The Integumentary System

Adapted from HASPI Labs

Background:
The integumentary system is made up of the skin, hair, nails, sweat glands, and
sebaceous glands. The skin is the largest organ in the body. It makes up 12-15% of
body weight and has an entire surface area between 1-2 meters. Our skin is our first
barrier against infectious disease and prevents fluid loss from our organs, which allows
our body to maintain homeostasis. The skin is such an important organ that even
moderate burns on more than 30% of the skin can be life-threatening due to fluid loss
and infection.

The primary functions of the integumentary system include:

 Maintain internal temperature (sweating and shivering)
 Receive of pressure, pain, heat, and cold
 Produce and secrete melanin and vitamin D
 Protect the body from infection
 Maintain fluid balance

The skin has 3 layers called the epidermis, dermis, and hypodermis.

The Epidermis:
The epidermis is the outermost layer of the skin. There are four types of cells that make
up the epidermis: melanocytes that produce melanin (influences skin color),
keratinocytes that produce keratin, Merkel’s cells that function in touch, and
Langerhans’ cells that function in immunity. There are a few layers, called strata, that
make up the epidermis. The epidermis is avascular and all nutrients for the living cells
of the epidermis diffuse from the basement membrane of the dermis below it. From the
superficial layer to the deep layer, the strata include:
 Stratum corneum: This is the outer layer that we see and is made up of layers
of dead keratinized cells. This layer is tightly bound together, and the keratin
protects the underlying cells from fluid loss while keeping the skin elastic. In a
process called desquamation, cells of the stratum corneum are sloughed off. Cells
from the epidermis are completely shed every 35-45 days, so essentially you have
completely new skin every month and a half!
 Stratum lucidum: This layer of dead keratinized cells is only found in areas
where skin is thick, such as the soles of the feet, and is not found in thin skin areas,
such as the forearm.
 Stratum granulosum: The cells of this layer are still living, but none of the
nutrients reach them. These cells begin producing keratin and the cells begin to
die. Eventually, the keratin protein produced will make up the majority of the dead
cells in the next two layers.
 Stratum spinosum: These cells are “spiny” as the name denotes. They have
been pushed out from the stratum basale and the spines interlock together to form a
support layer.
  Stratum basale: A layer of single cells that lays on the basement membrane of
the dermis. These cells continuously divide and push up towards the surface of the
skin.

The Dermis:
The dermis is the layer below the epidermis. The dermis is primarily made up of
connective tissue layers and proteins including collagen, elastin, and reticular fibers.
The arrangement of these fibers allows for the dermis to be extremely elastic and
flexible. It also allows for blood vessels, glands, hair follicles, and nerves to be
embedded in the dermis. The two main glands embedded in the skin include the sweat
and sebaceous glands. The sweat glands assist the body in temperature control. The
sebaceous glands produce oils that keep the outer layer of skin and hair moisturized.
Hair and nail growth begin in the dermis. Highly keratinized epithelial cells are arranged
to make up hair and nails.

The Hypodermis:
The hypodermis is the bottommost layer of skin, located under the dermis. This layer is
primarily made up of adipose tissue and functions in insulation and protection. The
base of blood vessels, nerves, and some hair follicles also extend into the hypodermis.

Skin Disorders:
There are more than 2,000 diseases and disorders that can affect the integumentary
system. The following table summarizes a few common skin disorders. The prevalence
is within the United States only for the year 2004.

