Integumentary System

Protective Covering and First Line of Defense

Integumentary system
Consists of the skin and accessory organs; hair, nails, and
cutaneous glands
Inspection of the skin, hair, and nails is significant part of a
physical exam
Skin is the most vulnerable organ
Exposed to radiation, trauma, infection, and injurious
chemicals
Receives more medical treatment than any other organ
system
Dermatology—scientific study and medical treatment of the
integumentary system
The Skin and Subcutaneous Tissue
Skin Trivia
21 Square Feet

4 Kilograms/9 pounds,
7% - 15% of Total Body Weight
Complex Combination of Tissues

Continuous Layer
One Square Inch Contains
20 Blood Vessels 100 Sebaceous/Oil Glands
65 Hairs & Hair Muscles 1300 Nerve Endings
78 Nerves 19,500,000 Cells
78 Sensors for Heat 0.5 Million Cells Dying & Being
13 Sensors for Cold Replaced
160 Sensors for Pressure
 Layers/Regions of the Skin
Epidermis

• Most Superficial

Dermis

• Tough, Leathery Fibrous Connective Tissue; Only Part Vascularized

Subcutaneous(Hypodermis)

• Superficial Fascia
• Mostly Fat (Insulate & Absorb Shock)
• Anchors Skin to Underlying Structures
The Skin and Subcutaneous Tissue
Skin is body’s largest and heaviest organ

• Covers 1.5 to 2.0 m2 ; composes 15% of body weight

Layers

• Epidermis: stratified squamous epithelium

• Dermis: deeper connective tissue layer
• Hypodermis—connective tissue layer below dermis
(not part of skin, but associated with it)
The Skin and Subcutaneous
Tissue
Skin is body’s largest and heaviest organ
• Skin thickness ranges from 0.5 to 6 mm
• Thick skin covers front of hands, bottoms of feet
Has sweat glands, but no hair follicles or sebaceous (oil)
glands
Epidermis 0.5 mm thick
• Thin skin covers rest of the body

Possesses hair follicles, sebaceous glands, and sweat glands

Epidermis about 0.1 mm thick

 Functions of the SKIN
Resistance to trauma and infection
• Keratin
• Dermacidin and defensins
• Acid mantle

Other barrier functions

• Water
• UV radiation
• Harmful chemicals

Vitamin D synthesis
• Skin carries out first step
• Liver and kidneys complete process
 Functions of the SKIN
Sensation
• Skin is an extensive sense organ
• Receptors for temperature, touch, pain, and more

Thermoregulation
• Thermoreceptors
• Vasoconstriction/vasodilation
• Perspiration

Nonverbal communication
• Facial expression
• Importance in social acceptance and self-image
The Epidermis
 The Epidermis
Epidermis—keratinized Outer layer of stratified
stratified squamous squamous epithelial tissue
epithelium Avascular
Includes dead cells at skin Complete regeneration every
surface packed with tough 35-45 days
keratin protein Thinner on scalp and armpit
Lacks blood vessels than on sole of foot
 Depends on the diffusion of
Cells of the epidermis
nutrients from underlying
connective tissue
Contains sparse nerve endings
for touch and pain
Cells of the Epidermis
Five epidermal cell types
1. Stem cells
 Undifferentiated cells that give rise to keratinocytes
 In deepest layer of epidermis (stratum basale)

2. Keratinocytes
 Great majority of epidermal cells
 Synthesize keratin

3. Melanocytes
 Synthesize pigment melanin that shields DNA from ultraviolet radiation
 Occur only in stratum basale but have branched processes that spread among
keratinocytes and distribute melanin
Cells of the Epidermis
Five epidermal cell types
4. Tactile cells
Touch receptor cells associated with dermal nerve fibers
In basal layer of epidermis

5. Dendritic cells
Macrophages originating in bone marrow that guard against pathogens
Found in stratum spinosum and granulosum
Layers of the Epidermis
 Thin skin contains four strata; thick
skin contains five strata

