Dermatology

MAY , 2021
Introduction to Dermatology
 Integumentary System
• Integumentary system is composed of the skin and accessory
structures (hair, hair follicles, nails, glands & nerves)
 SKIN
• The largest organ of the body
• 15% of total body weight
• Varies in thickness from 0.1-0.5 mm in the eyelids to 1.5- 6.3 mm in the soles of
the feet
• The top layer is full of keratin and hardened (cornified) to prevent water
loss
 Layer of skin
• Epidermis
- it is avascular
• Outermost layer of the skin that is composed of a surface of dead cells with an
underlying layer of living cells; complete regeneration appox 35 days and is
derived from the stratum basale layer
• Made up of stratified squamous cells that are capable of keratinizing (hard/tough)
• Melanocytes (pigment cells); increase in sun exposure will cause these cells to
produce more melanin
 Layer of skin
• Langerhans cells: macrophages
that activate the immune system
• Merkel cells: sensory nerve
receptors
 Layer of skin
• Dermis (corium or true skin)

• Called the “true” skin; the dermis contains the blood vessels and nerves
• Dense Connective tissue; strong/flexible
• Collagen, elastin (stretch/recoil)
 Layer of skin
• Contains:
• Blood vessels and capillaries
• Lymphatic vessels
• Nerves
• Hair shafts and hair follicles
• Sensory receptors
• Sudorferous glands- sweat
• Sebaceous glands- oil
**The epidermis and dermis are firmly connected
but can be separated by friction
(blisters) Dense Connective tissue
 Layer of skin
• Subcutaneous- hypodermis
• Not skin
• Adipose and areolar connective tissue
• Stores fat
• Anchors skin to underlying structures (muscles)
• Allows skin to slide freely
• Shock absorber, insulator
• Thickens with weight gain
 Types of skin
• Thick skin- only on palms & soles
• Thick epidermis (1.5-6.5mm) distinct stratum lucidum & thick stratum corneum
• Lacks hair follicles & sebaceous glands
• Thin skin- covers most of the body
• Thin epidermis (0.1-.15mm) lacks stratum lucidum
• Lacks epidermal ridges, fewer sweat glands & sensory receptors
Function of Skin/Integumentary System

• Protects the other body systems from injury and infection:

• Mechanical damage (cuts & bruises)
• Chemical damage (acids & bases)
• Thermal damage (heat & cold)
• Ultraviolet damage (sunlight)
• Defense against microorganisms
Function of Skin/Integumentary System
• Helps the body maintain homeostasis by regulating temperature, retaining
body fluids, and eliminating wastes
• Insulates and cushions deeper organs
 Skin Color
• Pigments:
• Keratin
• Yellow to orange
• Accumulates in stratum corneum and fatty tissue of hypodermis
• Color obvious in palms and soles
 Skin Color
• Melanin
• Only pigment in the skin
• Yellow to reddish-brown to black
• Synthesis depends on enzyme in melanocytes
• Racial differences vary on amount of melanin made
• Local accumulation in freckles and moles
• Exposure to sunlight increases manufacturing of melanin to prolonged exposure
 Accessory Structures
Hair and Hair Follicles
• Skin has hair in all areas except the soles of the feet and palms of
the hands
• Composed of keratin and proteins; also dead epidermal cells
• Hair serves to block foreign particles from entering the body
through structures such as the nose and eyes
 Accessory Structures
• The visible portion is called
the shaft
• The hair follicle is the root
with its covering
• Anagen: growing follicle
• Telogen: resting follicle
 Accessory Structures
• Growth:
• Lanugo: fetal hair and lost at birth
• Puberty: coarse hair
 Accessory Structures
• Arrection PILI/Hair musles
-This is a tiny muscle that attaches to the base of a hair follicle at one
end and to dermal tissue on the other end.  In order to generate heat when
the body is cold, the arrector pili muscles contract all at once, causing the
hair to "stand up straight" on the skin.  The arrector pili muscle is a source of
information when evaluating a skin biopsy since it is well-innervated with
autonomic nerves that control when the muscle contracts.
 Accessory Structures

Nails
• Tightly packed, keratinized cells
• Nail body is pink due to
• underlying capillaries
• Free edge appears white
• Lunula is white due to
• thickened stratum basale
 Accessory Structures
• Cuticle (eponychium)
• Nail root- buried under skin layer
 Accessory Structures
• Glands
• Four types of glands in the skin (exocrine)
• Sebaceous glands (oil)
• Sudoriferous glands (sweat)
• Ceruminous glands (wax)
• Mammary (milk) glands

• Function is to help regulate the body temperature and excrete

body wastes
 Accessory Structures
• Sebaceous (Oil) glands
• Secretory in dermis- open into hair shafts
• Sebum- combination of cholesterol, proteins, fats, and salts
• Keeps hair/skin soft and pliable
• Inhibits growth of bacteria and fungi
 Sudoriferous (sweat) glands
• Apocrine (sweat) glands- secrete at hair follicle and active at puberty
• In dermis with ducts that open into hair follicles
• Axilla (underarm)
• Perianal (near the anal area)
• Areole, (nipple)
• Periumbilical (around the belly button) , External ear canal,
• Eyelids
• Also consists of ducts and secretory coils, but these glands are larger than eccrine glands and
open onto hair follicles.
• Eccrine (sweat glands)
• Most areas of the body
• In dermis with ducts to surface
• Regulates body temp w/ perspiration
*produces about 500 mL p/day
Ceruminous glands (wax)
• Modified sweat glands
• Located in auditory canal
• Cerumen- contains secretions of oil and wax glands; barrier for
entrance of foreign bodies
• Impacted cerumen may reduce hearing
 Types of skin lesion
Primary lesion
• Macule - Non-palpable lesion with distinct borders, less than 1 cm in diameter
• Patch - Non-palpable lesion with distinct borders, greater than 1 cm in diameter
• Papule – Palpable, solid lesion less than 1 cm in diameter
• Plaque – Palpable, solid lesion greater than 1 cm in diameter
• Nodule – Palpable, lesion more than 1 cm in diameter which is taller than it is wide
 Types of skin lesion
• Vesicle – Fluid-containing, superficial, thin-walled cavity less than 1 cm
• Bulla – Fluid-containing ,superficial, thin-walled cavity greater than 1 cm
• Erosion – A skin defect where there has been loss of the epidermis only
• Ulcer – A skin defect where there has been loss of the epidermis and
dermis
• Pustule – Pus containing, superficial, thin-walled cavity
• Abscess – Thick-walled cavity containing pus
Macule and patch
Papule and plaque
vesicle
Bulla and erosion
nodule
ulcer

Ulcer: A skin defect where there

has been loss of the epidermis and
dermis
Pustule and abscess
 Types of skin lesion

• Secondary lesion: changes in skin which are superimposed or are the

consequence of the primary process
• Scale - desquamating layers of stratum corneum.
• Crust- dried serum, blood or purulent exudate. Crusts are a sign of pyogenic infection.
• Lichenification - skin thickening that is the result of chronic rubbing leading to accentuation
of normal skin lines.
 Types of skin lesion
• Scar- a lesion formed as a result of dermal damage.
• Excoriation - superficial excavations of the epidermis that result from scratching.
• Fissure - a linear painful crack in the skin
• Atrophy- epidermal atrophy results from a decrease in the number of epidermal cell
layers. Dermal atrophy results from a decrease in the dermal connective tissue.
Scale and crust
Scar and excoriation
Atrophy and lichenification