INTEGUMENTARY SYSTEM

Skin and Body Membranes:

I. BODY MEMBRANES
 Cover surfaces
 Line cavities
 Form protective (and often lubricating) sheets around organs.

2 Major Groups of Body Membranes

1. Epithelial membranes
- Cutaneous, mucous and serous membranes
2. Connective tissue membranes
- Synovial membrane and cutaneous membrane
- (skin or integumentary system)

II. CLASSIFICATION OF BODY MEMBRANES

a. Epithelial Membranes
- “Epithelial” – is not only misleading but also inaccurate
- Always combined with an underlying layer of connective tissue, although
they all do contain an epithelial sheet (thus, membranes are actually
simple organs)
Types of Epithelial Membrane
A. Cutaneous membranes (skin)
Parts:
1. Epidermis – superficial layer composed of keratinizing
stratified squamous epithelium
2. Dermis – deep layer mostly composed of dense fibrous
connective tissue.
B. Mucous membrane (mucosa)
- Composed of epithelium resting in a loose connective tissue (lamina
propia)
- Lines all body cavities that open to the exterior
- (hollow organs of respiratory, digestive, urinary and reproductive tracts)
- Usually “wet” or moist membranes that are almost continually bathed in
secretions

C. Serous membranes (serosa)

- Composed of simpled squamous epithelium resting on a thin layer of
areolar connective tissue.
- Lines body cavities that are closed to the exterior
- (except for the dorsal body cavity and joint cavities)
 - Layers of Serosa:
o Parietal Layer – lines a specific portion of the wall of the vertebral
body cavity
o Visceral layer – covers the outside of the organs in that cavity.
- Serous layers are separated by a serous fluid, secreted by both visceral
and parietal membranes.
Types of Serous membranes
1. Peritoneum – serosa lining the abdominal cavity
2. Pleura – serosa lining the lungs.
3. Pericardium – serosa around the heart

B. Connective Tissue Membranes

- Synovial membrane
- composed of connective without epithelial cells at all
Locations:
1. Joint capsule
2. Bursa
3. Tendon sheath

III. INTEGUMENTARY SYSTEM (SKIN)

a. Basic skin functions
i. Protection (major functions)
- Insulates and cushions the deeper organs and protects the entire body
from mechanical damage.
- (Cuts and bumps), chemical damage, (acids and bases), thermal damage
(heat and cold), ultraviolet radiation (sunlight), and bacteria.

b. Prevention of water loss from the body surface.

- Uppermost layer of the skin is full of keratin and cornified (hardened), to
prevent water loss from the body surface.
c. Regulation of Heat Loss
- Skins rich capillary network and sweat glands (both controlled by the
nervous system)
- Play an important role in regulation of heat loss from the body surface.

d. Excretion of urea, uric acid, salt and water

- (sweating)

e. Vitamin D synthesis
- Modified cholesterol molecules are located in the skin are converted to
vitamin D by sunlight.
 f. Sensation
- Cutaneous sensory receptors (touch, temperature, pressure, and pain
receptors) located in the skin.

STRUCTURE OF THE SKIN:

1. Epidermis – outer layer made up of stratified squamous epithelium
- Capable of becoming hard and tough
- (keratinizing)
- Avascular (this explains why a man can shave daily and not bleed even though
he is cutting many cell layers each time he shaves.
- Keratinocytes (keratin cells)
- Comprises most of cells of the epidermis that produces keratin.
- Keratin – tough fibrous protein responsible for the toughness of the epidermis.
- Abundance of this allows stratum corneum to provide a durable “overcoat” for
the body, which protects deeper cells from the hostile environment and from
water loss.

