells in the centre lose this, and become larger
and foamy as they accumulate droplets of lipid.

Apocrine glands
Anlagen of apocrine glands probably develop in all hair
follicles, but after the fifth month,most begin to
regress,so that by term they persist in only a few sites
namely the axillae,areola and the periumbilical and
anogenital skin
At 24 weeks,cord of cells which becomes coiled at its
Although the apocrine secretory segment secretes a
milky fluid beginning at 7 months,apocrine glands are
dormant postnatally until they resume secretory function
around puberty

Eccrine glands

In embryos of 12 weeks, the rudiments of eccrine

sweat glands are first identifiable as regularly spaced

undulations of the stratum germ.

These start to develop on the palms and soles at

about 3 months, but not over the rest of the body
until the fifth month.

Cells forming them lie palisading and closely together,

but otherwise they do not differ from the rest of the
stratum germinativum.

By 14-15 weeks, the tips of the eccrine sweat-gland

rudiments have penetrated deeply into the dermis,
and have begun to form the coils


The nail apparatus develops during the 9th embryonic

week from the epidermis of the dorsal tip of the digit
as a rectangular area, the nail field.
The proximal border of the nail field extends
downward and proximally into the dermis to form the
nail matrix primordium.
at 13 weeks, four morphologic components are
recognizable in the epithelium of a developing nail
unit. They are the basal zone,the spinous zone,the
granular zone and the cornified zone.This region now
termed e[ithelium of nail bed, loses its granular zone
by the twentieth week
At 14 weeks,cornified cells mature at the proximal
end of nail bed to form nail plate
By 16 weeks,nail plate advances to cover proximal
half of the nail bed
By 20th week,covers its completely at which time the
fetal nail resembles that of the adult

Mechanism that govern embryonal

development of skin


Epithelial interaction

Can occur via direct cell to cell contact or diffusible macromolecules

This interdependence is exemplified by embryogenesis of follicular


Epithelial unit will not develop from epidermis in absence of

mesenchymal papilla and conversely a follicular papilla will not

form in the absence of a covering epithelium


Stratification of epidermal cells is dependant on the

intactness of basal lamina

Seen in re epithelisation of healing wounds

The reconstitution of epidermis from keratinocytes of all

ectodermally derived epithelial structures of adnexa demonstrates
the pluripotentiality of adnexal keratinocytes

In conclusion

The development & maintenance of skin depend on

interactions between epithelium and mesenchyme,between

generative epithelium cells & components of their basal

lamina,and of epithelial cells with one another.

These interactions collectively result in a heterogenous but

unified structure i.e., skin with marked regional

differentiation in form,color,consistency

Samuel L. Moschella and Harry J. Hurley Dermatology 3/e


Jean L Bolognia MD ,Joseph L Jorizzo MD ,Ronald P Rapini

MD Dermatology 3/e