THE SKIN AND ITS APPENDAGES

The skin is the largest organ of the body which

covers the entire surface of the body thus serving
as:
A protective barrier from the external
environment of the body.
It is composed of two types of tissue, an outer
Epidermis of stratified squamous epithelium
(Ectodermal in origin) This is firmly connected
to an inner dense connective Tissue called
Dermis (Mesodermal in origin)

 Separation of the epidermis from the dermis

usually
results in a blister (Bullous
Pemphigoid).
Immediately beneath the dermis is a layer
(pad) of adipose tissue (Subcutaneous
tissue or Hypodermis)
This Layer attaches the skin to the deeper
structures of the body and serves as a layer
of shock absorber and insulator to deeper
structures of the body.

Functions of the Skin

1. Protection: This is in the form of:
Physical barrier against thermal and
mechanical assaults
Prevention of bacterial invasion
Protection against ultraviolet radiation
through melanin pigments
Prevention of water loss (Dehydration) or
water intake
2. Sensory reception utilizing the receptors
lodged in the skin.
3. Thermoregulation

4. Synthesis of Vitamin D required for

calcium metabolism
5. Excretion of electrolytes
6. Storage of energy in the form of Lipids in
the hypodermis
7. Sexual signaling by:

The synthesis and secretion of pheromones

by the Apocrine sweat glands and
The appearance of the skin and hair which
attracts the opposite sex

8. Personal identification through finger

prints patterns formed by the dermal
papillae

The Epidermis:
The epidermis is composed of several
layers of squamous cells most of which
are filled with the water-repellent, tough,
fibrous protein called Keratin.
In view of their principal content of
keratin these squamous cells are called
Keratinocytes.
Furthermore, the squamous cells of the
epidermis are organized into zones/layers
otherwise called strata. From without
inwards the strata include:

Stratum Corneum:
This is composed of dead keratinocytes
completely filled with keratin (15-20).
Stratum Lucidium:
This layer is also composed of dead keratinfilled squamous cells.
This layer is also encountered only in areas
where the skin is very thick and hairless
(Glabrous Skin) such as the palm of the
hand and sole of the foot (1-2).

Stratum Granulosum:
It lies deep to the Lucidium and is
composed of living keratin-filled
squamous cells (3-5)
Stratum Spinosum:
This is composed of living keratinocytes
with fewer keratins than the outer layers.
It is the thickest epidermal layer and its
deeper layer is involved in mitosis to
replenish keratinocytes.
This layer also contains Langerhans cells
which are implicated in the processing of
antigenic materials (over 30 layers).

Stratum Basale (Germinativum)- [1 layer]:

This is the innermost layer of the epidermis
which is made up of living cells which are
capable of differentiating to keratinocytes
and other derivatives of the epidermis.
It is the growing layer of the skin hence the
name stratum germinativum.
All the appendages of the skin are derived
from this layer which also contains several
melanocytes which synthesis melanin
pigments which impacts colour
(Yellow/Brown/Black) on the skin.

Merkel Tactile receptor cells are also located

in this layer.
Cells of the stratum spinosum and basale
continuously ingest melanin pigments to
obtain protection from the sun.

CLINICAL CORRELATES
Melanin is produced by melanocytes.
Melanocytes are derived from neural crest
tissue of the developing neural tube.
They have dendritic processes where melanin
pigment accumulate and are ingested by
keratinocytes for protection of their nuclei
against solar radiation
Excessive exposure of melanocytes to the sun
results in tanning due to excessive production
of melanin.
Excessive local aggregation of melanin in the
skin results in Freckles and Moles.

 Malignancies of the skin in adults

commonly involve the stratum basale
Basal cell carcinoma implicates the
stratum basale while
Squamous cell carcinoma implicates
the stratum spinosum
Incidence of skin carcinoma increases
in light-skinned people residing in
areas with high amount of solar
radiation.

 Malignant
melanoma
involves
the
melanocytes
in
areas
of
hyperpigmentation and moles.
Merkel cell Carcinoma: This is rare but
very aggressive when it occurs
Psoriasis, is a common benign skin
lesion characterized by:
Rapid mitosis of cells in the two growing
layers leading to
Epidermal thickening and abnormal
keratinization leading to:
Defective skin barrier.


1.
2.
3.

4.

Skin Color:
Skin color is determined by 4 factors
The quantity of melanin pigments and the
color of the pigments
The amount of oxygenated blood in the
dermal vessels
The amount of Carotene pigment (Orangeyellow in color) which is derived from
carrot, green vegetable and orange.
The emotional status of the individual.