LAYERS OF EPIDERMIS
1. Stratum corneum – thickest layer of epidermis
- Outermost layer about 20 – 30 cells layers thick
- Accounts about three-quarters of the epithelial thickness
- Cornified / horny cells-shingle-like dead cells remnants completely filled
with keratin
- Rubs and flakes off slowly and steadily and is replaced by cells produced
by the division of the deeper stratum basale cells

2. Stratum lucidum – (lucidus = clear)

- More apparent in the hairless thick skin of the palms and soles
- Consists of 3 – 5 layers of clear, flat, dead cells
- Contains intermediate substance eleidin that is transformed into keratin
- Combination of accumulating water-repellant keratin inside them and its
increasing distance from the blood supply (in the dermis) effectively
dooms the stratum lucidum cells due to inability to get adequate
nutrients and oxygen.

3. Stratum granulosum – consists of 3-5 layers of flattened cells that develop darkly
staining granules called keratohyaline (precursor of keratin)
- Keratin molecules assemble into intermediate filaments that form a
barrier to protect deep layers from injury and microbial invasion and
make the skin waterproof
 4. Stratum spinosum – contains 8-10 layers of polyhedral (many sided) cells that fit
closely together
- Cells are covered with prickly spines
- Filaments of the cytoskeleton are inserted into desmosomes, located at
each spine-like projection, tightly joining the cells to another

5. Stratum basale (stratum germinativum)

- Deepest layer of epidermis
- Lie closest to the dermis
- The only epidermal cells that receive adequate nourishment via diffusion
of nutrients from the dermis
- Cells are undergoing cell division
- Freckles and moles are seen where melanin is concentrated in one spot

MELANIN
 Yellow brown pigment produced by melanocytes, found in stratum basale
 Exposure of skin to sunlight – activation of melanocytes – melanocytes produces
melanin-
 Tanning – stratum basale eats melanin – accumulation of melanin within the stratum
basale cells – melanin forms a protective pigment “umbrella” over the superficial or
“sunny side” of the nuclei – melanin shields their genetic material (DNA)

EFFECTS OF EXCESSIVE SUN EXPOSURE:

1. Skin damage despite melanin’s protective effect
2. Clumping of elastin fibers loading to leathery skin
3. Depression of the immune system
4. Alteration of DNA of the skin cells leading to skin cancer

BURNS:
 First degree
 Second degree
 Third degree

DERMIS
 Strong stretchy envelope made up of dense fibrous connective tissue that helps to
hold the body together
 E.g. leather good (bags, belts, shoes)
 Thickness varies in regions (e.g. thick on the palm of the hands and soles of the feet
but quite thin on the eyelids)

PAPILLARY LAYER
  Upper dermal region – area for capillaries
 Dermal papillae – uneven fingerlike projections from the superior surface of the
papillary layer
o Contains capillary loops, which furnish nutrients to the dermis
 Houses pain receptors (free nerve endings) and touch receptors (meissner’s
corpuscle)
 Arranged in genetically determined patterns on palms and soles, forming ridges on
the epidermal surface that enables clopping ability of the hands and feet

RETICULAR LAYER
 Deepest skin layer
 Contents of the reticular layer:
o 1. Phagocytes – prevents bacteria from penetrating any deeper into the body
o 2. Collagen and elastin – these are found throughout the epidermis
 Collagen – responsible for the toughness of the dermis
 Elastin – responsible for the elasticity, especially in the young skin
 Aging – reduces the number of collagen and elastin fibers and fat loss of the
subcutaneous tissue leading to less elasticity of the skin and begins to sag and
wrinkle
o 3. Blood vessels – abundant and plays a role in maintaining body temperature
homeostasis

PRESSURE ULCER
 Any severe restriction of the normal blood supply to the skin resulting in cell death
(necrosis)
 Common in bedridden patients who are not turned regularly or who are dragged or
pulled across the bed repeatedly
 Occurs especially over bony prominences due to the pressure of the body weight on
the skin
 The skin becomes pale of blanched at pressure points due to restriction of blood
supply
 Permanent damage to the superficial blood vessels and tissues eventually results in
degeneration and ulceration of the skin

