DERMATOLOGY

EMERITA C. MENDOZA, R.N., M.D.

The Integumentary System
• The integumentary system is composed of the:

– Skin – Appendages
• Largest organ of the body

Functions of the Integumentary system
• • • • • • Gives shape to the body Protects the body from injury Serves as a barrier to infection Sensory reception Thermoregulation Maintenance of water balance

The SKIN: 3 divisions
• 1 – Epidermis • 2 – Dermis • 3 – Hypodermis or Subcutaneous Tissue
• The epidermis is the external covering of the body, whereas the dermis & subcutaneous tissue lie immediately beneath the epidermis.

The EPIDERMIS
• Composed mainly of 4 layers: > stratum corneum: outermost > stratum granulosum: lucidum in thick skin > stratum spinosum > stratum basale • Nerves: found in the epidermis, which function for pain and temperature sensation • Blood vessels: Avascular

Epidermis: 1st layer = stratum basale or germinativum

Epidermis: 1st layer
• • • • stratum basale/ stratum germinativum mitotically active basal layer protein keratin source of new epidermal cells, which gradually move upward • epidermis is renewed every 15-30 days • presence of melanocytes and Merckel cells
• Psoriasis results from the increased proliferation of cells from this layer, resulting in a thicker epidermis with continuous rapid turnover.

Epidermis: 2 layer
nd

• stratum spinosum • mitotically-active • bound together by spiny-looking desmosomal junctions • Spines are desmosomes that promote adhesion of epidermal stress • Langerhans cells present

Epidermis: 3 layer
rd

• stratum granulosum • acts as the impermeable epidermal sealant

Epidermis: 4 layer
th

• • • •

stratum corneum OUTERMOST layer most superficial flat, squamous keratinocytes • cornified (keratinized) cells • oldest keratinocytes

Epidermis: stratum lucidum
• • • • • stratum lucidum transitional zone flat, pale-staining keratinocytes anucleated cells found only in thick skin

Epidermal Cell Types (4)
• 1 – Keratinocytes • 2 – Melanocytes • 3 – Langerhans • 4 - Merckel

Keratinocytes
• most numerous (85%) • secrete keratin • provides the barrier function of the epidermis

Melanocytes
• found in the dermis and basal layer of the epidermis • produce melanin • protect from UV

Langerhans cells
• members of the immune system, and functioning as antigen-presenting cells. Found in stratum spinosum.

Merckel cells
• found in the basal layer and appear associated with sensory nerve fibers, functioning as mechanoreceptors.

The DERMIS
• layer beneath or internal to the epidermis • thicker than the epidermis • loose connective tissue, mainly collagen and elastic and reticular fibers • blood vessels • nerves

Functions
• • • • Provides pliability, elasticity, and tensile strength Binds water Aids in thermal regulation Increased receptors for sensory stimuli

Subcutaneous Tissue
• Consists mostly of adipose tissue • Contains larger blood vessels and nerves • May contain the base of hair follicles and sweat glands • Functions: caloric reserve, heat insulator, shock absorber

Skin Appendages
• • • • Sweat glands Sebaceous glands Hair Nails

Sweat glands – 2 types
• Eccrine: < 0.5mm diameter • found anywhere except penis • secretion contains protein, NaCl, urea, NH3, uric acid • Function in thermoregulation

Sweat glands – 2 types
• Apocrine: 3-5mm in diameter • Modified sweat gland • found in the axillary, areolar, anal regions • open up into hair follicles • secrete odor-producing discharges called “pheromones” • functional at puberty

Sebaceous or Oil glands
• secrete sebum • anywhere except on the palms and soles • lubricate hair follicles & skin surface and prevent dessication • functional at puberty • accumulation & obstruction of sebum  whitehead (comedo) & blackhead (dead cells with melanin) • rupture of sebaceous gland duct + sebum + bacteria  red papules (pimples) and pustules (lesions with pus)

Hair
• arises from hair follicles which are epidermal invaginations • Associated arrector pili muscle causes “goosebumps”

Nails
• like hair, are modified stratum corneum • keratin of nails is harder than that of hair • stratum basale of the nail area continuously proliferates and rapidly keratinizes • white cuticle of nails is called eponychium

• nail root – region with special epithelial cells  nail body • nail bed – area of keratinization • cuticle – fold of skin that hides nail root • lunula – area of thick germinal area

Meissner’s corpuscles
• present in the dermal papillae • surrounds nerves • connective tissue capsules • function as mechanoreceptors for fine touch  

Pacinian corpuscle
• found within the dermis and hypodermis • surround nerves and look like onions • function as mechanoreceptors for pressure & vibration.

First-degree burns
• red and painful affect the epidermis only (e.g. sunburn).

Second-degree burns
• characterized by blisters and pain, reach through the epidermis to parts of the dermis (e.g. minor burns from fires)

Third-degree burns
• damage all layers of the skin, including appendages, blood vessels, and nerve endings. • The destruction of nerve endings is the reason why severe burns are not painful.

Management of Burns
• Treatment for all burns starts with removing all clothes and substances touching the skin, and copiously irrigating all chemical burns with water. • Eye burns require up to 8 hours of flushing. All burn patients should be up to date with tetanus prophylaxis • Second- and third-degree burn patients must have their calculated fluid loss volumes replaced.

Management of Burns
• First-degree burns are managed merely by keeping them clean. • Second-degree burns require the removal of the blisters, and application of antibiotic ointment such as silver nitrate or silver sulfadiazine or mafenide or betadine, and then dressing. Removal of much burn tissue is termed debridement. • Third-degree burns, however, necessitate excision of the eschar and split-thickness skin grafting. Although minor burns are dressed with sterile bandage, major burns are not.