Skin/Integumentary System

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How much does the skin cover?

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1

How much does the skin cover?

1.6 to 1.9 m2 in avg adult

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2

What is the body’s largest organ?

Skin

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What is the structure of the skin?

  • Cutaneous

  • epidermis

  • dermis

  • hypodermis

<ul><li><p>Cutaneous </p></li><li><p>epidermis </p></li><li><p>dermis </p></li><li><p>hypodermis </p></li></ul>
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What is considered skin?

  • appendage

  • hair

  • nail

  • skin glands

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Keratinocytes

structural elements of outer skin

  • 90% of cells

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Melanocytes

contribute to skin colour + filter UV light

  • 5% of skin

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Epidermal Dendritic Cells

role in immune response

  • branched antigen-presenting cells

  • are Langerhans cells

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Tactile Epithelial Cells / Merkel Cells

forms light touch receptors

  • attach to sensory nerve endings

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Stratum Corneum / Corneocytes (horny layer)

barrier to water loss & many environmental threats

  • most superficial layer

  • dead cells filled w/ keratin (barrier)

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turnover/ regeneration time

time required for EPIDERMAL cells to form in stratum basale

  • migrates to skin surface

  • 35 days

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Growth factor

regulates epidermal growth & repair

  • hormones signal tissue repair

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shortened turnover time

  • ↑ thickness of stratum coronium

  • = callus formation

  • 10 to 12 % of all cells in stratum coronium ⇉ mitosis

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lamellar corpuscles / pacini corpusle

sense of deep touch, pressure & vibration

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Dermo epidermal junction

Partial barrier to the passage of some cells & drugs

  • basement membrane= fibrous elements + polysaccharides gel

  • gel (glue) attaches the epidermis to dermis

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tactile corpuscle/ meissner corpuscle

detecting light touch

  • slight pressure

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Dermis / corium

  • middle layer

  • true skin

  • thicker than epidermis

  • gives strength to skin

  • reservoir= water + electrolytes

  • sudoriferous (sweat) & sebaceous glands

  • blood vessels

  • sensory receptors

  • rich vascular supply = temperature regulation

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Nociceptors

pain, temperature, itch& tickle

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Thermo receptors

hot & cold

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sensory receptors

  • meissners corpuscle/ tactile corpuscle

  • pacinian corpuslce / lamellear corpuscle

  • nociceptors

  • thermoreceptors

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<p>exteroceptors </p>

exteroceptors

body surface

  • merkle disk

  • meissner

  • ruffini

  • krause end bulb

  • free nerve endings / nociceptors

  • hair root plexus

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<p>Where is thick skin found?</p>

Where is thick skin found?

surfaces of the palms & soles of feet

<p>surfaces of the palms &amp; soles of feet </p>
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<p>Where is thin skin found?</p>

Where is thin skin found?

most surface areas of body

<p>most surface areas of body </p>
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Epidermis contains

  • Keratinocytes

  • melanocytes

  • epidermal dendritic cells

  • tactile epithelial cells / merkel cells

  • stratum corneum/ horny later

  • lamellar corpuscles

  • dermo epidermal junction

<ul><li><p>Keratinocytes </p></li><li><p>melanocytes</p></li><li><p>epidermal dendritic cells </p></li><li><p>tactile epithelial cells / merkel cells </p></li><li><p>stratum corneum/ horny later </p></li><li><p>lamellar corpuscles </p></li><li><p>dermo epidermal junction </p></li></ul>
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merkle disk

gentle touch

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meissner

touch & low frequency vibration

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Ruffini

crude & persistent touch

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krause end bulb

touch & low freq vibration, textural sensation

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free nerve endings (nociceptor)

pain

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hair root plexus

detects movement of hair

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Pain receptors

free nerve endings = nociceptors

  • located on surface of body (exteroceptors)

  • In deep visceral organs: viseroceptors

  • Brain does not have

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Acute/ Fast (A) Pain

superficial injury of trauma

  • nerve fibers are [ in skin] + mucous membrane + superficial

  • ex., slamming your finger in car door

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Chronic/ slow (B)

dull or aching pain in VISCERAL structures

  • can be severe = kidney or gallstones

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diabetic neuropathy (nerve damage)

uncontrolled diabetes causing a loss of ability of sense pain on certain areas of body surface

  • skin of feet

  • patients w/ diabetes should be closely monitored for adequacy of cutaneous sensations

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referred pain

location far removed from site of injury or disease

  • due to mixing/ convergence of sensory nerve impulses from disease organ & skin area