SKIN COLOR
 3 pigments contributing to skin color:
 1. Melanin – yellow, reddish brown or black
o -people who produced a lot of melanin have browned-toned skin
o -light skinned (Caucasian) people have less melanin
 2. Carotene – amount of carotene deposits in the stratum corneum and
subcutaneous tissue
 o -orange-yellow pigment abundant in carrots, orange, deep yellow or leafy
green vegetables
 3. Oxygen – amount of oxygen bound to hemoglobin (pigment in RBC) in the dermal
blood vessels
o -the crimson color of oxygen rich hemoglobin in the dermal blood supply
flushes through the transparent cell layers above and gives the skin a “rosy
glow”
 Cyanosis – bluish discoloration of the skin due to poor oxygenation of the
hemoglobin
o -common during heart failure and severe breathing disorders
o -skin does not appear cyanotic in black people because of the marking effects
of melanin, but cyanosis is apparent in mucous membranes and nail beds

INFLUENCE OF EMOTIONAL STIMULI AND DISEASES IN SKIN COLOR

 1. Redness or erythema – indicates embarrassment
o (blushing), fever, hypertension, inflammation, or allergy
 2. Pallor or blanching – under certain types of emotional stress (fear, anger)
some people become pale
o - pale skin also signifies anemia or hypotension
 3. Jaundice or yellow cast – abnormal yellow skin tone usually signifies a liver
disorder where excess bile pigments are absorbed into the blood, circulated
throughout the body and deposited in body tissues
 4. Bruises or black and blue marks – due to escape of blood from the circulation
and has clotted in the tissue spaces
 Hematoma – clotted blood masses
 Unusual tendency to bruising may signify vitamin C

SKIN APPENDAGES
 Arises from the epidermis and plays a unique role in maintaining body homeostasis
o 1. Cutaneous glands
o 2. Hairs and hair follicles
o 3. Nails

CUTANEOUS GLANDS
 All are exocrine glands that release their secretions to the skin surface via ducts
 Formed by the cells of the stratum basale, pushing into the deeper skin regions and
reside almost entirely in the dermis
o Types:
 1. Sebaceous (oil glands)
 -found all over the skin except on the palms of the hands and
the soles of the feet
  -ducts usually empties into a hair follicle, but some open
directly onto the skins surface
 2. Sebum – mixture of oily substances and fragmented cells produced
by the sebaceous glands.
 Functions:
o 1. Keeps the skin soft and moist
o 2. Prevents the hair from becoming brittle
o 3. Kills bacteria
 Skin diseases due to affection of sebaceous glands:
o 1. White head – due to blockage of sebum on the duct
of sebaceous glands
o 2. Black head – due to oxidation and drying of the
accumulated sebum on the duct of sebaceous glands
o 3. Acne – an active infection of the sebaceous glands
accompanied by pimples on the skin
o 4. Seborrhoea – severer type of sebaceous glands
infection due to overactivity of the sebaceous glands
 -begins on the scalp as pink, raised lesions that gradually form
a yellow to brown crust that sloughs off
 3. Sweat glands – (sudoriferous)
 -widely distributed in the skin, about more than 2.5 million per
person
o Types of Sweat Glands:
o 1. Eccrine sweat glands
o 2. Apocrine sweat glands

ECCRINE SWEAT GLANDS

 More numerous and found all over the body
 Sweat – clear secretion primarily water plus some salts (sodium chloride), vitamin C,
metabolic wastes
 (urea, ammonia, and uric acid), and lactic acid
 (chemical that attacks mosquitoes)
o - acidic (pH from 4-6) inhibiting bacterial growth, which are always present on
the skin surface
 Pores – funnel-shaped duct that opens externally where sweat pass to reach the
skin’s surface
 Important and highly efficient part of the body’s heat-regulating equipment
 Supplied with nerve endings that cause them to secrete when the external
temperature or body temperature is high
 Sweat carries large amounts of body heat when it evaporates off the skin surface
  Secretes up to 7 liters of body water on a hot day

