Chapter 5

The Integumentary System

• Skin and its
accessory structures
– structure
– function
– growth and repair
– development
– aging
– disorders

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 General Anatomy

• A large organ
composed of all 4 tissue
types
1. Epithelial
2. Connective
3. Muscular
4. Nervous
• 22 square feet
• 1-2 mm thick
• Weight = 10 lbs.
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 4 Basic Tissues
1. Epithelial Tissue
– covers outside surfaces. Ex: skin
– lines hollow organs, cavities and ducts.
– glandular epithelium can secrete hormones.
2. Connective Tissue
– material found between cells
– supports and binds structures together
– stores energy as fat
– provides immunity to disease. Ex: blood & lymph
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 4 Basic Tissues
3. Muscle Tissue
– cells shorten in length producing
movement
4. Nerve Tissue
– cells that conduct electrical
signals
– detects changes inside and
outside the body
– responds with nerve impulses to
maintain homeostasis
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 Overview
• 2 Major layers of skin
1. Epidermis is epithelial
tissue only
2. Dermis is layer of
connective tissue, nerve &
muscle
• Subcutaneous tissue (or
hypodermis) is layer of
adipose & areolar tissue
– “subQ” = subcutaneous
injection
– “intradermal” = within
the skin layer
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 Overview of Epidermis
• Stratified squamous epithelium
– Function: protection
• Contains no blood vessels
• 4 types of cells
• 5 distinct strata (layers) of cells

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 Cell types of the Epidermis
1. Keratinocytes--90%
– produce keratin
2. Melanocytes-----8 %
– produces melanin pigment
3. Langerhan cells
– from bone marrow
– provide immunity
4. Merkel cells
– in deepest layer
– form touch receptor with
sensory neuron

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Layers (Strata) of the Epidermis

1. Stratum corneum
2. Stratum lucidum
3. Stratum granulosum
4. Stratum spinosum
5. Stratum basale

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 1. Stratum Corneum
• 25 to 30 layers of flat dead
cells filled with keratin and
surrounded by lipids
• Continuously shed
• Barrier to light, heat, water,
chemicals & bacteria
• Friction stimulates callus
formation

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 2. Stratum Lucidum
• Seen in thick skin on
palms & soles of feet
• Three to five layers of
clear, flat, dead cells
• Contains precursor of
keratin

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 3. Stratum Granulosum
• 3 - 5 layers of flat dying cells
• Show nuclear degeneration
• Contain dark-staining
keratohyalin granules
• Contain granules that release
lipids that repels water

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 4. Stratum Spinosum
• 8 to 10 cell layers held
together by desmosomes
• During slide preparation,
cells shrink and look
spiny
• Melanin taken in by
phagocytosis from nearby
melanocytes

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 5. Stratum Basale
• Deepest single layer of cells
• Called stratum germinativum
• Combination of merkel cells,
melanocytes, keratinocytes &
stem cells that divide repeatedly
• Cells attached to each other & to
basement membrane by
desmosomes &
hemidesmosomes

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Keratinization & Epidermal Growth
• Stem cells divide to produce keratinocytes
• As keratinocytes are pushed up towards the
surface, they fill with keratin (protein)
• This is a 4 week journey, unless outer layers are
removed by abrasion
• Hormone EGF (epidermal growth factor) can
speed up process
• Psoriasis = chronic skin disorder
– cells shed in 7 to 10 days as flaky silvery scales
– abnormal keratin produced
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 Skin Grafts
• New skin cannot regenerate if stratum
basale and its stem cells are destroyed
• Skin graft = covering a wound with a piece
of healthy skin
– Autograft = from self
– Isograft = from twin
– Autologous skin = transplantation of patient’s
own skin grown in culture
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 Dermis
• Connective tissue layer composed of collagen &
elastic fibers, fibroblasts, macrophages & fat cells
• Contains hair follicles, glands, nerves & blood
vessels
• Major regions of dermis
1. Papillary region
2. Reticular region

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 Papillary Region
• Top 20% of dermis
• Composed of loose connective tissue & elastic
fibers
• Finger like projections called dermal papillae:
• Functions
– anchors epidermis to dermis
– contains capillaries that feed epidermis
– contains Meissner’s corpuscles (touch) & free nerve
endings (pain and temperature) 5-17
 Reticular Region
• Dense, irregular connective tissue
• Contains interlacing collagen and elastic fibers
• Packed with oil glands, sweat gland ducts, fat &
hair follicles
• Provides strength, extensibility & elasticity to skin
– stretch marks are dermal tears from extreme stretching
• Epidermal ridges form in fetus as epidermis
conforms to dermal papillae
– fingerprints are left by sweat glands open on ridges
– increase grip of hand 5-18
 Skin Color Pigments (1)
1. Melanin produced in epidermis by melanocytes
– same number of melanocytes in everyone, but differing
amounts of pigment produced
– results vary from yellow to tan to black color
– melanocytes convert tyrosine to melanin
• UV in sunlight increases melanin production
• Clinical observations
– freckles or liver spots = melanocytes in a patch
– albinism = inherited lack of tyrosinase; no pigment
– vitiligo = autoimmune loss of melanocytes in areas of
the skin produces white patches 5-19
 Skin Color Pigments (2)
2. Carotene in dermis
– yellow-orange pigment (precursor of vitamin A)
– found in stratum corneum & dermis
3. Hemoglobin
– red, oxygen-carrying pigment in blood cells
– if other pigments are not present, epidermis is
translucent so pinkness will be evident

