INTEGUMENT

(Atty. Maria Merle. Mesina, MD)

INTEGUMENT Skin and Appendages Largest and heaviest Organ 16% of Body Wt. FUNCTIONS: 1. Protection against ext. damaging stimuli, bacteria Fungi 2. Sensation Receptors 3. Thermoregulation Thru rich vascular network 4. Metabolic synthesis of Vit. D 5. Forensic finger printing 6. Sexual Attractant products to improve the skin.

2 TYPES OF SKIN: Thick Skin

Location Total Thickness Palms and soles Thicker(0.8-1.4mm) Thicker(0.8-

Thin Skin
Entire body except palms and soles Thinner(0.07-1.12uum Thinner(0.07-

EPIDERMIS
-Str.

Corneum -Str. Lucidum -Str. Granulosum -Str. Basale -Dermatoglyphics

Thicker Present A few layers More merkels cells Present

Thinner Absent Single Fewer merkel s cell absent

DERMIS Hair follicles Sebaceous Glds. Eccrine Sweat Glds Meissner s corpuscle 2 LAYERS OF SKIN: 1. EPIDERMIS a. Str. Corneum b. Str. Lucidum c. Str. Granulosum d. Str. Spinosum e. Str. Basale 2. DERMIS a. Papillary Layer b. Reticular Layer Absent Fewer More More Present More Fewer Fewer

EPIDERMIS - Outer Layer - Origin Ectoderm - Stratified Squamous keratinized epith. - Cells keratinocytes - Non keratinocytes melanocytes, Langerhans Cell, merkels cell - Avascular - Innervation by unencapsulated free nerve endings DERMIS Inner layer Origin mesoderm Extensive capillary network and many AV anastomoses Rich supply of free nerve endings, encapsulated sensory receptors

DERMAL-EPIDERMAL JUNCTION - Zigzagging interdigitation between the upward projections of the dermis (dermal papillae) and the downward projections of the epidermis (epidermal ridges) = RETE APPARATUS DERMO-EPIDERMAL BASEMENT MEMBRANE - Found at the junction between thebasal surface of basal keratinocytes and the underlying dermis - Composed of lamina lucida, lamina densa, fibro-reticular lamina

DISORDERS OF EPIDERMAL BASEMENT MEMBRANE 1. Bullous Pemphigoid - Chronic, pruritic bullous eruptions usually occurring in the elderly - Autoimmune antigen-antibody RXN. Triggering a sequence of changes damaging the basement membrane and leading to separation of the epidermis and blistering. 2. Epidermolysis Bullosa - GR of hereditary dis. Of the skin charac. By blister form. After a minor trauma. - Due to defects I nthe intermediate fil. And in the anchoring fibrils.

a. Epidermolysis Bullosa Simplex - Separation within the basal epidermal cells. - Mutation in genes encoding intermed. Fil. - Blisters that heal with little or no scarring b. Junctional Epidermolysis Bullosa - Separation within the lamina lucida - Blisters that heal with scarring c. Dystrophic epidermolysis Bullosa - Separation in the upper dermis - Blisters that heal with scarring HYPODERMIS/SUBCUTANEOUS FASCIA - Not part of the Skin - Origin mesoderm - Loose CT and adipose tissue

EPIDERMIS Keratinocytes and keratinizing system - Comprise most of the epidermis - Continuous renewal of skin surface involving 4 overlapping stages cell renewal (mitosis), cell differentation (keratinization, cell death 9apoptosis) and sloughing of dead cells (exfoliation) - With form of new cell cells above are pushed to the surface in waves layer from several waves give the epidermis a stratified appearance; along their way to the surface the cell differentiate and begin to accumulate keratin fil in their cytoplasm. - 15 30 days

5 LAYERS: 1. Stratum Basale (Germinativum) - Deepest layer - Resp for constant regeneration of the other layers by repeated mitotic division - Single layer of cuboidal or low columnar basophilic keratinocytes. - Attached to neighboring cells by desmosomes and to the basal lamina by hemidesmosomes. - Basophilia of cells cytokeratin synthesis by ribosoid - Contain merkels cells and melanocytes 2. Stratum Spinosum/Prickle Cell Layer - Thickest layer several layers of keratinocytes - Polyhedral keratinocytes with large pale nuclei and prominent nucleoli (active protein synt. Function)

- Synthesize a Fibrillar protein, cytokeratin accumulates in the cells called tonofibrils tonofibril bundles form tonofibril packed desmosomal bridges connecting keratinocytes (spiny apperance) - Contains langerhans cells - Membrane coating granules (lamellar granules) * Malpighian Layer Str. Basale and Str. Spinosum 3. Stratum Granulosum - Granular layer - Thick Skin 3-5 layers of flattened polygonal cells filled with keratohyalin granules - Most superficial layer in which nuclei are observed - Also contain lamellar granules contents will seal the deeper layers and prevent dehydration - Combination of tonofibrils with kerathohyaline = keratin