Skin Description Symptoms Prevalence

Disorder
Herpes A virus that can cause Painful blisters, itching, 165 million
Simplex blisters such as cold sores burning, flu-like symptoms
and fever blisters
Dermatitis Inflammation of the dermis Skin lesions, swelling, itching, 87.5 million
redness
Varicose Swollen and clogged veins in Limb pain, visible veins, skin 62.4 million
Veins the extremities ulcers, brown coloration in
limbs, swelling
Warts Growths caused by human Growth with rough surface, 58.5 million
papillomavirus (HPV); maybe be itchy and/or painful
transmitted by contact
Eczema Chronic skin condition that Blisters, dry skin, discharge, 39.5 million
causes itchy, scaly rashes bleeding, redness,
inflammation
Cellulitis Bacterial skin infection Fever, pain, inflammation, 7.6 million
caused by Staphylococcus stretched skin, swelling, heat,
and Streptococcus sweating, fatigue
Staph Bacterial skin infection Boils, impetigo, cellulitis, 1.2 million
Infection caused by Staphylococcus bacteremia, toxic shock
 syndrome, septic arthritis
Diagnostic Tests for Skin Disorders:
The branch of medicine that focuses specifically on diseases of the integumentary
system is called dermatology. A dermatologist is a board-certified medical doctor with
additional training in skin, hair, and nail disorders. There are many types of tests
available to diagnose specific skin disorders. Three of the most common tests that are
performed when a skin disorder is suspected include:
 Skin Biopsy – When abnormal growths appear on the skin that may be
indicative of cancer, a skin biopsy may be performed. The suspect area of skin is
removed, and a pathology lab will prepare and examine the tissue microscopically to
determine whether the skin may be cancerous.
 Patch Test – These are used to detect whether an allergy may be causing the
skin disorder. A variety of allergens such as pollen, animal dander, milk proteins,
etc. can be applied to the skin directly, or through subcutaneous injections. The skin
is observed for a period of time for any redness, swelling, or itching that would
indicate an allergic reaction to that allergen. The image to the right shows a
common patch test.
 Skin Culture – When a bacterial, fungal, or viral infection is suspected of
causing a skin disorder, a skin culture can be taken. The culture may include
samples of tissue or fluids present in the affected portion of the skin. The sample is
then grown on different types of media in an attempt to identify the specific
microorganism that may be causing the skin infection.

REVIEW QUESTIONS:
1. What organs make up the integumentary system?
The integumentary system is made up of the skin, hair, nails, sweat glands, and
sebaceous glands.

2. What percent of body weight is the skin?

. It makes up 12-15% of body weight

3. What are the functions of the skin?

Our skin is our first barrier against infectious disease and prevents fluid loss from
our organs, which allows our body to maintain homeostasis.

4. What are the 3 main layers of the skin?

Epidermis, dermis, and hypodermis.

5. What are the four types of cells that make up the epidermis, and what is the
function of each?
The four types of cells that make up the epidermis are:
- Melanocytes – produce Melanin
- Keratinocytes – Produce Keratin (hair and nails)
- Merkel Cells – function with touch
- Langerhans - immunity
 6. Since the epidermis is avascular, how does it get nutrients?
All nutrients for the living cells of the epidermis diffuse from the basement membrane
of the dermis below it.

7. What is desquamation? How long does it take for a cell produced in the stratum
basale to be sloughed off at the stratum corneum?
Cells of the stratum corneum are sloughed off. Cells from the epidermis are
completely shed every 35-45 days

8. What types of proteins make up the dermis?

The dermis is primarily made up of connective tissue layers and proteins
including collagen, elastin, and reticular fibers

9. What structures can be found embedded in the dermis?

Structures such as blood vessels, glands, hair follicles, and nerves.

10. What is the function of sweat glands?

The sweat glands assist the body in temperature control.

11. What is the function of sebaceous glands?

Sebaceous glands produce oils that keep the outer layer of skin and hair
moisturized.

12. What are hair and nails made up of?

Highly keratinized epithelial cells are arranged to make up hair and nails.

13. According to the table in the background, what skin disorder was most prevalent
in the U.S. in 2004? What are the symptoms?
Herpes Simplex - Painful blisters, itching, burning, flu-like symptoms

14. What is a skin biopsy and what is it used to diagnose?

 A skin biopsy is when an area of skin is removed, and a pathology lab will
prepare and examine the tissue microscopically to determine whether the skin may
be cancerous.

15. What is a patch test and what is it used to diagnose?

Patch tests are used to diagnose allergies. Different allergens can be applied or
injected into the skin, to which it would be observed for redness, swelling, or any
other indication of irritation.

16. What is skin culture and what is it used to diagnose?

Samples of infected skin are taken and then it is grown on different types of media to
identify the issues. Used to identify Bastiral, fungal or viral infections