INTEGUMENTARY SYSTEM

Learning Outcomes
1. Describe the general structure of skin
2. Describe the epidermal, dermal and hypodermal layers
3. Differentiate and describe the strata of the epidermal layer
4. Describe cells of the epidermis
5. Compare and contrast thick and thin skin
6. Describe the accessory structures of the skin including the nails, hair, sweat glands and oil glands
7. Describe the functions of the integumentary system
8. Describe burn classification
9. Describe complications of burns
10. Describe the stages of wound tissue repair

COMMONWEALTH OF AUSTRALIA
Copyright Regulations 1969
WARNING
This material has been copied and communicated to you by or on behalf of The Queensland
University of Technology, pursuant to Part VB of The Copyright Act 1968 (The Act). The material
in this communication may be subject to copyright under The Act.
Any further copying or communication of this material by you may be the subject of copyright
protection under The Act.
Do not remove this notice.

1
 Workbook Module 14
INTRODUCTION TO THE INTEGUMENTARY SYSTEM

The integumentary system consists of the skin (known as the cutaneous membrane) and the
accessory organs (hair, nails, sweat glands, and sebaceous glands). The skin is only a few
millimetres at its thickest, yet is by far the largest organ in the body accounting for approximately 16%
of body weight. The integumentary system contains many cutaneous receptors that allow us to
detect damaging or potentially damaging stimuli in our environment. The skin allows us to excrete
wastes, synthesis vitamin D, regulate body temperature and forms a protective barrier for the body.

Being a barrier to the outside environment the skin is an integral part of appearance as it is often one
of the first things people will notice. For many centuries skin has been modified through procedures
such as tanning or lightening of the skin, removal of hair, use of dermal fillers, as well as being adorned
and embellished by make-up, tattoos and piercings in a bid to modify appearance and communicate
with the outside world.

To successfully complete Workbook Module 14 you will need to have completed the  The

Integumentary System: Anatomy Key Concept Module,  The Integumentary System:

Accessory Structures Key Concept Module and  The Integumentary System: Physiology Key
Concept Module available to you on the unit site.

You will also need access to the  Virtual Laboratory PowerPoint Presentation and the

 OpenStax Anatomy and Physiology Textbook.

2
 THE CUTANEOUS MEMBRANE

The cutaneous membrane is the medical term for skin. The superficial epidermal layer of the
cutaneous membrane is composed of a keratinised stratified squamous epithelium. The deeper
dermal layer is mostly composed of a dense irregular connective tissue. Unlike the epithelial
membranes of the body, the cutaneous membrane is a relatively dry membrane.

Examine the model of sectioned segments of thick and thin skin within the  Virtual Laboratory
PowerPoint Presentation. Identify and label the following structures:

• Epidermis
• Dermis
• Hypodermis1
• Adipose tissue
• Hair follicle
• Dermal papillae
• Hair bulb
• Hair shaft
• Sebaceous gland
• Sweat gland
• Arrector pili muscle
• Cutaneous receptors

1
The hypodermis is technically not part of the skin.

Epidermis

The epidermis of skin is a keratinised stratified squamous epithelium that contains several
discrete layers for maximum protection. This is necessary due to the friction and mechanical forces
which act upon skin.

Depending on where skin is located on the body, the epidermis will vary in thickness. For instance,
thin skin (that is only 0.3 millimetres thick) can be found in areas like that back of your knees, while
thick skin (that is up to 4 millimetres thick) can be found on the soles of the feet and the palms of the
hands.

The predominant cell type within the epidermis is the keratinocyte. Keratinocytes form epidermal
keratin that accumulates within maturing cells effectively waterproofing the cells. This accumulation
of keratin blocks the diffusion of nutrients and wastes into and out of the cell, and consequently the
cell dies. Epithelia with layers of dead cells full of keratin at their surface are said to be keratinised.