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 Skin Color as Diagnostic Clue
1. Jaundice
– yellowish color to skin and whites of eyes
– buildup of yellow bilirubin in blood from liver disease
2. Cyanosis
– bluish color to nail beds and skin
– hemoglobin depleted of oxygen looks purple-blue
3. Erythema
– redness of skin due to enlargement of capillaries in
dermis
– during inflammation, infection, allergy or burns
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 Erythema

Cyanosis
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 Accessory Structures of Skin

• Epidermal derivatives
• Cells sink inward during
development to form:
– hair
– oil glands
– sweat glands
– nails

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 Structure of Hair
• Aka, “pili”
1. Shaft – visible
2. Root – below the surface
3. Follicle – surrounds
root

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 Hair Related Structures

1. Arrector pili
– smooth muscle in
dermis contracts with
cold or fear.
– forms goosebumps as
hair is pulled vertically
2. Hair root plexus
– network of nerves
– detect hair movement
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 Hair Growth
• Growth cycle = growth stage & resting stage
1.Growth stage
– lasts for 2 to 6 years
– matrix cells at base of hair root producing length
2. Resting stage
– lasts for 3 months
– matrix cells inactive & follicle atrophies
• Old hair falls out as growth stage begins again
– normal hair loss is 70 to 100 hairs per day
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 Hair Color
• Result of melanin produced in melanocytes in
hair bulb
• Dark hair contains true melanin
• Blond and red hair contain melanin with iron and
sulfur added
• Graying hair is result of decline in melanin
production
• White hair has air bubbles in the medullary shaft
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 Functions of Hair
• Prevents heat loss
• Decreases sunburn
• Eyelashes help protect
eyes
• Touch receptors (hair
root plexus) senses light
touch

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 Glands of the Skin
• Specialized exocrine glands found in dermis
1.Sebaceous (oil) glands
2.Sudiferous (sweat) glands
3.Ceruminous (wax) glands
4.Mammary (milk) glands

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 1. Sebaceous (oil) glands
• Secretory portion in the dermis
• Most open onto hair shafts
• Sebum
– combination of cholesterol, proteins, fats & salts
– keeps hair and skin soft & pliable
– inhibits growth of bacteria & fungi(ringworm)
• Acne (disorder)
– bacterial inflammation of glands
– secretions stimulated by hormones at puberty
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 2. Sudoriferous (sweat) glands

1. Eccrine (sweat) glands

– most areas of skin
– secretory portion in dermis with duct to surface
– regulate body temperature with perspiration
2. Apocrine (sweat) glands
– armpit and pubic region
– secretory portion in dermis with duct that opens
onto hair follicle
– secretions more viscous
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 3. Ceruminous glands
• Modified sweat glands produce waxy
secretion in ear canal
• Cerumin contains secretions of oil and wax
glands
• Helps form barrier for entrance of foreign
bodies
• Impacted cerumen may reduce hearing

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 4. Mammary (milk) glands
• Modified sudoriferous (sweat) gland of
females that produces milk for the
nourishment of the young

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Nails

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 Structure of Nails
• Tightly packed keratinized cells
1. Nail body
– visible portion pink due to
underlying capillaries
– free edge appears white
2. Nail root
– buried under skin layers
– lunula is white due to thickened
stratum basale
3. Eponychium (cuticle)
– stratum corneum layer
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 Nail Growth
• Nail matrix below nail root produces growth
• Cells transformed into tightly packed keratinized cells
• Growth is 1mm per week--faster in summer & on
most-used hand

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 Types of Skin
1. Thin skin
– covers most of body
– thin epidermis (0.1 to 0.15 mm) that lacks stratum
lucidum
– lacks epidermal ridges, has fewer sweat glands and
sensory receptors
2. Thick skin
– only on palms and soles
– thick epidermis (0.6 to 4.5 mm) with distinct stratum
lucidum & thick stratum corneum
– lacks hair follicles and sebaceous glands 5-37
 General Functions of the Skin

1. Regulation of body temperature

2. Protection as physical barrier
3. Sensory receptors
4. Excretion and absorption
5. Synthesis of vitamin D

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 1. Thermoregulation
• Releasing of sweat onto the skin
– perspiration & its evaporation lowers body
temperature
• Adjusting flow of blood to the body surface
– in moderate exercise, more blood brought to surface
helps lower temperature
– with extreme exercise, blood is shunted to muscles
and body temperature rises
• Shivering and constriction of surface vessels
– raise internal body temperature as needed
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 2. Protection
• Physical, chemical and biological barrier
– tight cell junctions prevent bacterial invasion
– lipids released help prevent evaporation
– pigment protects somewhat against UV light
– Langerhans cells alert immune system

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 3. Cutaneous Sensations
• Touch, temperature, pressure, vibration,
tickling and some pain sensations arise
from the skin.