4. Stratum Lucidum - Found only in thick skin (plantar and palmar skin) - A narrow, acidophilic, translucent band of flattened keratinocytes whose nuclei, organelles and intercellular borders are not visible - Eleidin - Involucrin 5. Stratum Corneum - Superficial layer - Several layers of dead plate like enucleate keratinocytes nonviable, scale-like structures (horny cells or squames) - Continuously sheds cells thru desquamation

PSORIASIS - Maturation process is rushed Insuff. Time for full develt of tonofibrils and keratohyaline and proper granular layer does not form. - Surface opaque white scales composed of a mixture of keratin and debris of keratinocytes shed prematurely - The rapidly prolif. Epidermis is thickened to produce raised red patches under the white scales - Cause-unknown MELANOCYTES AND PIGMENTATION SYSTEM - Melanins Resp. for skin, eye and hair color - Synthesized by melanocytes - Include eumelain-epidermis, iris and brown and black hair - Pheomelanin red hair

- Melanocytes origin neural crest - Scattered among keratinocytes in the basal layer - Round cell bodies, cytoplasm has no tonofibrils but has round/oval darkstaining bodies 9promelanosomes and melanosomes)

MELANIN SYNTHESIS Tyrosine DOPA DOPAQUINONE

MELANINE

Melanosomes membrane=limited tyrosinase-filled vesicles 4 STAGES: Stage I - round vesicles, tyrosinase act. Ass. With fine granular to filamentous mat. In the vesicle periphery - melanin not yet present Stage II Ovoid vesicles, parallel fil., tyrosinase act. Triggers melanin deposition on fil. Stage III Melanin deposition partly obscured the fil. State IV Mature melanin granules completely filled with melanin Melanin granules Tips of melanocytes Long processes penetrate the cytoplasm of str. Spinosum cells pinched off thur cytocrine secretion

Keratinocytes Actas melanin depots melanin granules accumulate over the nuclei of keratinocytes protecting the DNA from the damaging effects of the sun. Function of Melanin protection absorb free radicals Factors Affecting Melanin Synthesis: - Differences in pigmentation differences in rates of melanin synthesis, accumulation and degradation - Differences in pigmentation is rel. more to location of melanin than to total no. of melanocytes in the skin. - Exposure to UV radiation - size and functional act. Of melanocytes - exposure to uv rays speends tyrosinase synthesis, melanocyte population Amt. and rate of melanin prod.

- Melanocyte stimulating hormone enhance pigmentation - White persons melanosomes are smaller and fewer, congregate in the area of the nucleus, degraded and removed more rapidly Black persons melanosomes are large, more numerous, dispoersed thru out the cytoplasm - Hydroquinone inhibits melanin synthesis ALBINISM - No melanin prod. Due to genetic defect in tyrosinase synthesis - Melanosomes have not progressed beyond stage II FRECKLES - Hyperpigmented spots on sun-exposed areas of skin melanin production and accumulation in the basal area

ADDISONS DISEASE - Insufficient prod. Of cortisol (adrenal cortex) pituitary releases excess actn stim. Of tyrosinase act. In melanocytes hyerpigmentation. VITILIGO - Symmentrical areas of depigmentation of skin often in hands, fingers, face. - Destruction of melanocytes (autoimmune) skin glaringly white. MOLES/NEVI - Bengin accumulations of melanocytes in the dermis (intradermal nevus epidermis (junctional nevus) or both (compound nevus)

MALIGNANT MELANOMA - Malignant accumulations of melanocytes in the dermis (intradermal nevus) Epidermis (junctional nevus) or both (compound nevus) MALIGNANT MELANOMA - Malignant melanocytic tumor arising in pigmented areas; skin, mucous memb., eyes, CNS - Risk factors sun exposure, pigmented moles (40 50%) - Rare in blacks LANGERHANS CELLS - Also called dendritic cells numerous long processes - Origin - mesodern

PART OF MONONUCLEAR PHAGOCYTE SYSTEM - Skins antigen-recognition and processing cells and have a large no. of lymphocyte and macrophage surface marker. - 1 in the str. Spinsum, also in the dermis and in the str squamous epith. Of the oral cavity, esophagus, vagina. - Birbeck granules rod like or racket shapes cytoplasmic granules resembling pingpong paddles; function is unknown; form a result of clathrin assisted endocytosis. - Play role in contact dermatitis - Rejection of skin allografts - Carcinogenesis chem. Carcinogens, UV exposure, immunosupressive agents no. and effectiveness of langerhans cells.