3
Keratinised stratified squamous epithelium is found almost exclusively in the skin.

In fewer numbers within the epidermis we find:

• Melanocytes: perform melanogenesis – a

multistage chemical process that produces the
coloured melanin pigment. Melanin pigments
can be classified into two major types -
eumelanin (dark brown and black) and
pheomelanin (yellow, red, and light brown).
Melanin has several functions but the most
apparent is its protective function against UV-
induced DNA damage. In a sense, melanin
functions like a biological sunscreen.
• Intraepidermal macrophages (also known as
Langerhans cells): most prominent in the stratum spinosum, provide immune defence – can
perform phagocytosis and antigen presentation.
• Merkel cells: are highly sensitive receptor cells associated with sensory neurons in the skin
that enable pressure detection.

Epidermal Layers

The epidermis is made up of four or five discrete layers of epithelial cells depending on its location in
the body. Skin that has four layers is classified as thin skin (most skin of the body is classified as thin
skin). Skin that has five layers is classified as thick skin and found on the palms of the hands and
soles of the feet.

• Stratum basale: (also known as the stratum germinativum) is the deepest layer of the
epidermis where cell proliferation occurs. The stratum basale is made up of a single layer of
basal cells (cuboidal-shaped keratinocyte stem-cell precursors). The daughter cells move up
the strata as they undergo multiple stages of cellular differentiation. Keratinocytes are
appropriately named as they produce the most important protein of the epidermis, keratin.
Merkel cells and melanocytes are also found here.
• Stratum spinosum: is composed of eight to 10 layers of keratinocytes named due to spinney
shaped cells. The spiny protrusions are cell processes that join neighbouring cells via a
structure called a desmosome. The keratinocytes in the stratum spinosum begin the synthesis
of keratin. Interspersed among them are the intraepidermal macrophages.

4
 • Stratum granulosum: three to five layers of cells named from the fact the cells in this layer
contain many granules. In this layer the cells produce a lot of keratin and the cells become
filled – a process known as keratinisation.
• Stratum lucidum: (thick skin only) derives its names form the lucid (clear) appearance it has
under a microscope. Cells in this layer are densely packed with eleidin (a clear protein rich in
lipids) which gives these cells their transparent appearance and provides a barrier to water.
This is the additional layer that makes thick skin thick and more water repellent than thin skin.
• Stratum corneum: The horny layer filled with cornified cells. Keratinocytes are called
corneocytes at this layer as they are completely devoid of a nucleus (terminally differentiated)
and are in essence a mass of protein rather than a cell. The corneocytes serve as a hard
protective layer against environmental trauma such as abrasion, light, heat, chemicals, and
microorganisms. The corneocytes eventually shed into the environment. This layer is thicker
in thick skin but consists of anywhere between 15 to 30 layers of corneocytes.

A mnemonic to help you remember the strata of the epidermis from superficial to deep:

COME! LET’S GET SOME BEER!

Corneum | Lucidum | Granulosum | Spinosum | Basale

Dermis

The dermis is the deep layer of the skin found under the epidermis. It consists of two layers – a thin
papillary layer attached to the epidermis with thin loosely arranged fibres of collagen, and a thick
reticular layer composed of dense irregular connective tissue, along with nervous tissue and blood
vessels. Overall, the dermis is much thicker than the epidermis and gives the skin its strength and
elasticity.

The papillary layer contains many nipple-like extensions called dermal papillae that protrude toward
the epidermis. The dermal papillae increase the surface area between the dermis and epidermis, thus
strengthening the connection between the two layers to prevent separation. Interestingly, the pattern
of ridges and grooves formed by the dermal papillae can then be observed on the surface of the skin
as friction ridges in certain areas of the body. It is likely you have heard of friction ridges on the
fingertips by their more commonly known name – fingerprints. Fingerprints are even more unique
than DNA – even identical twins who share DNA will not have identical fingerprints.

Contained with the dermal papillae are many nerves and blood vessels. Blood flowing through the
dermal papillae provides O2 and nutrients for the highly mitotic cells of the stratum basale.

