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Dr. Chairiyah Tanjung, SpKK
Departement of Dermato-venereology
University of North Sumatera
RSUP H.Adam Malik Medan

• The outermost layer, most complex
• A reflection of healthy man
• 15% of body weight; area of 1,5-1,75
• Thickness: 0,5mm-6mm

Basic science

Structure of the skin
Function of the skin
Structure of genitalia
Microbiology of the skin
Histopathology of the skin
Morphology and how to make
7. Basic science of dermatoimmunology

Structure of the Skin
1. Epidermis

Basal layer
Malphigian layer (spinous layer)
Granular layer
Lucidal layer
Stratum corneum

2. Dermis
2.1. Papillary dermis
2.2. Reticular dermis


Sub cutis

Diagramatic cross section of the skin
and panniculus


the cells change in form while move upward Melanocyte cell (+)  melanosome  melanin keratinocyte dermis 2. Malphigian layer (spinous layer) • • • The thickest layer: 6-8 layers. intercelular bridge (+) Langerhans’ cell (+) . Basal layer • • • Columnar shape cell. poligonal shape Glycogen >> .Epidermis 1. pallisade Mitotically active. differentiate.

nucleus (+) Function:  Apoptosis  Impermeable water barrier 4. Lucidal layer • • • Flatten cells. Granular layer • • • 2-3 flatten cell layers Cytoplasm: keratohyalin granules.3. basophilic. nucleus (-) Cytoplasm: protein→ eleidin Clearly seen in hands and soles .

nucleus(-) Cytoplasm: keratinous Desquamation (+) Merkel’ cells • • Found between basal keratinocyte. Stratum corneum • • • 20-25 flatten cell layers.5. in hairy/glaborous skin Intracytoplasmic neurosecretory like granules (+) . cornified.

vascular tissue • Papillary dermis: – Close to epidermis – Collagen fiber & elastic fiber in small bundles – Vascular and nerve ending (+) • Reticulary dermis – Close to sub cutis – Collagen fiber & elastic fiber in big bundles • Function: elasticity of the skin age  elasticity . fibrous protein. hair follicles. elastic fibers. cellular elements.The dermis • Thicker than epidermis • Composition: collagen fibers.

• Function heat insulator. . mechanical barier. 2. Sub papillary plexus.SUB CUTIS • Lobule of fat cells separated by fibrous septa • Vary in thickness. The cutaneus vascularization : 1. Associate with the vascular plexus are the dermal lymphatics. Deeper plexus. energy reserve.

Sebaceous glands. 2. 4. 1. .• EPIDERMAL APPENDAGES (THE ADNEXA). 3. Sweat glands: Eccrine glands. Nails. Apocrine glands. Hair.

lids (gland of Moll). forehead Axilla. probably body odor .Eccrine glands Apocrine glands Size. anogenital region. palms. form Small. spiral Bigger Location All over the body. areola. catecholamines Function thermoregulation Unknown. emotional Adrenergic innervation. axilla. ceruminous glands Secret Watery Juicy Orifice Skin surface Infundibular hair follicle Influencing factors Cholinergic innervations. soles. fear.

SEBACEOUS GLANDS. • Influence by androgen. cholesterol. children↓. release products into the upper portion of the hair canal. free fatty acid. . • Sebum: triglyceride. • Holocrine. • Sebum production: baby ↑. adolescence↑. squalene. wax ester. • Throughout all skin sites except the palms and soles.

labium minus. beard.60%. Velus hair <1 cm. • All over the skin. Indeterminate hair about 1 cm. • Hair composition :carbon 50.HAIR. . hydrogen6. forehead. oksigen 20. distal phalanges. Terminal hair >1 cm.0%. except the palms and soles. • Hair types : Lanugo hair fetus. baby. lips. sulphur 5. pubic hair. • Androgen hormon axillary hair. dorsal phalanges. nitrogen 17.80%.14%.36%.


• The rate of hair growth is dependent upon mitotic activity of bulb matrix. 3.3mm/day. Several months. Telogen (resting phase).THE HAIR CYCLE. Catagen (degenerative stage). 1. <1%. 2. 85%-90% human scalp hair follicle are in anagen. The club hair within the foreshortened follicle until a new anagen follicle develops. club hair (+). 2 weeks. Matrix activity(-). . Anagen (growth stage) 2-6 years : 0.


The capacity to pick up small objects. fingernails’ growth>toenails’ growth.THE NAIL. Enhancing tactile discrimination. • Grows 1mm / week. Used for scratching and grooming. • Functions: – – – – – Esthetics. • Consist of horny product. Protecting the distal phalanges. .


5.Thermoregulatory. 3.THE FUNCTION OF THE SKIN: 1. Another function: .Pigmentation.Protection.Excretion.Absorbtion.Photosynthesis of vit D.Keratinization.socio-sexual . 6. 4. immunologic .Perception. 8. 2.

.urocanic acid.stratum corneum.1Physical protection: . 1.elastic and collagen fibers . .3 Photo protection: . 1.melanocyte.desquamation .2 Chemical protection: .keratinization. 1.thickness of stratum corneum. .impermeability of stratum corneum .acidity of the skin.4 Microorganism protection .acidity of the skin .1. Skin as protection organ • • • • 1. .fat tissue.