  • ex. Heart attack pain , can occur at left shoulder or left arm

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Hypodermis

  • subcutaneous layer / superficial fascia

  • forms connections btwn skin + other structures

  • adipose + connective tissue

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subcutaneous injections

layer of fat btwn skin & muscle

  • insulin, morphine, heparin

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<p>melanin </p>

melanin

dark pigments in skin, hair & iris of eye

  • produced by melanocytes

  • forms a cap over the nucleus of Keratinocytes protecting it from UV radiations

<p>dark pigments in skin, hair &amp; iris of eye </p><ul><li><p>produced by melanocytes </p></li><li><p>forms a cap over the nucleus of Keratinocytes protecting it from UV radiations </p></li></ul>
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Beta- carotene

orange pigments from food can change skin color

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hemoglobin

changes in blood flow

  • redder: blood flow to skin = ↑ inflammation

  • cyanosis: bluish = inadequate oxygenation of blood

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Jaundice

yellowish Discolouration of skin & other tissues

ex., white (sclera) of the eye

  • accumulation of bile pigments due to improper liver functioning ex., hepatitsis

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neonatal jaundice

metabolic + physiological adjustments after birth

  • until day 8 in normal birth

  • day 14th for premature

  • treatment = phototherapy (light)

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Functions of Skin

  1. Protection

  2. Surface Film

  3. Sensation

  4. flexibility

  5. hormone production (vitamin D)

  6. execration

  7. immunity

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What does the function protection do?

  • physical barrier to microorganisms

  • barrier to chemical hazards

  • ↓ potential for mechanical trauma

  • prevents dehydration

  • protects from excess UV rays exposure (melanin fx)

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what does the function Surface Flim do?

  • residue + secretion of sweat + sebaceous glands + dead epithelial cells

  • antibacterial + antifungal activity

  • lubrication

  • hydration of skin surface

  • buffer of caustic irritants

  • blockage of toxic agents

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Desquamation

shedding of epithelial elements

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what does the function : Sensation do?

acts as a sophisticated sense organ

detects stimuli of

  • pressure

  • touch

  • temperature

  • pain

  • other general senses

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what does the function flexibility do?

permits change in body contours w/o injury

  • supple & elastic

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what does the function hormone production do?

produces vitamin D

  • skin + UV = cholecalciferol (precursor)

  • blood transports precursor → liver & kidneys = vitamin D

  • vita D = hormone

<p>produces vitamin D</p><ul><li><p>skin + UV = cholecalciferol (precursor) </p></li><li><p>blood transports precursor → liver &amp; kidneys = vitamin D</p></li><li><p>vita D = hormone </p></li></ul>
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what does the function excretion do?

filters wastes

  • water

  • urea/ ammonia / uric acid

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what does the function Immunity do?

epidermal dendritic cells trigger helpful immune reactions

  • phagocytic cells destroy bacteria

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Homeostasis of body temperature

  • body temperature

  • heat production

    • muscles & liver metabolism

    • direct relationships btwn amount of muscles activity & heat production

  • must equal heat lost

    • 80% occurs through skin

    • 20% through mucosa of:

      • respiratory

      • digestive

      • urinary tracts

<ul><li><p>body temperature </p></li><li><p>heat production</p><ul><li><p>muscles &amp; liver metabolism </p></li><li><p>direct relationships btwn amount of muscles activity &amp; heat production </p></li></ul></li><li><p>must equal heat lost </p><ul><li><p>80% occurs through skin </p></li><li><p>20% through mucosa of: </p><ul><li><p>respiratory</p></li><li><p>digestive </p></li><li><p>urinary tracts </p><p></p></li></ul></li></ul></li></ul>
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evaporation

heat energy is expended

  • important @ high temp when it is only method

  • heat can be lost from skin

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radiation

transfer of heat from one object to another w/o contact

  • important for cool environmental temps

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vasoconstriction

↓ heat loss due to ↓ blood flow across peripheral tissue

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vasodilation

↑ heat loss due to ↑ blood flow across peripheral tissue

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heat loss

  • controlled by -tive feedback loop

  • hypothalamus monitors body's internal temp

  • vasodilation = if temp ↑ hypothalamus ⇉ sweat glands + blood vessels of skin

  • hypothalamus continues until normal body temp

<ul><li><p>controlled by -tive feedback loop</p></li><li><p>hypothalamus monitors body's internal temp</p></li><li><p>vasodilation = if temp ↑ hypothalamus ⇉ sweat glands + blood vessels of skin </p></li><li><p>hypothalamus continues until normal body temp </p></li></ul>
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hirsutism

excessive hair growth from drugs

  • minoxidil ( Rogaine )

  • cyclosporine

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Androgenic alopecia

male pattern baldness

  • genetic tendency + male sex hormones

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nails - Epidermal cells

hard keratin

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nail body

visible part of each nail

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root

cuticle

  • nail in groove hidden by fold of skin

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Lunula

moon-shaped white area nearest root

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nail bed

layer of epithelium under nail body

  • abundant blood vessels

  • can be pink under translucent nails

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cyanotic nail

bluish colour

  • inadequate oxygenation

  • due to cardiovascular and/ or respiratory disorders

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nail growth

by mitosis in STRATUM BASALE under lunula

  • avg. 0.5 mm / week

  • 1 inch / yr

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onycholysis

separation of nail from the nail bed

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eccrine glands

small numerous sweat glands

  • over total BSA w/ exception of few small areas

  • secretes: perspiration or sweat

  • eliminates wastes: urea , ammonia , uric acid

  • maintains constant core temp

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apocrine glands

body odor

  • limited distribution

  • located: axillar & around anogenital areas

  • NOT involved in regulation of body temp

  • = to sexual scent glands of other animals

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sebaceous glands

secretes sebum: oily substance that keeps hair & skin soft & pliable

  • prevents excessive water loss

  • anti-fungal activity

  • in DERMIS

    • except in palms & sole

  • secretions ↑ in adolescence

    • formation of pimples & blackheads

    • meds such as accutane

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acne

over active sebaceous gland + blockage + inflammation of their ducts

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Pilosebaceous unit w/ apocrine & eccrine sweat glands