APOCRINE SWEAT GLANDS

 Largely confined to the axillary and genital areas
 Larger than eccrine glands and their ducts empty into hair follicles
 Its secretion contains fatty acids and proteins, as well as the substances of eccrine
secretion
 the secretion is odourless, but it causes unpleasant odor when bacteria that live on
the skin use its proteins and fats as source of nutrients for their growth

HAIR AND HAIR FOLLICLES

 Functions:
o 1. Minor protection
o 2. Filtration
o 3. Thermoregulation
 Minor protection – guarding the head against bumps, shielding the
eyes (eyelashes)
 Filtration – keeps foreign particles out of the respiratory tract (nose
hairs or vibrissae)
 Thermoregulation – provides insulation in cold weather

ROOT
 Enclosed by hair follicle

SHAFT
 Projects from the surface of the skin or scalp
o Parts:
 1. Medulla – central core
 2. Cortex – covers the medulla
 3. Cuticle – outermost part formed by a sinlge layer of cells that
overlap one another like shingles on a roof
o - roof-like arrangement helps to keep the hairs apart and keeps them from
mating
o - most heavily keratinized region, where it provides strength and helps keep
the inner hair layers tightly compacted

SPLIT ENDS
 Occurs due to susceptibility of the cuticle to abrasion
 Abrasion – wearing away of cuticle at the top of the shaft – frizzling out the keratin
fibris in the inner hair regions – split ends
HAIR FOLLICLES
 Flexible epithelial structure producing hair
o Parts:
 1. Epidermal sheath
 2. Dermal sheath
 3. Arrector pilli
 4. Hair bulb matrix

EPIDERMAL SHEATH
 Inner layer composed of epithelial tissue and forms the hair

DERMAL SHEATH
 Outer layer composed of dermal connective tissue
 Supplies blood vessels to the epidermal portion and reinforces it
 Its nipple like papilla provides the blood supply to the matrix in the hair bulb

ARRECTOR PILLI
 Small bonds of smooth muscles that connect each side of the hair follicle to the
dermal tissue
 Contraction (cold or frightened) pulls the hair upright, dimpling the skin surface with
“goose bumps”
 (piloerection)
 Helps keeps animals warm in winter by adding a layer of insulating air to the fur
 Hair-raising phenomenon is not very useful to human beings

HAIR BULB MATRIX

 Growth zone
 Division of stratum basale cells located at the inferior end of the follicle
 Daughter cells migrate from the hair bulb matrix where they become keratinized and
die
 Thus, the bulk of the hair shaft (like the bulb of epidermis) is dead material
 Hair pigment is made by melanocytes in the hair bulb with varying amounts of
different types of melanin
 (yellow, brown, and black) combine to produce all varieties of hair color from pale to
pitch black

NAILS
 Scale-like modifications of the epidermis that corresponds to the hoof or claw of
animals
o Parts:
 1. Free edge
  2. Body
 3. Root
 4. Nail folds
 5. Cuticle
 6. Nail bed
 7. Nail matrix
 8. Lunula

BODY OF THE NAILS

 Visible attached portion

NAIL FOLDS
 skin folds covering the borders of the nail

CUTICLE
 Thick proximal nail fold

NAIL BED
 Extension of the stratum basale beneath the nail

NAIL MATRIX
 Thickened proximal area responsible for nail growth
 Nails become heavily keratinized and die as produced by the matrix (thus, nails are
mostly dead materials)

LUNULA
 White crescent nail matrix at the nail bed
 Nails are transparent and nearly colorless, but they look pink because of the rich
blood supply in the underlying dermis
 Nails take on cyanotic (blue cast) when the oxygen supply in the blood is low

HOMESTATIC IMBALANCE OF THE SKIN

 1. Infections and allergies
 2. Burns
 3. Skin cancer

INFECTIONS AND ALLERGIES

1. Athlete’s foot
2. Boils and carbuncles
3. Cold sores
4. Contact dermatitis
 5. Impetigo
6. Psoriasis

ATHLETE’S FOOT
 Tinea pedis
 Itchy, red peeling condition of the skin between the toes due to fungal infection

