Dermatology

Skin and Integumentary System

Skin and the Integumentary System Composed of several tissues Maintains homeostasis Protective covering Retards water loss Regulates body temperature Houses sensory receptors Contains immune system cells Synthesizes chemicals, including Vitamin D Excretes small amounts of waste Layers of Skin 1. Epidermis - stratum basale - keratinocytes = 90% epidermal cells - melanocytes = 8% epidermal cells - subdivided into layers of stratified squamous epithelium - lacks blood vessels - keratinized - thickest on palms and soles (0.8 1.4 mm) - melanocytes provide melanin - rests on basement membrane Epidermal Differentiation - Increase in cell size and shape - Appearance of new cellular organelles - Change from a generalized cellular metabolism to a more focused metabolism - Alteration in the properties of the plasma membrane cell surface antigen and receptor - Dehydration of cellular organelles - Terminally diff keratinocyte (keratin filaments, matrix proteins, protein reinforced membrane with surface associated lipids Nonkeratinocyte in epidermis Melanocyte pigment producing cell Merkel cell mechanoreceptor Langerhans cell Melanocyte - Dendritic pigment synthesizing cell derived from the neural crest - HISTO: pale staining cytoplasm with ovoid nucleus and the intrinsic color of pigment containing melanosomes - (+) vimectin, (-) keratin filaments

Divides at a rate keeping pace with keratinocyte turnover - EPIDERMAL MELANIN UNIT (36 basal and suprabasal keratinocyte coexist with one melanocyte) Merkel cell - slow adapting type 1 mechanoreceptor - located in sites of high tactile sensitivity e.g. digits - nonkeratinocyte located at the basal layer of the epidermis - HISTO: pale staining cytoplasm, nucleus is lobulated and margins of cell project cytoplasmic spines toward keratinocytes - Sites: hairy and glaborous skin of digits, lips, regions of the oral cavity, outer root sheath of hair follicle Langerhans cell - nonkeratinocyte distributed in basal, spinous and granular layers with preference for the suprabasal position - HISTO: pale staining and have convoluted nuclei - Electron microscopy: with dispersed vimectin filaments and small rod or racket shaped structures called birbeck granules - Responsible for recognition, uptake, processing and presentation of soluble antigens and haptens to sensitized T lymphocytes *Basement membrane - is anchored to the dermis by short fibrils and separates these two layers of skin 2. Dermis - made up of connective tissue, epithelial tissue, smooth muscle tissue, nervous tissue, and blood - on average 1.0 2.0 mm thick - dermal papillae - binds epidermis to underlying tissues - irregular dense connective tissue - muscle cells - nerve cell processes - blood vessels - hair follicles - glands -

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Dermatology Skin and Integumentary System

a. Papillary region i. superficial dermis with papillae ii. areolar connective tissue b. Reticular region i. deeper four/fifths of dermis ii. dense irregular connective tissue iii. collagen and elastic fibers iv. contains: blood vessels, nerves, glands and hair follicles

Sweat or Sudoriferous Glands widespread in skin deeper dermis or hypodermis eccrine glands types of merocrine gland that secrete fluid (sweat) product released through the cell membrane aprocrine sweat, ceruminous (wax), and mammary (milk) glands types of apocrine glands that secrete cellular product and portion of the free ands of cells Sebaceous Glands usually associated with hair follicles holocrine glands disintegrating cell and its contents for the secretion secrete sebum absent on palms and soles Hair Follicles epidermal cells tube-like depression extends into dermis hair root hair shaft hair papilla dead epidermal cells melanin arrector pili muscle Hair cycle o Anagen growing phase 80-90% of scalp hair, 3-4 years in human scalp o Telogen phase resting phase Average of 3 months o Catagen phase transitory phase Clubhair, average of 3 weeks

3 segments o infundibular portion o isthmus o inferior or matrix 3. Subcutaneous layer Hypodermis Loose connective tissue Adipose tissue Insulates Major blood vessels Skin Color Genetic Factors Varying amounts of melanin Varying size of melanin granules Albinos lack melanin Physiological Factors Dilation of dermal blood vessels Constriction of dermal blood vessels Carotene Jaundice Environmental Factors Sunlight UV light from sunlamps X-rays Mechanics of pigment transfer Fusion and breakdown of plasma membrane of both melanocyte and keratinocyte establishing a communication between the cells Phagocytosis of melanosomes containing the dendritic processes by the keratinocyte called apoptosis *All people have the same number of melanocytes in their skin 2 types of melanin Eumelanin brown or black color, elliptical in shape Pheomelanin red or yellow. With less regular shape *size of melanosomes in black skin are larger than in light skin individuals

kirstie

Dermatology Skin and Integumentary System

Nails Protective coverings Nail plate Nail bed Lunula Life Span Changes Scaly skin Age spots Dermis becomes reduced Loss of fat Wrinkles Sagging Sebaceous glands secret less oil Melanin production slows Hair thins Number of hair follicles decrease Impaired nail growth Sensory receptors decline Inability to control body temperature Less vitamin D production Skin Problems Hair follicle o Alopecia areata, telogen effluvium, androgenetic alopecia Sebaceous gland o Acne vulgaris, sebaceous cyst, steatocystoma multiplex Apocrine gland o Hidradenitis suppurative, Fox fordyces disease Sweat gland o Hyperhidrosis, bromhidrosis, anhidrosis, chromhidrosis o Syringoma Keratinocyte o Psoriasis Melanocyte o Vitiligo, Albinism, Postinflammatory hyper/hypopigmentation

Clinical Application Acne Vulgaris Most common skin disorder Sebum and epithelial cells clog glands Produces whiteheads and blackheads (comedones) Anaerobic bacteria trigger inflammation (pimple) Largely hormonally induced Androgens stimulate sebum production Treatments include antibiotics, topical creams, birth control pills *please refer to the slides for the pictures Asteatotic eczema Sebaceous hyperplasia Psoriasis Chronic Bullous disease in children (epidermo dermal junction) Vitiligo Generalized type Postinflam hypopigmentation (melanocytes) Pigmentary problems (melanocytes) Melasma (melanocytes) Syringoma (eccrine glands) Steatocytoma multiplex (sebaceous glands) Fox fordyces disease (apocrine glands) Alopecia areata (hair follicle) Androgenic alopecia (hair follicle) Female androgenic alopecia Onycholysis in Psoriasis Onychomycosis Xeroderma Pigmentosum extreme freckling and skin cancer due to lack of DNA repair enzymes Squamous and basal cell carcinoma derived from epithelial tissue Malignant melanoma derived from melanocytes

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