Anatomy of Skin and

Basic Skin Lesions

Layers of Skin
Epidermis

- stratum basale
- stratum spinosum
- stratum granulosum

- stratum corneum
Dermis
- papillary dermis
- reticular dermis
Subcutaneous Fat

Types of Cells in Epidermis

Keratinocyte
Melanocyte
Langerhans
Merkel

cell

cell

Strata of Epidermis
Stratum

basale: Cuboidal / columnar cells;

large oval nuclei, dense basophilic cytoplasm

Stratum

spinosum (spinous/prickle cell layer):

Polygonal cells with delicate processes,
desmosomes connect adjacent keratinocytes

Stratum granulosum: Flattened diamond

shaped cells filled with coarse basophilic
keratohyaline granules

Strata of Epidermis
Stratum

lucidum :
Clear layer found in palms and soles

Stratum

corneum :
Flat, anuclear, eosinophilic corneocytes
Dead layer shed during epidermal turnover
Epidermal turnover/ transit time:
Time taken for a cell to pass from basal layer
to surface of skin.
52-75 days (normal skin)

Melanocyte
Neural

crest derived cells

Dendritic cells that synthesize and secrete
melanin containing organelles called
melanosomes
Located in basal layer; 1:10 ratio
Epidermal Melanin Unit: A single melanocyte
supplies melanosomes to 36 keratinocytes(1:36)
Melanosomes

vary in number and size

according to skin type

Melanocyte
Melanin

formed through mediation of tyrosinase

and DOPA
Function of melanin
- Impart colour to skin and hair
- Protect the skin from UV radiation
- Biochemical neutralizer of toxic, free radical
oxygen derivatives

Langerhans cell and Merkel cell

Langerhans

cell
- Type of macrophage
- Role in various immune processes like allergic
contact dermatitis, immune tolerance,
surveillance against neoplasia
Merkel

cell
- Neuritic cells
- Touch receptors
- Detect mechanical deformities of epidermis

Functions of Epidermis
Cornification
Barrier

function
Permeability
Maintenance of fluid and electrolyte balance
Thermoregulation
Pigmentation
Immune function
Sensory receptor
Vitamin D Synthesis

Dermis
Papillary
Reticular

dermis - thin zone beneath epidermis

dermis - thick zone which extends

from base of papillary dermis to the surface of
subcutaneous fat

Structure of dermis
Non-cellular

connective tissue
Constituted of collagen, elastic fibers and
ground substance (mucopolysaccharides,
chondroitin sulphate, glycoproteins)
Embedded nerves, blood vessels, lymph
vessels, muscles and pilo sebaceous, apocrine
and eccrine units
Cellular contents include fibroblasts, mast cells,
histiocytes, Langerhans cells, lymphocytes and
eosinophils

Variation of thickness of skin

Difference

of thickness of the skin is dependent

largely on dermal thickness, with the palms and
soles being thickest (1.5 mm) and thinnest in
the eyelids and post-auricular region (0.05
mm).
Children and elderly have thinner skin than
adults
Males have thicker skin than females

Dermo-Epidermal Junction
Consists

of
- Basal lamina
- Lamina lucida
- Lamina densa
- Anchoring filaments
- Anchoring fibrils
- Dermal microfibril bundles

Functions of Dermo-Epidermal junction

Attachment

of dermis to epidermis
Support to epidermis
Regulation of permeability
Autoantibodies to proteins in the dermoepidermal junction may be responsible
for vesiculobullous disorders

Embryology of skin
All constituents derived from ectoderm and
mesoderm
Ectoderm and mesoderm begin to proliferate and
differentiate at 4th week of intrauterine life
The specialised structures of skin, teeth, hair,
nails and glands begin to appear at this time

Epidermal Appendages
Hair

follicles

Sebaceous
Apocrine
Eccrine

glands

glands

glands

Hair
Types

- Lanugo
- Vellus
- Terminal

Sites of hair follicles

Found over the entire surface of the body except
palms, soles, glans penis, clitoris, labia minora,
mucocutaneous junction and distal portions of the
fingers and toes

Anatomy of hair
Longitudinal section
Infundibulum
Isthmus
Stem
Bulb

Cross section
Outer sheath
Inner sheath
- Henles layer
- Huxleys layer
- Cuticle
Cortex
Medulla

Phases of hair growth

Hair cycle consists of three phases:
Anagen

: Growing phase lasts for 2-10 years.