MERKELS CELLS - Scattered in STR. Basale - Origin epithelial in origin - Rounded cells with clear or pale staining cytoplasm, containing small dense cored granules 9neuroendocrine type memb, -bound vesicles) - Function as mechanoreceptors

DERMIS (CORIUM) - Origin mesoderm - Bundles of collagen fibers and elastic fibers - Vascular 2 LAYERS: 1. PAPILLARY LAYER - Superficial - Loose CT, rich in elastic fibers - Dermal papillas upward projections that interdigitate with epidermal ridges - Anchoring fibrils collagen fibers that reinforce the D E junction - Has immunoprotective cells, rich capillary network, abundant free nerve ending and meissners corpuscles

2. RETICULAR LAYER - Thicker, dense irreg. CT - Richly vascularized many AV anastomoses - Rich supply of nerves free and encapsulated - Proteoglycans rich in dermatan sulfate - Sweat glds., sebaceous glds, hair follicles - Smooth muscle skin of penis and scrotum, areolae around nipples.

- Arrector pili muscle smooth muscle inserted into the hair follicle contraction erect the hairs when body is cold or exposed to cold environment (goose bumps) - Glomus Body derms of fingertips, ext. ear and other areas prone to excussive cold. - Highly convuluted segment of AV shunt enveloped by condensed collgenous tissue - Controls flow in AV shunts

SKIN APPENDAGES: - Thin skin - Filamentous, keratinized structures - Grow over most of the body except vermillon zone of lips, palms and, soles and sides of feet, dorsum of distal phalanges of fingers and toes, glans penis, clitoris, labia minora, vestibular aspect of labia majora. - Functions tactile sensation - Hair develt 3rd month of fetal life hair begins to form in hair bulb. - 5th-6th month fetus covered w/ lanugo (fine hair, - Just before birth most of lanugo is shed - A few months after birth terminal hairs replace lanu-vellus (fine short hairs) - Puberty termina hairs replace vellus in certain areas: male axilla, pubic reg., face female axilla, pubic reg.

- Hair grow is optimal 16 46 yrs. Old after age of 50 hair growth begins to diminish after delivery hair loss is temporarily increased STRUCTURE OF HAIR: Hair Follicles - Tubular structures consisting of layers of epith. Cells - Invaginations of the epidermis extending into the dermis, hypodermis or both PARTS: 1. Hair Bulb - Bulbous expansion at the base where the hair is rooted - Composed of hair root and dermal papilla - Hair root whole epithelial mass surrounding the dermal papilla

- Dermal Papilla stromal core of CT containing abundant bld. Vessels and nerve twigs nourishes a basal layer of active germinative cells - Germinal Matrix bulk of epith. Cells composing the hair root surrounding the dermal papilla 4 CONCENTRIC ZONES AROUND THE PAPILLA: 1. Most Central Matrix Cells medulla form the core of hair shaft 2. Slightly peripheral Matrix Cells cortex of hair shaft. 3. More Peripheral cells cuticle 4. Most Peripheral Cells internal root sheath - Zone closest to the papilla contains melanocytes; w/ age, melanocytes lose their ability to produce tyrosinase giving the hair a gray color.

2. HAIR SHAFT - Long, slender fil. That extends to and thru the surface of the epidermis. 5 LAYERS OF HAIR FOLLICLE: 1. Medulla - Core of the hair shaft - Moderately keratinized 2. Cortex - Surrounds the medulla - Broad, highly keratinized forming the bulk of the hair. 3. Cuticle - Overlapping keratin plates to prevent matting of hair. 4. Internal Root Sheath - Closest to hair shaft - Extends fR. Bulb only to the level of sebaceous gld. Ducts. - Cells are slightly keratinized and disintegrate at the level of sebaceous gld. Ducts leaving a space for sebum to be secretes.

3 LAYERS: a) Cuticle of Int. root sheath flat cells b) Huxleys layer 1-3 layers of low cuboidal cells c) Henles layer translucent layer of flattened to cuboidal cells 5. External Root Sheath - Surrounds the int. root sheath and is continuous w/ the epidermis - Separated from the sheath of CT surrounding the follicle by the glassy membrane. (thickened basal lamina)

- Ave. Growth of hair 1 cm/mo. - Hair Grows in Cycles 1. Anagen Phase - Active Growth Phase - Proliferation and differentiation of cells in the germinal matrix cause hair to grow. - Hair bulbs are prominent with well-formed papilla 2. Catagen Phase regeression; pd. Of involution. 3. Telogen Phase - Resting Phase - Hair bulbs are small, no dermal papilla - Mature aged hairs are shed - Catagen and telogen phase germinal matrix becomes inactive and may atrophy - Growth cycles varies scalp anagen up to 6 yrs.

