This is composed of the skin and its appendages

>>> ANATOMY >>>

Skin/Integument/Cutaneous Membrane
 Largest organ (Surface area= 12-20 ft2)
 Thinnest organ (0.5 – 5 mm thick)

I. 2 MAIN LAYERS (overview)

A. EPIDERMIS- outer, thinner layer
• Composed of epithelial tissues
• Avascular
• Originated from the ectoderm

*Dermal-Epidermal Junction- area between the epidermis and the dermis

B. DERMIS- inner, thicker layer

• Composed of dense connective tissue
• Vascular
• Average thickness: 4mm
• Originated from the mesoderm

*Hypodermis/Subcutaneous layer/Superficial fascia

• Areolar and adipose tissue

II. TYPES BASED ON THICKNESS OF THE EPIDERMIS

C. Thin- covers most part of the body
• Some epidermal strata maybe absent
• Fewer cell layers/stratum

D. Thick- covers the volar parts and areas subjected to friction

• All 5 epidermal strata are present
• Each stratum is stratified
• Dermal papillae are raised to form fingerprints or footprints
• Hair is absent

III. LAYERS
E. EPIDERMIS

1. CELL TYPES
a. Keratinocytes- 90% of epidermal cells
• Filled with Keratin (tough and fibrous protein)
• Most important cells in the epidermis
b. Melanocytes- 5% of epidermal cells
• Contribute color to the skin
• Decrease the amount of UV that enters the skin
c. Langerhans cells- found in deep layers of the epidermis
• From the bone marrow
• Work with the TH cells to initiate specific immune response

2. CELL LAYERS

a. Stratum corneum (Horny layer)

• Most superficial layer
• Upper layer is composed of dead stratified squamous epithelium
• Cytoplasm of cells have been replaced with KERATIN (water-repellent protein)
• Function: blocks harmful chemicals and microbes from entering the skin

b. Stratum lucidium (Clear layer)

• Keratinocytes are closely packed and clear
• Usually, nuclei are absent
• Cells are filled with ELEIDIN (gel-like transitory product of Keratohyalin)
• Absent in thin skin
• Present in volar areas
• Function: blocks water penetration or loss

c. Stratum granulosum (Granular layer)

 • Where keratinization starts
• Composed of 2-4 layers of cells
• Cells have “keratohyalin” (precursor of keratin)
• Cells are without nucleus and degenerating
• Rich in lysosomal enzymes
• Maybe absent in thin skin

d. Stratum spinosum (Spiny layer)

• 8-10 layers of irregularly shaped cells
• Rich in RNA (needed for synthesis of KERATIN)

e. Stratum basale (Base layer)

• 1 row of columnar cells
• Regenerates the other layers

**Stratum germinativum- S. spinosum + S. basale

• only layer capable of mitosis

*DERMAL-EPIDERMAL JUNCTION
• composed of basement membrane, fibers and polysaccharide gel

FUNCTIONS:
1. Cements the epidermis to the underlying dermis
2. Provides mechanical support for the epidermis
3. Serves as a partial barrier to some cells and large molecules from the dermis
4. Prevents harmful chemicals or microbes from entering the dermis

F. DERMIS
- also called “Corium”
- “true skin”
- Structure:
o Composed of 2 layers:
 Papillary layer- thinner layer composed of loose connective tissue
 Reticular layer- thicker layer composed of dense connective tissue
o Thicker than the epidermis
 4 mm on volar parts
 0.5 mm on eyelids and penis
- Functions:
o Provides mechanical strength to the skin
o Reservoir for water and important electrolytes
o Receives stimuli from the external environment
o Regulates body temperature

i. Papillary layer
 superficial layer that projects into the epidermis
 ridges of this layer forms the creases of the fingers and toes
 unique in each individual
 Composition: loose connective tissue + network of collagen and elastin