About 90% of hair are in anagen at a time.

Catagen

: Involution phase lasts for 1-3 weeks.

About 1% hair are in catagen.

Telogen

: Resting phase lasts for about three

months. About 10% hair are in telogen.

Telogen

hair is shed and anagen hair replaces it.

Sebaceous Glands
Lipid

producing holocrine glands

Arise

from the hair follicle at the junction of the

infundibulum and the isthmus

Distributed

all over the body except the palms

and soles; most numerous , large and

productive over the face and scalp
Mature

at puberty and are stimulated by various

hormones

Sebaceous Glands
Consists

of lobules of epithelial cells that

differentiate toward lipid producing cells in a

centripetal manner
Enlarged,

vacuolated cells in the center of the

lobule disintegrate into an amorphous mass sebum

Major

components of sebum: Triglycerides, wax

esters, squalene, cholesterol esters and

cholesterol

Eccrine Sweat glands

Thermoregulation
Entire

surface of the body except the lips,

external ear canal and labia minora

Most

concentrated in the palms and soles

Apocrine Sweat Glands

Vestigial
Axillae

sexual function

and anogenital regions

Mammary

glands considered modified and

specialized type of apocrine glands

Blood / Lymphatic supply of skin

Extensive
Dermal

subdermal and dermal plexuses

plexus: Horizontal superficial and deep

plexuses, connected by vertical communicating

vessels
Cutaneous

vasculature important in

thermoregulation
Cutaneous

lymphatics parallels the blood supply

Skin innervation
Light

touch: Merkel cells of the epidermis,

Meissners corpuscles in dermal papillae
Pressure: Pacinian corpuscles in deep dermis or
subcutaneous tissue
Pain: transmitted through naked nerve endings
located in the basal layer of the epidermis
Temperature:
- Krause bulbs detect cold, Ruffini end organs
detect heat
- Heat, cold and proprioception also located in the
superficial dermis
- Adjacent dermatomes often overlap, important in
local anaesthesia

Classification
Primary

lesions

Secondary
Special

lesions

lesions

Basic Skin Lesions

Primary Skin Lesions

Macule

Vesicle

Patch

Bulla

Papule

Pustule

Plaque

Cyst

Nodule
Wheal

Secondary Skin Lesions

Scale

Ulcer

Crust

Excoriation

Lichenification

Fissure

Induration

Erosion

Atrophy

Scar

Special Skin Lesions

Burrow
Comedo
Milium

Poikiloderma

Telangiectasia

Target lesion

Macule
Definition:

A circumscribed alteration in the

colour or texture of the skin

Types:

Erythematous, hypopigmented,

hyperpigmented, depigmented, purpuric

Examples:

caf au lait macule, vitiligo

Erythema / Purpura
Erythema:

Redness of the skin, blanches on

pressure and is due to vascular congestion or
increased perfusion. Eg: SLE, Rosacea
Purpura: Discoloration of skin or mucous
membrane, non- blanchable due to
extravasation of red blood cells. Eg: Vasculitis,
clotting disorders
Petechiae: 1-2 mm small purpuric lesions,
occurs in crops. Eg : clotting disorders
Ecchymoses: larger extravastions of blood.
Eg: post traumatic

Papule
Definition:

A circumscribed palpable elevation,

less than 1 cm in diameter

Types:

dome-shaped, flat-topped, umbilicated,

pedunculated

Examples: Warts, Molluscum

Plaque
Definition:

An elevated area of skin, 1cm or

more in diameter; surface area is greater than
the height.

It may be formed by the extension or

coalescence of either papules or nodules
Examples: psoriasis, granuloma annulare

Nodule
Definition:

A solid mass in the skin, which can

be observed as an elevation or can be palpated.
It is more than 0.5 cm in diameter.