5
Why is the reticular layer of the dermis composed of dense irregular connective tissues and not dense
regular connective tissue?

Match the skin layer or cell type with its description in the following cutaneous membrane activity.
A. Dermal papillae
B. Dermis
C. Epidermis
D. Keratinocyte
E. Melanocyte
F. Stratum basale
G. Stratum corneum

Layer of epidermis where there is rapid cell division

Vascular connective tissue beneath the epidermis of the skin

Tough, water repellent layer; contains dead squamous shaped cells

Cells that produce keratin which forms the waterproofing of the skin

Projections of dermis that cause epidermal ridges

Epithelial layer of skin

Produce the pigment that shields cells form UV radiation

ACCESSORY STRUCTURES OF THE SKIN

Accessory structures (also referred to as skin appendages) are skin-associated structures that
include hairs (and associated arrector pili), nails, sweat glands and sebaceous glands.
Embryologically these structures originate from the epidermis and can extend down as far as the
hypodermis. Each structure has its own unique structure, function, and histology.

6
Access the readings on ‘Hair’, ‘Nails’, ‘Sweat glands’ and ‘Sebaceous glands’ under section  5.2 |
Accessory Structures of the Skin (OpenStax Anatomy and Physiology) and complete the following
table by summarising the key features and functions of the accessory structures in the following table.

STRUCTURE FEATURES AND FUNCTIONS

Hair

Nails

Sweat glands

Sebaceous glands

A hair and its associated arrector pili muscle and sebaceous gland form a pilosebaceous unit.
Pilosebaceous units are found in nearly all regions of the skin except for the lips, palmar and plantar
surfaces, and are most dense on the scalp.

PHYSIOLOGY OF THE INTEGUMENTARY SYSTEM

Protection

Apart from the physical protection offered by the tough, stratified, epidermal layer, the outer layer of
skin is also slightly acidic. With a pH of approximately 5.5 on its surface, skin is often referred to as
an ‘acid mantel’. The acid mantel is actually a thin film on the surface of the skin composed of a mix
of lipids and amino acids (from sebaceous and sweat glands) that creates a chemical barrier that
prevents microbial overgrowth.

7
Dry, red, sensitive, or flaky skin can all be signs that pH of the skin is out of whack. Certain soaps and
cleansers with strong detergent molecules can strip the skin of its natural oils making it more
challenging for the skin to maintain its optimal pH.

Temperature homeostasis

The skin is able to reduce body temperature through sweating and the vasodilation of blood vessels.
Sweat produced by eccrine sweat glands delivers water to the surface of the body where it begins
to evaporate. The evaporation of sweat absorbs heat and cools the surface of the body. Vasodilation
is the process through which blood vessels in the dermis relax and allow more blood to flow to the
skin. As blood transports heat through the body, heat is transported from the core and is deposited in
the skin where it can then radiate out of the body and into the external environment.

Conversely, vessels in the skin can undergo vasoconstriction to reduce blood flow to the skin
maintaining blood flow around the body’s core and vital organs in situations of low temperature.
Another mechanism to preserve heat is the contraction of the arrector pili muscles. Contraction of
the arrector pili muscles forms goose bumps by moving the hair follicle and lifting the hair shaft
upright from the surface of the skin. This movement results in more air being trapped under the hairs
that is warmed and used to insulate the surface of the body.

Cutaneous Sensation

The skin allows the body to sense its external environment by picking up signals for touch, pressure,
vibration, temperature, and pain through sensory receptors in or beneath the skin. The density of
these sensory receptors in the skin varies throughout the body, resulting in some regions of the body
being more sensitive to touch, temperature, or pain than other regions.

Absorption and Excretion

The absorptive properties of skin allow a substance applied to be conveyed into the blood stream,
and is a function of skin that is increasingly exploited in medicine. The most common mechanism of
drug administration through the skin is with the use of ointments. Thin skin has an increased
absorptive function in comparison to thick skin, and areas that are rich in sweat glands or hair follicles
will have greater absorption yet, as substances can pass through these structures. Logically, any
change in the horny layer will favour absorption.