BOILS AND CARBUNCLES

 Inflammation of hair follicles and sebaceous glands found on the dorsal neck
 Typically caused by bacterial infection
 (staphylococcus aureus)

COLD SORES
 Fever blisters
 Small-fluid filled blisters that itch and sting, caused by herpes simplex infection
 The virus localizes in a cutaneous nerves, where it remains dormant until activated
by emotional upset, fever, or UVR
 Commonly occurs around the lips and in the oral mucosa of the mouth

CONTACT DERMATITIS
 Itching, redness, and swelling of the skin, progressing to blisters
 Caused by exposure of the skin to chemicals (poison ivy) that provoke allergic
responses in sensitive individuals

IMPETIGO
 Pink water-filled, raised lesions that develop a yellow crust and eventually rupture
 Caused by a highly contagious staphylococcal infection
 Commonly affects elementary school-aged children
 Commonly occurs around the mouth and nose

PSORIASIS
 Chronic condition characterized by reddened epidermal lesions covered with dry,
silvery scales
o Triggering factors:
 1. Trauma
 2. Infection
 3. Hormonal changes
 4. Stress

BURNS
 Causes:
 o 1. Thermal
o 2. Chemical
o 3. Electrical
o 4. Radiation

RULE OF NINES IN BURNS

 Estimation of the burned body surface
 Divides the body into 11 areas each accounting for 9% of the total body surface area
(TBSA), plus on additional surrounding the genital region (perineum) representing
1% of TBSA

BURN CLASSIFICATION ACCORDING TO SEVERITY:

 1. First degree burns
 2. Second degree burns
 3. Third degree burns

FIRST DEGREE BURNS

 Partial thickness burn
 Epidermis is damaged
 Generally heal 2-3 days without any special attention
 The area between becomes red and swollen (sunburn)

SECOND DEGREE BURNS

 Partial thickness burn
 Involves the dermis and upper region of the dermis
 Skin is red and painful and blisters appear
 Regeneration of the epithelium (healing) can still occur because of sufficient number
of epithelial cells still present

THIRD DEGREE BURNS

 Full thickness burn
 Destroys the entire thickness of the skin
 Burned area appears blanched (gray white) or blackened
 Painless because the nerve endings in the area are destroyed
 Regeneration (healing) is no longer possible
 Skin grafting must be done to cover the underlying exposed tissue (due to absence of
regeneration)

CRITICAL BURNS
 1. Over 25% TBSA has secondary degree burns
  2. Over 10% TBSA has 3rd degree burns
 3. 3rd degree burns of the face, hands or feet
o Facial burns are dangerous because of the possibility of the burned
respiratory passageways to swell and cause suffocation
o Joint burns are troublesome because scar tissue formation can severely limit
joint mobility

COMPLICATION OF BURNS
 1. Circulator shock
 2. Renal failure
 3. Infection
 4. Depression of the immune system

CIRCULATORY SHOCK
 Due to extravassation of fluids containing proteins and electrolytes from the burned
surface- dehydration & electrolyte imbalance – decrease volume – circulatory shock

RENAL FAILURE
 Due to extravassation of fluids containing proteins electrolytes from the burned
surface – dehydration & electrolyte imbalance – renal failure

INFECTION
 Leading cause of death after burns
 Burned skin is sterile for about 24 hours
 After 24 hours, bacteria and fungi easily invade areas where the skin has been
destroyed and multiply rapidly in the nutrient rich environment of dead tissues

SKIN CANCER
 Single most common type of cancer in humans
 Most skin cancers are idiopathic
o Risk factors:
 1. Over exposure to UVR
 2. Infection
 3. Chemical
 4. Physical trauma