The depth of a nodule differentiates nodules

from papules. The absolute size is probably not
very important.
Examples: furuncle, erythema nodosum

Vesicles and Bullae

Definition:

Visible accumulations of fluid within

or beneath the epidermis. Vesicles are small,
less than 0.5 cm in diameter. Bullae are larger
and may be of any size above 0.5 cm in
diameter.

Examples: Herpes simplex, Eczema,

Pemphigus, Burns, Impetigo

Pustule
Definition:

A visible accumulation of free pus. It

may occur in association with infection or may
be sterile

Examples: Bacterial / Candidial infections,

Psoriasis (sterile)

Wheal
Definition:

An area of dermal or dermal and

hypodermal oedema, erythema and pallor;
which is evanescent

Examples: characteristic lesion of urticaria

Cyst
Definition:

Any closed cavity or sac (normal or

abnormal) with an epithelial, endothelial or
membranous lining and containing fluid or
semisolid material

Examples: epidermal cysts, pilar cysts,

sebaceous cysts

Scale
Definition:

Visible exfoliation of a flat plate or

flake of stratum corneum

Examples:
Furfuraceous - Pityriasis Versicolor
Ichthyotic, lamellar- Ichthyosis
Micaceous - Psoriasis
Collarette - Pityriasis rosea

Crust
Definition:

Types:

Crusts consists of dried serum and

other exudates

hemorrhagic crust (scab), purulent

Examples: Impetigo

Excoriation
Definition:

Loss of skin substance produced by

scratching

Types:

- linear
- circumscribed

Examples: Acne excoree, Prurigo

Fissure
It

is a linear crack in the skin, which may be

superficial or deep to the dermis

Erosion
Definition:

A loss of whole part of epidermis,

which heals without scarring. It commonly
follows a blister

Examples: Impetigo
Pemphigus

Ulcer
Definition:

A loss of epidermis and some parts

of dermis, may involve underlying tissues.

Examples: trauma, stasis ulcer

Scar
Definition:

A replacement by tissue that has

been destroyed by injury or disease by fibrous
tissue

Types: atrophic
hypertrophic
cribriform
varioliform
pitted

Lichenification
Definition:

The thickening of the epidermis and

to some extent of the dermis, pigmentation and
accentuation of skin markings,in response to
prolonged rubbing.

Examples: Lichen simplex chronicus

Induration
Definition:

firm and thick skin due to dermal

involvement

Sclerosis
Definition:

A diffuse or circumscribed induration

of the subcutaneous tissues. It may also involve
the dermis.

Sclerosis

is better felt than seen

Examples: Scleroderma

Atrophy
Definition:

A loss of tissue characterized by the

loss of normal skin markings

Types of atrophy: Epidermal, dermal,

subcutaneous, mixed

Loss

of skin markings occur in epidermal

atrophy only

Burrow
Definition:

A small tunnel in the skin that houses

a metazoal parasite

Examples: Scabies

Comedo
Definition:

A plug of keratin and sebum in a

dilated pilosebaceous orifice

Types: open
closed

Examples:

Acne

Telangiectasia
Definition:

visible and permanent dilatation of

capillaries

Types: punctate, matt-like, linear, spider

Examples:

Rosacea
Nail fold telangiectasias in systemic
sclerosis

Milium
Definition:

A tiny white cyst containing

lamellated keratin

Milia

are lined by epithelium

Poikiloderma
Definition:

The association of cutaneous

pigmentation, atrophy and telangiectasia

Examples:

Dermatomyositis

Target lesions
Definition:

These are less than 3 cm diameter

and have 3 zones; a central zone of dusky
erythema or purpura, a middle paler zone of
oedema and an outer ring of erythema with a
well-defined edge.

The

diameter of target lesions may not be

significant

Examples:

Erythema multiforme

Alopecia
Definition:

Loss of hair from a normally hairy area

Types: Scarring, Non-scarring

Examples:

Alopecia areata, Androgenic alopecia

Patterns
Annular
Linear
Grouped
Discoid
Reticulate

Thank you