Sweat produced by eccrine sweat glands contains mostly water with many electrolytes and a few
other trace chemicals (the most common electrolytes being sodium and chloride). When these
electrolytes reach high levels in the blood, their presence in sweat also increases, helping to reduce

8
their presence within the body. In addition to electrolytes, sweat helps to excrete small amounts of
metabolic waste products such as lactic acid, urea, uric acid, and ammonia.

Vitamin D Synthesis

Vitamin D is an essential vitamin necessary for increasing the intestinal absorption of calcium from
food. The major natural source of the vitamin is synthesis of cholecalciferol in the skin from cholesterol
through a chemical reaction that is dependent on ultraviolet light striking the skin.

Blood Reservoir

Blood vessels of the skin store approximately 5% of total blood volume. This blood is diverted from
the skin to the internal organs if there is blood loss (for example, following an injury) or when there is
an increased demand for oxygen and nutrients (for example, when a person is exercising).

BURNS

Burns are a common injury type seen in hospitals all around the world that result from skin
encountering (and subsequently becoming damaged) by a heat source. Burns can result from fire,
scalding, electricity, radiation, and chemicals with symptoms ranging from a feeling of minor
discomfort to a life-threatening emergency. Thermal burns are by far the most common type of burn.

Burns are categorised based on their severity. Severity of a burn is a combination of its depth and
size. It is important to note that electrical burns can be deceiving as they often occur with small entry
and exit wounds but extensive internal damage in between.

Depth

Burn depth is classified as either, first, second, third, or fourth degree and will be discussed during
class time. You can record your working below.

First degree burns (also known as superficial burns)

9
Superficial burns can be treated at home with the 4C’s of minor burn care and will usually heal on
their own.

• Cooling to prevent progression of the burn

• Cleaning with soap or a mild antibacterial wash
• Covering with an absorbent dressing or burn dressing
• Comfort with use of over-the-counter pain medications if necessary

Second degree burns (also known as partial thickness burns)

Third degree burns (also known as full thickness burns)

Fourth degree burns

10
Size

The size of a second of third-degree burn can be quickly estimated by first responders using the ‘Rule
of Nines’ (sometimes called the Wallace Rule of Nines) assessment method. The ‘Rule of Nines’
divides the surface area of the body into factors of nine which allows the size of a burn to be estimated
relative to total surface area. Measurement of the initial surface area damaged is critical in estimating
fluid resuscitation requirements. The removal of the skin barrier due to burns quickly leads to fluid
loss and dehydration. Morbidity and mortality tend to increase as the total surface area of a burn
increases.

Access the readings on ‘Burns’ under section  5.4 | Diseases, Disorders, and Injuries of the
Integumentary System (OpenStax Anatomy and Physiology) and record the assigned percentages to
the different body regions.

11
Burn Complications

The most common systemic complications of burns are hypovolemia and infection.

• Hypovolemia: result from burns that are deep or involve large percentages of total surface
area (>20%) leading to massive fluid loss, hypoperfusion, and sometimes shock
• Infection: impaired host defenses and devitalised tissue enhance bacterial invasion and
growth. Infection is a common cause of sepsis and mortality, as well as local complications
with burn patients

Multiple organ dysfunction syndrome (MODS) is a progressive physiological disorder that affects
two or more organ systems leading to an inability to maintain homeostasis following acute injury or
illness. The incidence of MODS increases when burns exceed 20% of total surface area.

Wound Healing

Wound healing will be discussed in class. You can record your working below.

12
 Word Element Glossary
adip/o fat epi- above, on, upon
-aesthesia feeling, sensation -graft transplant of tissue
-crine secrete granul/o granules
cut/i skin immune/o protection
cutane/o skin kerat/o hard, horny tissue
-cyte cell macro- large
derm/o skin melan/o black
derm/a skin onycho- pertaining to nails
diaphor/o profuse sweating sudor/o sweat

13