- Telogen 4 months - Pubic hair, trunk hair, eyelashes, eyebrows short anagen, long telogen preventing excessive growth of hair in this areas. ASSOCIATED STRUCTURES: 1. Sebaceous Glands - Near the neck of root sheath - Empty their secretions thru a short duct into the follicular canal 2. Arrector Pili Muscle - Extend obliquely toward hair follicle to insert into the CT sheath bel the sebaceous Gld. - Contraction compresses sebaceous glds hair stand upright (goose bumps)

KERATINIZATION:
HAIR


EPIDERMIS

Keratin of hair s cortex and  Keratin is soft cuticle is harder  Keratinized cells are continuously  keratinized hair remain tightly sloughed attached to each other  Keratinization is continuous and occurs over entire surface Keratinization is intermittent and restricted to the bulb.  keratinized cells are identical Keratinized cells differ in structure and function.

GLANDS IN THE SKIN a. Eccrine sweat glands - Most numerous; abundant in thick skin - Occur over most of body except glands penis, clitoris, vermillon of lips.

- Simple coiled tubular glands with slightly coiled duct lined with simple to stratified cuboidal epith. - Secretory cells dark cells (mucoid cells) and clear cells. - Dark cells  smaller, pyramidal, resembling an inverted cone  have dark glycoprotein containing granules.  secrete mucus-rich mat. - Clear cells  larger, pyramidal, lack secretory granules  secrete the bulk of the watery sweat - Myoepithelial Cells  surround the secretory party of gland and contains actin and myosin  Aid in expressing the secretion into the duct - Ducts open on surface of skin at sweat pores

- Functions thermoregulation excretion - Secretions are released by exocytosis 9merocrine secretion) - Innervated by cholinergic fibers b. Apocrine Glands - Less numerous, mainly in the axilla, pubic and anal reg., areolae of breasts. - Simple coiled tubular glands with larger and wider lumen - Ducts open into hair follicles - Secretion is viscous, odorless but once secreted it acquires a distinctive odor due to bacterial degradation - Secretory cells release their apical extoplasm along with secretory prod.

May represent scent glands. Innvervated by adrenergic fibers. Myoepith, cells surround the secretory part Do not become functional until puberty and in women, glands undergo cyclical changes rel to menstrual cycle - Ceruminous glands and glands of moll-modified apocrine glands. c. Sebaceous Glands - Occur in all thin skin, most numerous in skin of the face, forehead and scalp - Has a branched acinar form, the acini converge upon a duct which empties into the hair follicle. - Acinus mass of rounded cells packed with lipid-filled vacuos appearing as pale staining and foamy - Secretion lipid droplets containing a mixture of triglycerides, waxes, squalene and cholesterol; released into the ducts together w/ cell debris

- Holocrine secretion - Function lubrication antibacterial /antifungal effects. Pilosebaceous unit - hair follicle and ass. Arrector pili muscleand sebaceous gland.

NAIL - Highly keratinized epith, cells arranged in plates of hard keratin (nail plate that rest on a bed of epidermis (nail bed).

- Nail Plate 2 parts (1) nail body (visible) (2)nail root (partly hidden) - Nail matrix contains dividing and keratinizing cells - Resp. for nail growth - Eponychium - Cuticle - Thick keratinized layer from upper surface of nail groove over the most distal part of nail. - Hyonychium local thickening of Str. Corneum underlying the distal end of nail - Lunula whitish, opaque, crescent-shaped reg. in the proximal nail body Warts - Verrucae - Benign epidermal growths due to papilloma virus

- Sharply demarcated, rough-surfaced, round/irregular, firm, light gray, yellow, brown or gray-black nodules. - Fingers, elbows, knees, faced, around the nail plated or sole of the foot. ACNE - A common inflammatory disease of pilosebaceous glands, charac. By comedones, papules, pustules, inflamed nodules, superficial pus filled cysts and canalizing and deep inflamed sometimes purulent sacs. - Interaction among hormones, keratin, sebum and bacteria det. The course and severity. - Intrafollicular hyperikeratosis blockage of pilosebaceous comedone form. 9sebum, keratin, micro org. part, propionibacterium acnes)

BASAL CELL CA (RODENT ULCER) - Superficial, eroding ulcer that derives from and resembles epidermal basal cells. - Most common type of skin cancer; more common in fair skinner, exposed persons, rare in blacks. - Commonly may alternately crust and heal - Rarely metastasize but may invade healthy tissues. SQUAMOUS CELL CA - Arises fr. The malpighian cells of the epithelium, usually occur on sun-exposed areas - 2nd most common type of skin cancer

- Locally invasive and may metastasize - Bowens disease - intraepidermal squamous cell CA - A superficial squamous cells CA in Situ - Lesion is solitary or multiple resembling. A localized patch of psoriasis, dermatitis or a dematophyte infection

LABORATORY