 Stratum basale
 (deepest epidermal layer)
A single layer of stem cells and
keratinocytes resting on the
basement membrane
Stem cells divide and give rise to
keratinocytes that migrate toward
skin surface to replace lost cells
Also contains a few melanocytes and
tactile cells
 Layers of the Epidermis
 Stratum spinosum
 Several layers of keratinocytes joined
together by desmosomes and tight
junctions
 Named for appearance of cells after
histological preparation (spiny)
 Also contains some dendritic cells
 Layers of the Epidermis
 Stratum granulosum
Three to five layers of flat
keratinocytes
Cells contain dark-staining
keratohyalin granules
 Layers of the Epidermis
 Stratum lucidum
Thin, pale layer found only in
thick skin
Keratinocytes packed with clear
protein eleidin
 Stratum corneum (surface
layer)
Several layers (up to 30) of dead,
scaly, keratinized cells
Resists abrasion, penetration,
water loss
 Layers of the Epidermis
Based on the number of layers (strata) in Epidermis we have
two types of skins

Thin Skin Thick Skin

The rest of the body in high-abrasion areas (palms, soles)
Surface 4 Stratum corneum 5 Stratum corneum
4 Stratum lucidum
3 Stratum granulosum 3 Stratum granulosum
2 Stratum spinosum 2 Stratum spinosum
1 Stratum basale 1 Stratum basale
Deep
The Life History of a
KERATINOCYTE
 Keratinocytes are produced by mitosis of stem cells in stratum basale or
mitosis of keratinocytes in deepest part of stratum spinosum
 Mitosis requires abundant oxygen and nutrients, so once cells migrate away from blood
vessels of the dermis, mitosis cannot occur
 New keratinocytes push older ones toward the surface
 Over time, keratinocytes flatten, produce more keratin and membrane-
coating vesicles
 In 30 to 40 days a keratinocyte makes its way to the skin surface and flakes
off (exfoliates) as dander
 Slower in old age
 Faster in injured or stressed skin
 Calluses or corns—thick accumulations of dead keratinocytes on hands or feet
The Life History of a
KERATINOCYTE
Four important events occur in stratum granulosum
 The Life History of a
KERATINOCYTE
Epidermal water barrier
Water retention is fostered by tight
junctions between skin cells and the
waterproofing that occurs in the
stratum granulosum
Helps prevent dehydration
Does not prevent the absorption of water
by the stratum corneum when we soak in
a bath (“prune fingers”)
The Dermis
Dermis—connective tissue layer beneath epidermis
Ranges from 0.2 mm (eyelids) to 4 mm (palms, soles)
Composed mainly of collagen
Well supplied with blood vessels, sweat glands, sebaceous
glands, and nerve endings
Houses hair follicles and nail roots
Is the tissue of the facial skin to which skeletal muscles attach
and cause facial expressions of emotion
Has a wavy, conspicuous boundary with the superficial
epidermis
Dermal papillae are upward, finger-like extensions of dermis
Epidermal ridges are downward waves of epidermis
Prominent waves on fingers produce friction ridges of fingerprints
 Characteristics of Dermis
Strong, flexible connective tissue
Hide of the skin
Cells: fibroblasts, macrophages, mast cells, WBCs
Collagen, elastin (stretch-recoil), reticular fibers
Wrinkling of elderly = loss of elastin and subcutaneous
fat
 Contents of Dermis
 Blood vessels Sudoriferous/sweat glands
 Capillaries (eccrine & apocrine)
 Lymphatic vessels Sebaceous/oil glands (sebum =
 Nerves
lubricant)
Ceruminous glands
 Hair shafts & hair follicles (anagen
(cerumen/earwax)
= growing follicle, telogen =
Sensory receptors
resting follicle)
 Arector pili (hair muscles)
 The Dermis
 Papillary layer—superficial zone of dermis
 Thin zone of areolar tissue in and near the
dermal papilla
 Allows for mobility of leukocytes and other
defense cells
 Rich in small blood vessels
 Connects epidermis to dermis
 Connective tissue
 Capillaries
 Pain receptors
 Touch receptors (Meissner’s
corpuscles)
 Dermal ridges (palms & soles):
create epidermal ridges for friction &
gripping; sweat on ridges =
fingerprints, footprints
 The Dermis
 Reticular layer—deeper and thicker layer of
dermis
 Consists of dense, irregular connective tissue
 Stretch marks (striae): tears in the collagen
fibers caused by stretching of the skin due to
pregnancy or obesity
 80% of dermis
 Deep dermis of collagen for elasticity
 Dense irregular connective tissue
 Collagen strength, resilience, hydration
 Lines of cleavage/tension lines
(longitudinal = head & limbs, circular =
neck & trunk): parallel incisions heal
better and faster
The Hypodermis
 The Hypodermis
Hypodermis
Subcutaneous tissue
Has more areolar and adipose than dermis has
Pads body and binds skin to underlying tissues
Common site of drug injection since it has many
blood vessels
Subcutaneous fat
Energy reservoir
Thermal insulation
Thicker in women
Thinner in infants, elderly
SKIN COLOR
 Color of the Skin
 Melanin—most significant factor in skin color
 Produced by melanocytes, accumulates in keratinocytes
 melanin is transferred into the keratinocytes via a cellular vesicle called a melanosome
 Exposure to the UV rays of the sun or a tanning salon causes melanin to be manufactured
and built up in keratinocytes
 All humans have same number of melanocytes, so color differences are due to amount
and form of melanin
 Freckles appear with irregular accumulation of melanocytes in the skin.