DEPRESSION OF IMMUNE SYSTEM

 Occurs in severe burn cases

TYPES OF SKIN CANCER

 1. Basal cell carcinoma
  2. Squamous cell carcinoma
 3. Malignant melanoma

BASAL CELL CARCINOMA

 Most common and least malignant cancer
 Alteration of the cells of stratum basale – inability to distinguish the boundary
between the dermis and epidermis – invasion of the cancer cells in the dermis and
subcutaneous tissues
 Most commonly occurs on exposed areas of the skin
 Appears as shiny dome-shaped nodules that later developed a central ulcer with
pearly beaded edge
 Slow growing and metastasis seldom occurs before it is noticed

SQUAMOUS CELL CARCINOMA

 Arises from the cells of the stratum spinosum
 Scaly reddened papule (small rounded elevation) that gradually forms a shallow
ulcer with a firm, raised border
o Common sites:
 1. Scalp
 2. Ears
 3. Dorsum of the hands
 4. Lower lip
 Grows rapidly and metastasizes to adjacent hymph nodes if not removed
 Believed to be sun-induced
o Good prognosticating factors:
 1. Early detection
 2. Early removal through surgery
 3. Early chemotherapy

MALIGNANT MELANOMA
 Cancer of melanocytes
 Accounts of 5% of skin cancer
 Occurs spontaneously in pigmented areas but some develop from pigmented moles
 Usually appears as a spreading brown to black patch that metastasize rapidly to
surrounding hymph and blood vessels
 50% chances of survival with early detection

ABCD CLASSIFICATION FOR MALIGNANT MELANOMA:

 A – asymmetry
 o Two sides of the pigmented spot or mole does not match
 B – border irregularity
o Borders of the lesion are not smooth but exhibit indentations
 C – color
o Pigmented spot contains areas of different colors
o (black, brown, tan and sometimes blue, red)
 D – diameter
o Spot is larger than 6 mm in diameter (size of a pencil eraser)
o Wide surgical excision along with immunotherapy is the usual management
for malignant melanoma

DEVELOPMENTAL ASPECTS OF SKIN AND BODY MEMBRANES

 Lanugo – down type of hair covering the soon-to born infant during 5th-6th months of
fetal development (shed by birth)
 Vermix caseosa – accumulations of small white spots in the sebaceous glands on the
baby’s nose and forehead
o Normally disappear by the 3rd week after birth

SKIN DEVELOPMENT
 Fetal – (+) lanugo
 Neonatal – vermis caseosa and millia
o Very thin and blood vessels can easily be seen through it
 Infancy – thicker and moist, and more deposition of subcutaneous fats
 Adolescence – skin and hair become oilier due to activation of sebaceous glands,
causing acne
o Acne subsides in early adulthood
 Adulthood – 20-30
o Skin reaches its optimal appearance
 Genetic Period:
o 1. Reduction of subcutaneous fats
o 2. Dry skin
o 3. Thinning of the skin
o 4. Decrease skin elasticity
o 5. Baldness
o 6. (+) vellus hair

REDUCTION OF SUBCUTANEOUS FATS

 Causes cold intolerance

DRY SKIN
  Due to decrease oil production and reduction of collagen fibers
 Causes itchiness and discomfort

THINNING OF THE SKIN

 Increase the risk for bruising and other types of injuries

DECREASE SKIN ELASTICITY

 Along with the loss of subcutaneous fat causes eyebags and sagging of jowls

BALDNESS
 Alopecia
 Occurs in 5th decade of life
 Due to reduced number of degeneration of hair follicles
 “male pattern baldness” = obvious balding / hair loss with aging

VELLUS HAIR
 Very tiny and colorless hairs ion the bald area due to degeneration of the hair
follicles

PREMATURE GRAYING OF HAIR

 Causes:
o 1. Emotional crisis (problems)
o 2. Anxiety
o 3. Protein deficient diets
o 4. Chemotherapy
o 5. Radiations
o 6. Excessive vitamin A
o 7. Fungal diseases (ringworm)
 These conditions are not genetically determined