ii. Reticular layer

 deep layer
 in animals, this layer is processed to produce leather
 composition:
• Dense connective tissue (collagen provides strength; elastin makes the skin
stretchable and elastic)
 Several structures are present in the dermis:
• Skeletal Muscle- in the skin of the face and scalp
o Permits facial expressions
• Smooth muscle
o Arrector pili/pilorum- associated with hair follicles
 Controls movement of the hair
 When it contracts, it pulls the follicle and its hair to an erect position
and it elevates the skin above to produce a “goose bump”
o Cremaster Muscle- elevates the testes upon exposure to cold temperature
o Dartos muscle- causes wrinkling of the scrotum
o Smooth muscle in the dermis of the areola- causes erection of the nipples
• Base of epidermal glands
• Hair follicle
• Blood vessels
• Nerve endings
o Free Nerve endings
 Nociceptor- primary sensory receptors for pain, heat and cold
• Secondary function: receptor for itching, tickling, touch,
movement, mechanical stretching
 Root hair plexuses- network of free nerve endings that surround the
hair follicle
 • Function: detect hair movement
 Mekel’s Disks- light/discriminative touch (subtle sensation which can
be located exactly on the skin surface)
o Encapsulated Nerve endings- primarily touch and pressure receptors
 Pacinian Corpuscles- crude touch (can recognize the sensation but
exact location is hard to determine)
• Large mechanoreceptors found in the deep dermis of the skin
(in volar areas) and joint capsules throughout the body
• Detects deep pressure, high frequency vibration and stretch

 Meissner’s corpuscle- egg-shaped mechanoreceptors

• Also called “Tactile Corpuscle”
• Primary receptor for light touch
• Numerous in hairless skin areas (nipples, fingertips, lips)
 Variants of Meissner’s Corpuscle:
• Krause’s End Bulbs
o Egg-shaped but smaller than Meissner’s
o Also called “Mucocutaneous Corpuscles”
o Primary receptor for light touch and low frequency
vibration
o Numerous in mucous membranes than in the skin
o Secondary function: “Cold Receptor” (stimulated by
temperatures lower than 18ºC)
• Ruffini’s Corpuscles- deeply located in the dermis
o Primary receptor for crude and persistent touch
o Secondary function: “Heat receptors” (stimulated by
temperatures ranging from 29-49ºC)
• Langer’s Cleavage Lines- patterns made by bundles of collagen fibers in the dermis
o Surgical incisions are made parallel to these cleavage lines so the wound wont
be subjected to too much stress

>>> PHYSIOLOGY >>>

IV. FUNCTIONS OF THE SKIN

1. PROTECTION

a. Protects underlying tissues against microbes/chemicals

b. “”” from mechanical injury
c. “”” from dehydration by preventing evaporation of internal body fluids
d. “”” unwanted entry of fluids from the external environment
e. Melanin protects us from harmful effects of UV

2. SENSATION- skin contains millions of sensory nerve endings so it functions as a sense organ

3. MOVEMENT W/O INJURY- skin is elastic so it allows contraction of muscles w/o tearing/breaking

4. EXCRETION- certain waste materials are secreted with sweat (urea, salt, ammonia, uric acid)(minor
role in overall excretion of body wastes)

5. ENDOCRINE FUNCTION- UV converts 7-dehydroxycholesterol (found in skin cells) to

cholecalciferol

i. cholecalciferol is then transported in the blood to the liver and kidney where it is converted to
Calciferol (promotes Ca absorption, dev. Of bones and teeth)
ii. *Dark skinned people produce less Vit. D

6. IMMUNITY- langerhans cells act as macrophages of the skin

7. TEMPERATURE REGULATION
I. body must maintain a constant temp. range
II. vital processes depend on normal enzyme functioning
III. enzymes can be easily denatured by heat
IV. to maintain an even temperature, the amount of heat production = amount of heat loss
V. If heat production > heat loss, body temp increases above normal (36.2º C, early morning –
37.5º C, late afternoon)
VI. Skin plays a critical role in heat loss by the ff. processes:

i. Evaporation- heat energy is spent by evaporating body water

 ii. Humidity prevents evaporation and therefore lessens the cooling effect derived from
it
iii. Radiation- transfer of heat from one surface to another w/o actual contact between
the two objects
• Heat radiates from the skin to nearby objects that are cooler than the skin
• Heat radiates from hot objects to the skin
iv. Conduction- transfer of heat to any substance in contact with the body (Ex. Clothing,
jewelry, ingested food or liquid)
v. Convection- transfer of heat away from a heated surface by movement of air or fluid
particles