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1st degree burn

damaged epidermis & edema

  • partial thickness burns

  • edema ( fluid trapped = swelling)

<p>damaged epidermis &amp; edema </p><ul><li><p>partial thickness burns </p></li><li><p>edema ( fluid trapped = swelling)</p></li></ul>
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2nd burns

damaged epidermis & dermis

  • partial thickness burn

<p>damaged epidermis &amp; dermis </p><ul><li><p>partial thickness burn </p></li></ul>
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3rd degree burn

  • deep tissue damage

  • to the subcutaneous

<ul><li><p>deep tissue damage </p></li><li><p>to the subcutaneous </p></li></ul>
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Children cycle life

  • smooth + unwrinkled + elasticity + flexibility

  • few sweat glands

  • rapid healing

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adults cycle of life

development & activation of sebaceous + sweat glands

Increase

  • sweat production

  • body odor

  • sebum production (acne)

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old age cycle of life

wrinkling

decrease in

  • sebaceous & sweat gland activity

  • less sebum productions

  • body’s ability to cool itself

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skin cancer

95% of skin cancer = basal cell & squamous cells carcinomas

  • very responsive to treatment & seldom metastasize ( spread)

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malignant melanoma

metastazie

  • tumor produced by melanocytes

  • occur on the skin but spread to gastrointestinal tract & brain

  • 35, 000 cases reported per year

  • 7000 = deaths

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kaposi sarcoma

immune deficiencies

ex., AIDS

  • producing purple papules → lymph nodes + internal organs

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ringworm

tinea = fungal infection of the skin

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mycoses

fungal infection of skins ; skin or nails

  • also cause infections in mouth, throats lungs, urinary tract

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<p>Acne Vulgaris </p>

Acne Vulgaris

  • self limited disorder

  • primarily in teenagers & young adults

  • areas of the body that have the greatest # of sebaceous glands

    • face, neck, chest, upper back & upper arm

  • external factors

    • oil, greases, dye in hair products

    • detergents, soap , astringents

    • occlusive clothing : turtleneck & bra straps

    • psychological stress

    • diet

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type 1 acne

comedones w/ small inflamed papule or pustule

  • no scarring present

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treatment for type 1 acne

topical therapies, BC pills

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type 4 acne

  • numerous large cysts

  • on face , neck & upper trunk

  • severe scarring

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treatment for type 4 acne

Accutane tabs

  • can cause severe birth defects

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treatment for noninflammatory (Comedones) acne

  • topical retinoids (tretinoin, adapalene)

  • salicylic acid

  • azelaic acid

  • benzoyl peroxide

  • glycolic acid

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treatment for inflammatory acne

  • papular

  • topical retinoids

  • benzoyl peroxide

  • azelaic acid

  • topical antibiotics

  • sodium sulfacetamide

  • pustular

  • oral antibiotics

  • nodulocystic

  • isotretinoin

  • oral corticosteroids

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what is the treatment for hormonally- induced acne

  • oral contraceptives

  • spironolactone

  • corticosteroids

  • flutamide

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<p>acne rosacea </p>

acne rosacea

in middle-aged & older adults

  • vascular dilation of the central face

    • nose ,cheeks, eyelids & forehead

  • unknown cause

  • is chronic

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treatments for acne rosacea

topical antibiotics: METRONIDAZOLE gel

  • benzoyl peroxide

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treatment for acne rosacea w/ papular or pustular lesions

TRETINOIN creams

  • when it’s unresponsive to other treatment

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<p>Allergic contact dermatitis </p>

Allergic contact dermatitis

any dermatitis arising from DIRECT skin exposure to a substance

  • allergic = immune response

  • irritant- induced = directly damages skin

  • common sensation in North America is plant oleoresin

    • poison ivy, poison oak, poison sumac

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treatment for allergic contact dermatitis

  • corticosteroids: topical or oral in acute phase

  • hydrocortisone

  • BETNOVATE cream

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<p>Psoriasis </p>

Psoriasis

red plaques w/ sliver scales

developed as a 2ndary response = triggered by WBC

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Plaque psoriasis

symmetrically distributed plaques

  • scalp, extensor elbows , knees & back

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pustular psoriasis

most severe form

  • erythema ( redness) , scaling & sheets of superficial pustules w/ erosions

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nail psoriasis

typical abnormality

  • pitting w/ colour changes & crumbling of nail

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treatments for psoriasis

topical emollients, topical steroids (BETNOVATE) ,TAR

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