 Two forms of the pigment

 Eumelanin—brownish black
 Pheomelanin—reddish yellow (sulfur-containing)
 Color of the Skin
People of different skin colors have the same number of
melanocytes
Darker skinned people
 Produce greater quantities of melanin
 Melanin breaks down more slowly
 Melanin granules more spread out in keratinocytes
 Melanized cells seen throughout the epidermis
Lighter skinned people
 Melanin clumped near keratinocyte nucleus
 Little melanin seen beyond stratum basale
 Color of the Skin
Exposure to UV light stimulates melanin secretion and darkens skin
This color fades as melanin is degraded and old cells are exfoliated

Other pigments can influence skin color

Carotene—yellow pigment acquired from egg yolks and yellow/orange
vegetables
 Concentrates in stratum corneum and subcutaneous fat
 Yellow to orange pigment (carrot's color)
 Most obvious in palms and soles
 Accumulates in stratum corneum and hypodermis
 Can be converted to vitamin A for vision and epidermal health
 Color of the Skin
Other pigments can influence skin color
Hemoglobin—pigment in red blood cells
Adds reddish to pinkish hue to skin
Skin of Caucasians is more transparent, so color of hemoglobin shows
through
Sudden drop in oxygenation can affect skin color, causing the skin to
initially turn ashen (white).
With a prolonged reduction in oxygen levels, dark red deoxyhemoglobin
becomes dominant in the blood, making the skin appear blue.
This happens when the oxygen supply is restricted, as when someone is
experiencing difficulty in breathing because of asthma or a heart attack .
Color of the Skin
Colors of diagnostic value
Cyanosis—blueness due to oxygen deficiency
Erythema—redness due to increased blood flow to skin
Pallor—paleness due to decreased blood flow to skin
Albinism—milky white skin and blue-gray eyes due to genetic
lack of melanin synthesizing enzyme
Jaundice—yellowing due to bilirubin in blood (can be caused
by compromised liver function)
Hematoma—bruising (clotted blood under skin)
 The Evolution of Skin
Color
Variations in skin color result from multiple evolutionary
selection pressures, especially differences in exposure to UV
light (UV accounts for up to 77% of skin tone variation)
UV light has both harmful and beneficial effects
Adversely: it causes skin cancer, breaks down folic acid
Beneficially: it stimulates vitamin D synthesis
Populations that evolved in the tropics have well- melanized
skin to protect against excessive UV
 The Evolution of Skin
Color
Populations that evolved in far northern and southern
latitudes (weak sun) have light skin to allow adequate
UV
Populations that evolved at high altitudes or dry
climates (less UV filtering) also are darker skinned
Importance of vitamin D for calcium (crucial for
pregnancy, lactation) might explain why women are
lighter skinned than men
 The Evolution of Skin
Color
Other factors complicate the association
between UV exposure and skin tone
Migration, cultural differences in clothing, and shelter
Intermarriage of people of different geographic
ancestries
Sexual selection: a preference in mate choice for
partners of light or dark complexion