The Dermis:
The dermis is the strong, stretchy dense layer of
connective tissue which attaches the skin to the
body.
It is quite thick in the palm and the sole of the
foot but thin in thin-skinned areas such as the
eyelids and ear lobule.
It is composed of two structurally different parts:
1. An outer papillary layer which sends finger-like
projections into the basal part of the epidermis
and is responsible for finger print patterns.
This part is also composed of loose connective
tissue, blood vessels, nerve fibres and sensory
receptors.

A well developed basal lamina and a

reticular lamina occur between the dermal
papillary layer and the stratum basale of
the epidermis.
The union of basal lamina of the epidermis
and reticular lamina of the dermis forms a
special Basement membrane of the skin
This arrangement permit diffusion of
nutrients from the vascular dermis to the
avascular epidermis

2. An inner reticular layer of dense irregular

connective tissue which forms the deepest
layer of the skin and contains blood
vessels and several appendages of the skin
such as:
Special pressure receptors (Pacinian
corpuscle),
Sweat glands,
Oil glands
Hair and
Phagocytes.

 Both layers of the dermis also contain

large stores of elastic and collagen fibres
which impact elasticity and strength on
the entire skin.
The dermis is thus responsible for the
elasticity of the skin
Collagen fibres of the dermis also help to
keep the skin hydrated.
The dermis is also partly responsible for
the
ability
of
the
skin
to
regulate/maintain body temperature.

Appendages of the Skin:

1.
Hair:
Hair is an outgrowth of the stratum basale of
the epidermis.
The outer part of the hair which appears on
the skin surface is referred to as the hair
shaft while the inner part of it
accommodated by the hair follicle is
referred to as the hair root.
At the base of the follicle, the hair root is
indented by dermal papilla called hair
papilla which contains the blood vessels
that nourish the hair.

From within outwards, the hair root is made up of

the following layers (see diagram):
Medulla
(M)
Cortex
(CO)
Cuticle
(CU)
Internal Root Sheath
(IRS)
External Root Sheath
(ERS)
Glassy Membrane.
(GM)
Connective Tissue Sheath
(CTS)
The bulk of the hair is made up of dead
keratinized cells. It is also pigmented by
melanocytes which impose a color on the hair
Ranging from pale blond to pitch black

 Hair is present all over the body surface

with the exception of:
The soles of the feet
The palms of the hands
The lips
The nipples of the breast.
Glans penis
Clitoris
Labial minora

 Hair follicles normally assume a slanting

position.
They are brought to an erect position by the
arrector pilli muscles which attach them to
the papillary layer of the dermis.
This process is implicated in the control of
temperature by the skin.

Oil (Sebaceous) Gland:

This is epidermal in origin and a derivative of the

stratum basale.
It is associated with the hair follicle into which it
empties its secretions.
Sebaceous gland secretes Sebum which
lubricates and softens the skin as well as keeps
the hair soft.
Sebum also has antibacterial and antifungal
property.
Sebaceous glands are very active in the
adolescent period of growth.
They are found all over the skin except in the
palms of the hands and the soles of the feet.

CLINICAL CORRELATES
When the secretory pores are blocked, the
glands are swollen to form Whiteheads.
Oxidation of sebum in whitehead by bacterial
activities results in Blackheads.
Infection of the glands leads to Acne which is
accompanied by Pimples.
Overactive sebaceous glands in infants results
in Seborrhea.

In the areola of the nipples, eyelids, labial

minora, lips and cheek, sebaceous
glands drain directly unto the skin.

Sweat (Sudoriferous) Gland:

Sweat glands are epidermal derivatives which are
lodged in the dermis.
The skin posesses an enormous quantity of sweat
glands widely distributed all over it.
An individual may have as many as 3 million
glands which produce up to 10 litres of sweat per
day.
Sweat glands are connected to the skin surface by
sweat ducts which empty their secretions onto the
surface through the sweat pores.
The secretory portion sweat gland is surrounded
by Myoepithelial cells whose contraction facilitate
the secretion of sweat.

Two types of sweat glands are encounted in the

skin,these are:
Eccrine glands which secrete colorless sweat
containing:

Water,
Sodium chloride,
Vitamin C,
Ammonia,
Uric acid and
Lactic acid (Lactic acid attracts mosquitoes to the skin).

Eccrine secretion is involved in prevention

of bacterial attack on the skin because of its
acidic nature.
It is also implicated in thermoregulation.

Apocrine glands:
These are fewer in number and restricted to the
axillary region and the genital areas of the
body.
They are much larger than Eccrine glands and
empty their secretions into the hair follicle.
The contents of their secretions include all
those listed for the Eccrine gland plus proteins
and fatty acids.
Apocrine glands secretion is milky and
yellowish in color.

