Chapter 5

The Integumentary System

Why This Matters

● Understanding the integumentary system will help you evaluate and treat injuries to
the skin such as burns

Integumentary System
● Integumentary system consists of:
– Skin
– Hair
– Nails
– Sweat glands
– Sebaceous (oil) glands

5.1 Structure of skin

● Skin consists of two distinct regions:
– Epidermis: superficial region
● Consists of epithelial tissue and is avascular
– Dermis: underlies epidermis
● Mostly fibrous connective tissue, vascular
– Hypodermis (superficial fascia)
● Subcutaneous layer deep to skin
● Not part of skin but shares some functions
● Mostly adipose tissue that absorbs shock and insulates
● Anchors skin to underlying structures: mostly muscles

5.2 Epidermis
Cells of the Epidermis
● Epidermis consists mostly of keratinized stratified squamous epithelium
● Four cell types found in epidermis:
1. Keratinocytes
● Produce fibrous keratin (protein that gives skin its protective properties)
● Major cells of epidermis
● Tightly connected by desmosomes
● Millions slough off every day

Cells of the Epidermis (cont.)

2. Melanocytes
● Spider-shaped cells located in deepest epidermis
● Produce pigment melanin, which is packaged into melanosomes
 – Melanosomes are transferred to keratinocytes, where they protect nucleus
from UV damage
3. Dendritic (Langerhans) cells
● Star-shaped macrophages that patrol deep epidermis
– Are key activators of immune system
4. Tactile (Merkel) cells
● Sensory receptors that sense touch

Layers of the Epidermis

● Epidermis is made up of four or five distinct layers
– Thick skin contains five layers (strata) and is found in high-abrasion areas
(hands, feet)
– Thin skin contains only four strata
● Five layers of skin
1. Stratum basale
2. Stratum spinosum
3. Stratum granulosum
4. Stratum lucidum (only in thick skin)
5. Stratum corneum

Layers of the Epidermis (cont.)

1. Stratum basale (basal layer)
– Deepest of all epidermal layers (base layer)
– Layer that is firmly attached to dermis
– Consists of a single row of stem cells that actively divide (mitotic), producing two
daughter cells each time
● One daughter cell journeys from basal layer to surface, taking 25–45 days to
reach surface
– Cell dies as it moves toward surface
● Other daughter cell remains in stratum basale as stem cell
– Layer also known as stratum germinativum because of active mitosis
– 10–25% of layer also composed of melanocytes

Layers of the Epidermis (cont.)

2. Stratum spinosum (prickly layer)
– Several cell layers thick
– Cells contain weblike system of intermediate prekeratin filaments attached to
desmosomes
● Allows them to resist tension and pulling
– Keratinocytes in this layer appear spikey, so they are called prickle cells
– Scattered among keratinocytes are abundant melanosomes and dendritic cells
Layers of the Epidermis (cont.)
3. Stratum granulosum (granular layer)
– Four to six cells thick, but cells are flattened, so layer is thin
– Cell appearance changes
● Cells flatten, nuclei and organelles disintegrate
● Keratinization begins
– Cells accumulate keratohyaline granules that help form keratin fibers in
upper layers
● Cells also accumulate lamellar granules, a water-resistant glycolipid that
slows water loss
– Cells above this layer die
● Too far from dermal capillaries to survive

Layers of the Epidermis (cont.)

4. Stratum lucidum (clear layer)
– Found only in thick skin
– Consists of thin, translucent band of two to three rows of clear, flat, dead
keratinocytes
– Lies superficial to the stratum granulosum

Layers of the Epidermis (cont.)

5. Stratum corneum (horny layer)
– 20–30 rows of flat, anucleated, keratinized dead cells
– Accounts for three-quarters of epidermal thickness
– Though dead, cells still function to:
● Protect deeper cells from the environment
● Prevent water loss
● Protect from abrasion and penetration
● Act as a barrier against biological, chemical, and physical assaults

Layers of the Epidermis (cont.)

● Cells change by going through apoptosis (controlled cell death)
– Dead cells slough off as dandruff and dander
– Humans can shed ~50,000 cells every minute

5.3 Dermis
● Strong, flexible connective tissue
● Cells include fibroblasts, macrophages, and occasionally mast cells and white blood
cells
● Fibers in matrix bind body together
– Makes up the “hide” that is used to make leather
● Contains nerves, blood vessels, and lymphatic vessels
● Contains epidermal hair follicles, oil glands, and sweat glands
● Two layers
– Papillary
– Reticular

Papillary Layer
● Superficial layer of areolar connective tissue consisting of loose, interlacing collagen
and elastic fibers and blood vessels
● Loose fibers allow phagocytes to patrol for microorganisms
● Dermal papillae: superficial region of dermis that sends fingerlike projections up into
epidermis
– Projections contains capillary loops, free nerve endings, and touch receptors
(tactile corpuscles, also called Meissner’s corpuscles)

Papillary Layer (cont.)