Absorbtion function skin permeability skin respiration Influenced by many factors absorbtion (+) epiderm intercellularal cell gland orifice .2.

urea. uric acid.3. ammonia • Product of sebaceous gland acidity of the + skin Product of sweat gland . Excretion function • Sebaceous gland  sebum oily of the skin protection excessive evaporation • Skin gland  metabolic residue : NaCl.

Perception function Kind of perception Sensory receptor Location Touch Meissner’s Dermal corpuscle papillae Merkel Ranvier Epidermis Pressure Pacinian corpuscle Deep dermis. sub cutaneous tissue Heat Ruffini’s ends Dermis. sub cutaneous Cold Pain Krause Free nerve Dermis Papillary .4.

Pigmentation Skin colour depends on: ~ ~ ~ ~ ~ thickness of the skin carotens melanin oxyhemoglobin deoxygenated hemoglobin . Thermoregulatory Function By eccrine gland skin circulation constriction of blood vessels 6.5.

6 dihydroxyndole .6 dihydroxyndole – 2 5.Tyrosinase Tyrosine + + Dopaquinone 2 – S Cysteinyldopa or 5 – S Cysteinyldopa Leucodopachrome Dopachrome Benzothiazine intermediate carboxylic acid or Pheomelanine Quinone Eumelanin 5.

Keratinization – 14 – 21 days – Skin protection againts infection by physiologic mechanism .7. Photosynthesis of vitamin D sunlight (295-300 nm) 7 dehydrocholesterol vitamin D 8.

Structure of genitalia .

Male genitalia .


Female genitalia .


Pelvic lymph nodes and lymph nodes along abdominal aortic .Horizontal tract of superficial lymph nodes and deep lymph nodes 2.Lymphatic system of male / female genitalia 1.

external iliac nodes.Superficial .deep Srotum Spongy uretra Membranous & prostatic urethra Prostate and seminal vesicles Testis. anorectal nodes External iliac nodes . epididymal duct Lymph nodes Superficial medial inguinal nodes Superficial medial inguinal nodes Deep medial inguinal nodes Superficial medial inguinal nodes Superficial medial inguinal nodes Deep inguinal nodes Vesicle lateral nodes  internal iliac nodes Sacral.Organ Penis . internal iliac nodes.

interiliac nodes. deep inguinal nodes. superficial inguinal Labium minus Bartholin’ s gland Clitoris Urethra Ovary Fundus of uterus Body of uterus .organ Lymph nodes Labium majus Superficial medial inguinal nodes. external iliac nodes Anterior vesicle nodes Superficial medial inguinal nodes. external iliac nodes Superficial medial inguinal nodes. deep inguinal nodes. external iliac nodes Superficial medial inguinal nodes. gliteal inferior nodes Nodes along abdominal aortic Nodes along abdominal aortic Nodes along abdominal aortic. deep inguinal nodes.

clinical sign (-) • Virulensi : depends on microorganism’ strain .Microbiology of the skin • Keratinization  fat. nitrogen. mineral etc  microorganism consuming  colonization(+) pathogen • Microorganism opportunistic pathogen non pathogen • Carrier : pathogen microorganism (+).

Defense mechanism/ hospes immunity . infarction – Cellular reaction → systemic spread → distant lesion 3.Portal of entry : – Vascular wall : hemorrhage. thrombosis.Pathogenesis of bacterial infection towards the skin depends on : 1.Characteristic of pathogenic : – invasive potensial – toxigen properties of the organism 2.

desquamation . Natural: .Skin disease in immunodeficiency person (+) .normal bacterial o.IgA.t.Defense mechanism/hospes immunity 1.dessication .t. in the serum <<< .acid mantle theory . IgG. skin .skin structure: .chemical protection: -unsaturated fatty acid .IgM in the sweat (-) . skin 2. IgD. Immunoglobulin & delayed type hypersensitivity .bacterial interference o.

non Non pathogen pathogen Multiplicating (-) (+) Eradication from the skin easy hard .Normal cutaneus flora Comes from Pathogenicity Transient skin flora Resident skin flora Out of skin Skin Pathogen.

Normal flora in the orifice of the body microorgani sm External acoustic meatus Nasal vestibule urethr a vulva Micrococci (+) (+) (+) (+) Diphteroid (+) (+) (+) (+) Staphylococc us (+) Streptococcus (+) Mycobacteriu m smegmatis umbilic al (+) Enterococci (+) Coliform (+) Staphylococc us aureus (+) Streptococcus Pyogenus (+) .

Histopathology of the skin Histophatology diagnosis defenitive diagnosis helpful in making biopsy  fixation  processing -punch -scalpel coloring Histopathology examination .

sclerosis. vasculitis.• Histopathologic alteration : – Epidermis : hyperkeratosis. – Sub kutis : inflamation. degenerative process. hypergranulosis. etc. atrophy. tissue necrosis. . spongiosis. hypoplasia. etc. – Dermis : papillomatosis. fibrosis. hyperplasia. baloon degeneration. akantosis.

Kulit Normal .

Hiperkeratosis .

Parakeratosis .

Hipergranulosis .

Akantosis .

Celah suprabasal .

Eksositosis. Spongiosis Eksositosis Spongiosis .

Degenerasi balon .

Pemanjangan rete ridge .

Papilomatosis .

Good Luck! .