V. SKIN COLOR
vi. MELANIN
- skin color variations are primarily caused by different amounts of melanin produced by the melanocytes
(Note: number of melanocytes in all races are equal)
- Melanocytes are the only cells that convert tyrosine into melanin (dark-brown pigment) with the help of the
enzyme Tyrosinase
- Conversion Depends on:
1. Genes- 4-6 pairs of genes control melanin production
o if tyrosinase is absent from birth, melanocytes cannot form melanin (w/c would lead to albinism,
characterized by absence of pigment in hair, skin, eyes)
2. Sunlight- stimulates melanocytes to produce more melanin
o facilitates melanin production
3. ACTH (Adrenocorticotropic hormone)- secreted by the adenohypophysis (anterior pituitary gland)
o too much secretion will darken the skin
4. Age- in older persons, tyrosinase production is decreased (results in graying hair)

vii. CAROTENE- yellow pigment that also contributes color to the skin

viii. BLOOD
o change in blood volume in skin capillaries can also influence skin color
o change is temporary
o change is more evident in individuals with less melanin
o Ex:
 If blood vessels constrict (frightened state), blood volume decreases; skin may turn pale
 If blood vessels dilate (when blushing), blood volume increases; skin may turn pinker/redder
 Cyanosis- in an abnormal condition (during trauma, accidents, extreme injury); the amount of
deoxygenated blood increases so skin turns blue/grayish

VI. APPENDAGES OF THE SKIN

I. HAIR
- Only a few areas of the skin are hairless (volar, lips, nipples, some areas of the genitalia)
- 3 mo fetal life, follicles begin to develop
- 6 mo fetal life, fetus is covered with lanugo (L. lana= fine wool; extremely fine and soft)
- Before birth, most lanugo hair is lost
- 5-6 mo, any lanugo hair that remains is lost and replaced by vellus (stronger hair)
- Vellus appears on the scalp, eyebrows, eyelids)
- Puberty, terminal hair develops (coarser)
- In males- 80-90% of vellus on chest and extremities is replaced with terminal hair, terminal hair
forms the beard
- In females- Less vellus is replaced with terminal hair except in the pubic and axillary areas

A. STRUCTURE
1. Follicle wall- with 2 layers
a. Dermal Root sheath
b. Epithelial Root sheath
i. External Epithelial Root sheath
ii. Internal Epithelial Root sheath
2. Germinal matrix- cap-shaped cluster of cells at the bottom of the follicle
a. responsible for forming hair
3. Papilla- part of the dermis
a. Contains blood vessels that nourishes the germinal matrix
4. Shaft- visible part
5. Root- hidden in the follicle
6. Medulla- inner core of the hair
 7. Cortex- superficial portion
8. Cuticle- covering layer
9. Sebaceous glands- secrete sebum into each hair follicle
a. Functions:
i. Lubricate hair
ii. Keep it from becoming dry and brittle

B. HAIR COLOR
- Cortex is composed of stratified keratinized cells
- Hair color is due to varying amounts of melanin deposited in these keratinized cells (high
amount=black; moderate=brown; low=blond)
- Unique type of melanin containing Fe is responsible for red hair
- White hair- results from a decrease in melanin content
*Melanin makes the hair stronger

C. STRAIGHT or CURLY HAIR

- depends on the shape of the follicle opening
1. Straight- round
2. Wavy- oval
3. Curly- spiral

HAIR GROWTH, LOSS AND REPLACEMENT

- We are constantly shedding and replacing our hair
- Hair is shed when its growth is complete
1. Scalp hair- 0.4 mm/day for 3-5 yrs
2. Eyebrows- 1-3 mo
- After a short period of rest (3-4 mo), the root produces a new hair
- Each hair has its own life cycle so no area sheds all of its old hair at the same time

- Hair grows faster:

1. at night
2. in warm weather
3. in young persons (16-24yo)
4. black hair grows faster than blond
* Frequent cutting or shaving does not stimulate hair growth

- Life span
1. Scalp hair- 3-5 years
2. Eyebrow and eyelash- 10 wks
- Average scalp contains 125,000 hairs
- On the average we lose 50-100 hairs/day

- Patterned Baldness= genes + high amount of testosterone

- Baldness caused by disease, stress, malnutrition etc.