Skin Markings
Friction ridges—markings on the fingertips that
leave oily fingerprints on surfaces we touch
Everyone has a unique pattern formed during fetal
development that remains unchanged throughout
life
Not even identical twins have identical fingerprints
Allow manipulation of small objects
 Flexion lines (flexion creases)—lines on the
flexor surfaces of the digits, palms, wrists, elbows
Mark sites where skin folds during flexion of joints
Skin bound to deeper tissues along these lines
 Skin Markings
Freckles and moles—tan to black aggregations of
melanocytes
Freckles—flat, melanized patches
Moles (nevi)—elevated, melanized patches often with hair
Moles should be watched for changes in color, diameter, or contour that may
suggest cancer
 Hemangiomas (birthmarks)—patches of discolored skin
caused by benign tumors of dermal capillaries
Some disappear in childhood, others last for life
Capillary hemangiomas, cavernous hemangiomas, port-wine stain
Accessory Organs of the
Skin
Hair, Nails, Sweat Glands, Sebaceous Glands
 Hair and Nails
Hair, nails, and cutaneous glands are accessory
organs (appendages) of the skin
Hair and nails are composed of mostly dead,
keratinized cells
Pliable soft keratin makes up stratum corneum of
skin
Compact hard keratin makes up hair and nails
Tougher and more compact due to numerous cross-
linkages between keratin molecules
 Hair
Pilus—another name for a hair; pili—plural of pilus
Hair—a slender filament of keratinized cells growing from a
tube in the skin called a hair follicle
Hair covers most of the body
Hair does not cover: palms, soles; palmar, plantar, and lateral surfaces and
distal segments of fingers and toes; lips, nipples, and parts of genitals
Limbs and trunk have 55 to 70 hairs per cm2
 Face has about 10 times as many
100,000 hairs on an average person’s scalp
Differences in hairiness across individuals is mainly due to differences in
texture and pigment of hair
 Hair
Three types of hair
1. Lanugo: fine, downy, unpigmented hair that appears on the
fetus in the last 3 months of development
2. Vellus: fine, pale hair that replaces lanugo by time of birth
 Two-thirds of the hair of women
 One-tenth of the hair of men
 All of hair of children except eyebrows, eyelashes, and hair of the scalp

3. Terminal: longer, coarser, and more heavily pigmented

 Forms eyebrows, eyelashes, and the hair of the scalp
 After puberty, forms the axillary and pubic hair
 Male facial hair and some of the hair on the trunk and limbs
Structure of the Hair and
Follicle
Hair is divisible into three
zones along its length
Bulb: a swelling at the base
where hair originates in dermis
or hypodermis
 Only living hair cells are in or near
bulb
Root: the remainder of the hair
in the follicle
Shaft: the portion above the
skin surface
 Structure of the Hair and
Follicle
Dermal papilla—bud of
vascular connective tissue
encased by bulb
Only source of nutrition
for hair
Hair matrix—region of
mitotically active cells
immediately above papilla
Hair’s growth center
 Structure of the Hair and
Follicle
Three layers of the hair in cross section
Medulla
 Core of loosely arranged cells and air spaces
Cortex
 Constitutes bulk of the hair
 Consists of several layers of elongated keratinized
cells
Cuticle
 Composed of multiple layers of very thin, scaly cells
that overlap each other
 Free edges directed upward
 Structure of the Hair and
Follicle
Follicle—diagonal tube that
extends into dermis and possibly
hypodermis
Epithelial root sheath
Extension of the epidermis lying
adjacent to hair root
Widens at deep end into bulge—
source of stem cells for follicle
growth
Connective tissue root sheath
Derived from dermis but a bit
denser
Surrounds epithelial root sheath
 Structure of the Hair and
Follicle
Hair receptors—sensory
nerve fibers entwining follicles
Piloerector muscle (arrector
pili)—smooth muscle attaching
follicle to dermis
Contracts to make hair stand
on end (goose bumps)
 Hair Texture and Color
Texture—related to cross-sectional shape of hair
Straight hair is round
Wavy hair is oval
Curly hair is relatively flat
Color—due to pigment granules in the cells of the cortex
Brown and black hair is rich in eumelanin
Red hair has high concentration of pheomelanin
Blond hair has an intermediate amount of pheomelanin and very little
eumelanin
Gray and white hair have little or no melanin
Air present in medulla
 Hair Growth
Three stages of hair cycle
and Loss
1. Anagen: growth stage
90% of scalp follicles at a given time
Stem cells multiply
Root sheath cells above papilla form hair cells of hair matrix
Hair cells make keratin and die as they are pushed upward