CLINICAL CORRELATES
Body odor in some individuals is the result
of bacterial attack of the proteins and fatty
acid contents of Apocrine gland secretion.
Furthermore, the activities of Apocrine
glands are increased by:
Pain,
Stress and
Sexual activities.

Nails:
These are scale-like epidermal derivatives of
the skin, which are made up of dead
keratinized cells and cover the dorsal aspect
of the distal ends of the toes and fingers.
Each nail consists of a free edge, body and
root.
The body and root are supported by the nail
bed.
Nail grows from the part of the stratum
basale called nail matrix (See diagram).

The Hypodermis
Also called Subcutaneous or Superficial fascia, it
is a layer of Adipocytes (Fat cells).
Its thickness varies from one region of the skin to
another and is dependent on the nutritional status
of the individual.
It is highly vascularised and hence facilitates the
absorption of drugs injected into it.
It is actively involved in the regulation of body
temperature.
It also cushions off pressure brought to bear on
the skin.

BLOOD SUPPLY OF THE SKIN

The skin receives its blood supply from
two arterial plexuses, one in the
hypodermis and the other at the junction of
the two parts of the dermis (Mid-dermal
region). Both plexuses are fed by blood
from large blood vessels in the
hypodermis.
Furthermore, both plexuses are connected
by arteriovenous shunts, a structure
actively involved in thermoregulation

CLINICAL CORRELATES
Burns
This is the most threatening lesion of
the skin characterized by tissue
damage and cell loss from:
Intense heat of hot water or naked
flame
Electricity
UV radiation (Sunburns) and
Chemicals such as acids.

The consequences of burns to the body

are quite enormous and include:
1. Loss of body fluids and electrolytes
leading
to
dehydration
and
hypovolaemic shock
2. Altered body metabolism
3. Impaired immune system
4. Impaired renal function
5. Death from the above complications.

Classification of Burns:
Burns is classified on the bases of the extent of
the layers of skin affected:
First-Degree Burns: In first-degree burns only the
epidermis is damaged. This is characterized by
redness, swelling and short-lived discomfort/pain.
Second-Degree Burns: In second-degree burns
the epidermis as well as the upper aspect of the
dermis is damaged. This is characterized by
redness, swelling, appearance of blisters, and
more prolonged pain.
25% of this type of burns is dangerous and calls
for emergency attention.

Third-Degree Burns:
This is also described as Full-thickness
burns because the entire thickness of the
skin is affected i.e. Epidermis and Dermis.
It is characterized by blackening of the burnt
area and absence of pain due to nerve
damage.
Skin grafting will be required for treatment.
Furthermore, 10% of this lesion or
3rd degree burns of the face, hands and feet
calls for emergency attention.

Fluid Loss in Burns:

Fluid loss is the greatest threat to life in burns.
Fluid replacement therapy must be initiated to
save the patients life.
The formula for calculating fluid loss in burns is
referred to as The rule of Nines.
Fluid loss is calculated in percentage of body
surface.
The body surface is thus subdivided into 11 parts
each part accounting for 9% of the entire body
surface. By this calculation the 11 parts account
for 99% of total body surface. The remaining 1% is
assigned to the Perineum. The 11 parts are
distributed as shown in the diagram
(See diagram)

 Basal Lamina/Basement Membrane

Both structures are connective tissue
condensation found at the interphase
between the epithelium and connective
tissue.
Features/Composition of Basal Lamina:
It is only visible under the electron
microscope
It is about 20-100 nm thick
It is made up of an electron dense lamina
densa and an electron-lucent lamina rara on
one or both sides of the lamina densa

Other Features include:

Type IV collagen
Proteoglycan (Perlecan)
Glycoprotein (Laminin and Entactin)
Anchoring fibril made up of Collagen type
VII
Reticular fibres formed by the adjourning
connective tissue

Functions of Basal Lamina

Epithelial cell support
Epithelial cell differentiation and
proliferation
Serve as pathway for cell migration
Regulation of macromolecular exchange
between epithelium and connective tissue
Facilitation of cell metabolism

BASEMENT MEMBRANE:
The basement membrane is a double
layered, PAS-positive structure found at the
interphase between the connective tissue
and other body tissues.
Unlike the basal lamina, it is visible under
the light microscope.
The two layers could be two fused layers of
basal lamina or a fusion of a basal lamina
and a reticular lamina.

 The basement membrane is usually found in

areas where there is no intervening
connective tissue between two epithelial
tissues.
Examples of such areas include:
Pulmonary Alveoli
Renal tubules
Renal glomeruli
The functions of the basement membrane
are identical to those of the Basal Lamina