II. NAILS
- Composed of heavily keratinized epidermal cells

A. STRUCTURE
1. Nail body- visible part, cornified dead cells
2. Root- lies in a groove hidden by the cuticle
3. Lunula (Little Moon)- crescent shaped white area near the root
4. Nail bed- under the nail body
a. Contains abundant blood vessels so it appeared pink
5. Eponychium- cuticle; at the base of the nail

B. NAIL GROWTH
- Nail grows by mitosis of cells in the S. germinativum beneath the nail root and lunula
- 0.5 mm/wk
- Fingernails grow faster than toenails
- Nails grow faster in the summer than in the winter

NAIL DISEASE
- Onycholysis- caused by minor trauma to long nails
- separation of the nail from the NAIL BED starting at the distal end of the affected nail

III. SKIN GLANDS

A. SWEAT or SUDORIFEROUS- most numerous of the skin glands
1. Eccrine/Merocrine
a. Most numerous, important sweat glands
b. Distributed over the total body surface except the lips, ear canal, nail beds,
glans penis
c. Simple, coiled, tubular
d. Base is in the hypodermis
e. Sweat rich in salts, ammonia, urea, uric acid etc.
 f. 1 in2 of the palm= 3,000 sweat glands
g. Numerous on soles of the feet, forehead, upper torso
2. Apocrine
a. located deep in the hypodermis of the armpit, areola, pigmented areas around
the anus
b. Simple, branched, tubular
c. Larger than ECCRINE
d. Connected with hair follicles
e. Secretion is more viscous and colored than ECCRINE
f. Becomes functional at puberty
g. Odor assoc. with apocrine is caused by contamination with skin bacteria
h. In women- secretions is connected to the menstrual cycle
B. SEBACEOUS
- Assoc w/ hair follicles (2/hair)
- Functions of Sebum:
1. Keeps the hair and skin soft
2. Prevents excessive water loss
3. Have antifungal properties
- simple branched alveolar
- found in the dermis of body surface except in volar parts
- some directly open on the skin surface of glans penis, eyelids, lips
C. CERUMINOUS
- Modified APOCRINE sweat glands
- Simple, coiled, tubular
- Ducts open onto the :
1. free surface of the skin in the external ear canal
2. necks of hair follicles in the external ear canal
- Cerumen= mixes secretions of oil and ceruminous (brown and waxy)

VII. PHYSIOLOGICAL AND ANATOMICAL ABNORMALITIES

I. BURN
- thermal injury caused by:
a. contact of the skin with some hot object of fire
b. overexposure to UV
c. contact with an electric current or corrosive chemicals
- depth of a burn injury depends on the tissue layers of the skin that are involved

- Classification of Burns

Type of Burn Surface area Depth of tissue Major effects

Affected damage
Partial-Thickness
Burn
1. Minor (1st Degree), < 10% of body Epidermis is damaged -mild swelling
typical sunburn surface but not destroyed -reddening
-minor discomfort
-injured layer peels
off
-heals w/o scarring (2
wks)
2. Serious (2nd >15% for an Adult Epidermis and Part of -reddening
Degree) 10% for a Child the Dermis is -edema
destroyed -blisters
-new skin may -swelling
regenerate -greater pain than 3rd
degree burn
Full-Thickness Burn
3. Severe (3rd >20% of body All skin layers White or charred
Degree) surface, burns of destroyed appearance
face, eyes, hands, -May involved -insensitive to pain
feet, genitals underlying fascia, immediately after
muscles, bone injury bec. Of the
-Skin cannot be destruction of nerve
regenerated endings
-scarring is a serious
problem (surgery and
skin grafts needed)
II. LESIONS
NAME EXAMPLE DESCRIPTION
1. Bleb, bulla 2nd Degree burn Fluid-filled elevation of the
skin
2. Macule Freckle, flat pigmented mole Discolored spot, neither
elevated or sunken
3. Papule Acne, measles Raised, small pimples
4. Pustule Acne vulgaris, small pox Raised, pus-filled pimple
5. Vesicle Blister Small sac filled with serous
Chicken pox, herpes simplex fluid
6. Wheal Mosquito bite Local swelling, itching
Hives