2. Catagen: degeneration stage

Mitosis in hair matrix ceases and sheath cells below bulge die
Base of hair keratinizes into a hard club—club hair
 Easily pulled out by brushing

3. Telogen: resting stage

When papilla reaches the bulge
 Hair Growth and Loss
We lose about 50-100 hairs daily
A club hair may fall out during catagen or telogen or be pushed out in the next
anagen phase
In young adults, scalp follicles spend 6–8 years in anagen, 2–3 weeks in catagen, 1–2
months in telogen
Hair growth—scalp hairs grow 1 mm per 3 days
Alopecia—thinning of the hair or baldness
Pattern baldness—hair lost from select regions
Baldness allele is dominant in males and expressed when testosterone levels are
high
Testosterone causes terminal hair on top of scalp to be replaced by vellus hair
Hirsutism—excessive or undesirable hairiness in areas that are not usually
hairy
 Functions of Hair
 Most hair on trunk and limbs is vestigial
Has little present function but kept ancestors warm
Hair receptors alert us of parasites crawling on skin
Scalp retains heat and protects against sunburn
Pubic and axillary hair signify sexual maturity and aid in
transmission of sexual scents
Guard hairs (vibrissae)
Guard nostrils and ear canals
Eyelashes and eyebrows
Nonverbal communication
 NAILS
Fingernails and toenails—clear, hard derivatives of stratum
corneum
Composed of thin, dead cells packed with hard keratin
Functions:
Improve grooming, picking apart food, other manipulations
Provide a counterforce to enhance sensitivity of fleshy
fingertips to tiny objects
Nail plate—hard part of the nail
Free edge: overhangs the fingertip
Nail body: visible attached part of nail
Nail root: extends proximally under overlying skin
NAILS
Nail fold—surrounding skin
rising above nail
Nail groove—separates nail
fold from nail plate
Nail bed—skin underlying
the nail plate
Hyponychium—epidermis of
the nail bed
NAILS
Nail matrix—growth zone
(mitotic) of thickened stratum
basale at proximal end of nail
1 mm per week in fingernails,
slightly slower in toenails
Lunule—opaque white crescent
at proximal end of nail due to
thickness of matrix
Eponychium (cuticle)—narrow
zone of dead skin overhanging
proximal end of nail
Cutaneous Glands

Sweat
Two kinds of sweat (sudoriferous)
Glands
glands: apocrine and merocrine
Apocrine sweat glands
 Locations: groin, anal region, axilla, areola, beard
area in men
 Inactive until puberty
 Ducts lead to nearby hair follicles
 Produce sweat that is milky and contains fatty
acids
 Respond to stress and sexual stimulation
 Believed to secrete pheromones—chemicals
that can influence behavior of others
Bromhidrosis—disagreeable body odor
produced by bacterial action on sweat from
apocrine glands