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 4. Excretion and Absorption
• Only a minor role is played by the skin
• 400 mL of water evaporates from it daily
• Small amounts of salt, CO2, ammonia, and
urea are excreted
• Lipid soluble substances can be absorbed
through the skin
– vitamins A, D, E and K, Oxygen and CO2
– acetone and dry-cleaning fluid, lead, mercury,
arsenic, poisons in poison ivy and oak
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 5. Synthesis of Vitamin D
• Sunlight activates a precursor to vitamin D
• Enzymes in the liver and kidneys transform
that molecule into calcitriol (most active
form of vitamin D)
• Necessary vitamin for absorption of
calcium from food in the gastrointestinal
tract

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Transdermal Drug Administration
• Method by which drugs in a patch enter the
body
• Drug absorption most rapid in areas where skin
is thin (scrotum, face and scalp)
• Examples
– Nitroglycerin (prevention of chest pain from
coronary artery disease)
– Scopolamine ( motion sickness)
– Estradiol (estrogen replacement therapy)
– Nicotine (stop smoking alternative)
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 Epidermal Wound Healing
• Abrasion or minor burn
• Basal cells migrate across the wound
• Epidermal growth factor stimulates cell division
• Full thickness of epidermis results from further
cell division

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 Deep Wound Healing
• If an injury reaches dermis, healing occurs in 4 phases
1. Inflammatory phase: clot unite wound edges and WBCs arrive
from dilated and more permeable blood vessels
2. Migratory phase: the re-growth of epithelial cells and the
formation of scar tissue by the fibroblasts
3. Proliferative phase: the completion of tissue formation
4. Maturation phase: the scab falls off
• Scar formation
– Hypertrophic scar (excessive enlargement or overgrowth of
tissue) remains within the boundaries of the original wound
– Keloid scar extends into previously normal tissue
• collagen fibers are very dense and fewer blood vessels are present so the
tissue is lighter in color
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 Phases of Deep Wound Healing

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 Development of the Skin
• Epidermis develops from ectodermal germ layer
• Dermis develops from mesodermal germ layer
– Nails begin to form at 10 weeks, but do not reach the
fingertip until the 9th month
– Dermis forms from mesoderm by 11 weeks
– By 16 weeks, all layers of the epidermis are present
– Oil and sweat glands form in 4th and 5th month
– By 6th months, delicate fetal hair (lanugo) has formed
• Slippery coating of oil and sloughed off skin
called vernix caseosa is present at birth
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 Age Related Structural Changes
• Collagen fibers decrease in number & stiffen
• Elastic fibers become less elastic
• Fibroblasts (cells that begin new cell growth)
decrease in number
• Langerhans cells and macrophages decrease in
number and become less-efficient phagocytes
• Oil glands shrink and the skin becomes dry
• Walls of blood vessels in dermis thicken so
decreased nutrient availability leads to thinner skin
as subcutaneous fat is lost 5-49
 Photodamage
• Ultraviolet light (UVA and UVB) both
damage the skin
• Acute overexposure causes sunburn
• DNA damage in epidermal cells can lead to
skin cancer
• UVA produces oxygen free radicals that
damage collagen and elastic fibers and lead
to wrinkling of the skin
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 Skin Cancer
• 1 million cases diagnosed per year
• 3 common forms of skin cancer
1. Basal cell carcinoma (rarely metastasize = spread)
2. Squamous cell carcinoma (may metastasize)
3. Malignant melanomas (metastasize rapidly)
• most common cancer in young women
• arise from melanocytes ----life threatening
• key to treatment is early detection watch for changes in
symmetry, border, color and size
• risks factors include-- skin color, sun exposure, family
history, age, and immunological status
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 Burns
• Destruction of proteins of the skin
– chemicals, electricity, heat
• Problems that result:
– shock due to water,
plasma and plasma
protein loss
– circulatory & kidney
problems from loss of
plasma
– bacterial infection
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 Types of Burns
1. First-degree
– only epidermis (sunburn)
2. Second-degree burn
– destroys entire epidermis & part of dermis
– fluid-filled blisters separate epidermis & dermis
– epidermal derivatives are not damaged
– heals without grafting in 3 to 4 weeks & may scar
3. Third-degree or full-thickness
– destroy epidermis, dermis, & epidermal derivatives
– damaged area is numb due to loss of sensory nerves
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 Pressure Sores
• Decubitus ulcers
– Caused by constant
deficiency of blood
flow to tissue
– Areas affected is skin
over bony prominence
in bedridden patients
– Preventable with proper
care
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