III. SOME COMMON SKIN DISORDERS

A. Acne vulgaris (common acne)
- most common among teenagers (high hormone levels; high oil production)
- oil clogs a follicle
- Clogs are called either whiteheads or blackheads
a. Closed Comedones (whiteheads)- do not protrude, covered by the epidermis
b. Open Comedones (blackheads)- protrude from the follicle, not covered by the
epidermis
- blocked follicle may become infected with bacteria
- bacteria converts sebum into free fatty acids
- acids irritate the follicle lining
- eventually, follicle will burst
a. when acid and sebum seep into the dermis, they will cause inflammation
b. appears as pus-filled pimple
- scratching will spread the infection
- appears mostly on the face, chest, upper back, shoulders
- more severe in teenage males bec. of testosterone
B. Bedsores/Decubitus Ulcers- common in bed-ridden patients
- weight of the body causes poor circulation
- may 1st appear as red spots which may become purplish (indicates that blood vessels are
being blocked)
- Skin may break (lack of nutrients and oxygen will eventually kill the tissue)
- If left untreated, 2nd bacterial infection is common
- Sol:
a. Maintain cleanliness and dryness of surroundings
b. Change the position of the patient frequently (promote blood circulation)
C. Birthmarks (Vascular Nevus)
1. Nevus flammeus (“Port-wine Stain”)
- Pink to bluish-red lesion
- Cause is unknown
2. Hemangioma (“Strawberry Mark”)
- Affects the superficial blood vessels
- Usually present at birth but may also appear anytime after birth
- May grow slowly
- May become smaller
- May disappear as the individual grows older

D. Mole (Nevus)
- in most cases, is a benign lesion that usually appears before the age of 5 or 6
- May appear anytime up to about 30 yrs of age
- Moles that darkens, enlarge, bleed or appear after the person is 30 should be checked (it
maybe transformed into a cancerous growth)
- Inherited

E. Psoriasis
- inherited
- attacks can be brought on by pregnancy, hormonal changes, emotional stress, cold weather,
trauma (PHECT)
- Physiology
a. Occurs when basal cells move to the S. corneum before they mature (4 days instead
of the usual 28)
b. S. corneum becomes flaky, lesions are red, dry, elevated, covered with scaly patches
- Usual sites: elbows, knees, scalp, face, face, lower back

F. Allergic responses
- allergens may sip through the skin or maybe inhaled
- will trigger plasma cells to produce antibodies against the allergen
- Antibodies will trigger mast cells to produce histamine w/c would initiate the inflammatory
response

G. Warts (Verrucae)
 - caused by papilloma viruses
- usually not pigmented except for plantar warts (yellowish)
- contagious
- usually disappear after a year
- maybe removed through surgery

H. Bruises
- hard blow to the surface of the skin may break underlying capillaries
- releases blood to the dermis
- black and blue color is because skin reflects blue light and absorbs other colors
- may turn green/yellow after several days (indicates that spilled blood begun to decompose,
hemoglobin decays to hemosiderin {yellowish})

I. WOUND HEALING
- can take from 1 week to a month depending on the severity of the cut
- Epidermis- when the epidermis is damaged, basal cells quickly divide to form daughter cells that fill
the wound
- Dermis- when the dermis is cut, fibroblasts become active and fill in the gap w/ a dense mass of
collagen fibers
i. If the mass is small, it may be eventually replaced by normal tissue
ii. If the mass is deep, or if cell damage is extensive, it may remain as a dense fibrous mass
called a SCAR
iii. An unusually thick scar that develops in the deep part of the dermis is called a keloid
II. BLISTER FORMATION
- when skin is burned or irritated, blood vessels in the dermis widen and plasma leaks out
- plasma accumulates in the dermal-epidermal region in a fluid-filled pocket of blister

III. WRINKLES
- Wrinkles are produced when ELASTIN loses its stretchability and degenerates into ELACIN
- This causes the dermis to become more closely bound to the muscle tissue
- The layer beneath the skin shrinks causing the skin to sag into wrinkles
- Exposure to UV facilitates the wrinkling process (UV causes the fibers to degenerate)