Sweat
Two kinds of sweat (sudoriferous)
Glands
glands: apocrine and merocrine
Merocrine (eccrine) sweat glands
 Most numerous skin glands—3 to 4 million in adult
skin
 Especially dense on palms, soles, and forehead
 Simple tubular glands
 Watery perspiration that helps cool the body
Myoepithelial cells—contract in response
to stimulation by sympathetic nervous
system and squeeze perspiration up the duct
Found in both apocrine and merocrine
glands

Sweat Glands
Sweat—begins as a protein-free filtrate of blood plasma produced by
deep secretory portion of gland
Some sodium chloride and other small solutes remain in the sweat
Some sodium chloride reabsorbed by duct
Some drugs are excreted in sweat
On average, 99% water, with pH range of 4 to 6
Acid mantle—inhibits bacterial growth
Insensible perspiration—500 mL/day
Does not produce visible wetness of skin
Diaphoresis—sweating with wetness of the skin
Exercise—may lose 1 L sweat per hour
Sebaceous Glands
Sebaceous glands are flask-shaped
and have short ducts opening into
hair follicles
Holocrine secretion style
Sebum—oily secretion of sebaceous
glands
 Keeps skin and hair from becoming dry, brittle,
and cracked
 Lanolin—sheep sebum
 Ceruminous glands
Ceruminous glands are simple,
coiled, tubular glands in external
ear canal
Their secretion combines with
sebum and dead epithelial cells to
form earwax (cerumen)
 Keeps eardrum pliable
 Waterproofs the canal
 Kills bacteria
 Makes guard hairs of ear sticky to help
block foreign particles from entering
auditory canal
Mammary Glands
Mammary glands—milk-producing glands that
develop only during pregnancy and lactation
Modified apocrine sweat glands
Rich secretion released through ducts opening at
nipple
Mammary ridges or milk lines
Two rows of mammary glands in most mammals
Primates kept only two glands, but a few people have
additional nipples along the milk line (polythelia)
Cutaneous Glands
Skin Disorders
 Skin Cancer
Skin cancer—most cases caused by UV rays of the sun damaging
skin cell DNA
Most often on the head, neck, and hands
Most common in fair-skinned people and the elderly
One of the most common, easily treated cancers
Has one of the highest survival rates if detected and treated
early
Three types of skin cancer named for the epidermal cells in
which they originate
Basal cell carcinoma, squamous cell carcinoma, and
malignant melanoma
 Burns—leading cause of accidental death
Burns
 Fires, kitchen spills, sunlight, ionizing radiation, strong acids or bases, or
electrical shock
 Deaths result primarily from fluid loss, infection, and toxic effects of eschar (burned, dead

tissue)
 Debridement: removal of eschar
 Classified according to depth of tissue involvement
 First-degree burn: involves only epidermis
 Redness, slight edema, and pain
 Heals in days
 Second-degree burn: partial-thickness burn; involves part of dermis
 May appear red, tan, or white; blistered and painful
 Two weeks to several months to heal and may leave scars

 Third-degree burn: full-thickness burn; involves epidermis, all of dermis, and often
some deeper tissues
 Often requires skin grafts
 Needs fluid replacement, infection control, supplemental nutrition
 UV Rays and Sunscreen
UVA and UVB are improperly called “tanning rays” and “burning
rays”
Both thought to initiate skin cancer
No such thing as a “healthy tan”
Sunscreens protect you from sunburn but unsure if they provide
protection against cancer
High SPF numbers can give false sense of security
Chemical in sunscreen damage DNA and generateharmful free
radicals
 Skin Grafts and Artificial
Skin
Third-degree burns often require skin grafts
Graft options
 Autograft: tissue taken from another location on the same person’s body
 Split-skin graft—taking epidermis and part of the dermis from an undamaged
area such as the thigh or buttocks and grafting it into the burned area
 Isograft: skin from identical twin

Temporary grafts (immune system rejection)

 Homograft (allograft): from unrelated person
 Heterograft (xenograft): from another species
 Amnion from afterbirth
 Artificial skin from silicone and collagen