● In thick skin, dermal papillae lie on top of dermal ridges, which give rise to epidermal
ridges
– Collectively ridges are called friction ridges
● Enhance gripping ability
● Contribute to sense of touch
● Sweat pores in ridges leave unique fingerprint pattern

Reticular Layer
● Makes up ~80% of dermal thickness
● Consists of coarse, dense fibrous connective tissue
– Many elastic fibers provide stretch-recoil properties
– Collagen fibers provide strength and resiliency
● Bind water, keeping skin hydrated
● Cutaneous plexus: network of blood vessels between reticular layer and hypodermis
● Extracellular matrix contains pockets of adipose cells

Reticular Layer (cont.)

● Cleavage (tension) lines in reticular layer are caused by many collagen fibers
running parallel to skin surface
– Externally invisible
– Important to surgeons because incisions parallel to cleavage lines heal more
readily

Reticular Layer (cont.)

● Flexure lines of reticular layer are dermal folds at or near joints
– Dermis is tightly secured to deeper structures
 – Skin’s inability to slide easily for joint movement causes deep creases
– Visible on hands, wrists, fingers, soles, toes

Clinical – Homeostatic Imbalance 5.1

● Extreme stretching of skin can cause dermal tears, leaving silvery white scars called
striae
– Also known as “stretch marks”
● Acute, short-term traumas to skin can cause blisters, fluid-filled pockets that
separate epidermal and dermal layers

5.4 Skin Color

● Three pigments contribute to skin color
1. Melanin
● Only pigment made in skin; made by melanocytes
– Packaged into melanosomes that are sent to keratinocytes to shield DNA
from sunlight
– Sun exposure stimulates melanin production
● Two forms: reddish yellow to brownish black
● All humans have same number of keratinocytes, so color differences are due
to amount and form of melanin
● Freckles and pigmented moles are local accumulations of melanin

Skin Color (cont.)

2. Carotene
● Yellow to orange pigment
● Most obvious in palms and soles
● Accumulates in stratum corneum and hypodermis
● Can be converted to vitamin A for vision and epidermal health
3. Hemoglobin
● Pinkish hue of fair skin is due to lower levels of melanin
– Skin of Caucasians is more transparent, so color of hemoglobin shows
through

Clinical – Homeostatic Imbalance 5.2

● Excessive sun exposure damages skin
– Elastic fibers clump, causing skin to become leathery
– Can depress immune system and cause alterations in DNA that may lead to skin
cancer
– UV light destroys folic acid
● Necessary for DNA synthesis, so insufficient folic acid is especially dangerous
for developing embryos
– Photosensitivity is increased reaction to sun
 ● Some drugs (e.g., antibiotics, antihistamines) and perfumes cause
photosensitivity, leading to skin rashes

Clinical – Homeostatic Imbalance 5.3

● Alterations in skin color can indicate disease
– Cyanosis
● Blue skin color – low oxygenation of hemoglobin
– Erythema (redness)
● Fever, hypertension, inflammation, allergy
– Pallor (blanching or pale color)
● Anemia, low blood pressure, fear, anger
– Jaundice (yellow cast)
● Liver disorders

Clinical – Homeostatic Imbalance 5.3

● Alterations in skin color can indicate disease (cont.)
– Bronzing
● Inadequate steroid hormones (example: Addison’s disease)
– Bruises (black-and-blue marks)
● Clotted blood beneath skin

5.5 Hair
● Consists of dead keratinized cells
● None located on palms, soles, lips, nipples, and portions of external genitalia
● Functions:
– Warn of insects on skin
– Hair on head guards against physical trauma
– Protect from heat loss
– Shield skin from sunlight

Structure of a Hair
● Hairs (also called pili): flexible strands of dead, keratinized cells
● Produced by hair follicles
● Contains hard keratin, not like soft keratin found in skin
– Hard keratin is tougher and more durable, and cells do not flake off
● Regions:
– Shaft: area that extends above scalp, where keratinization is complete
– Root: area within scalp, where keratinization is still going on

Structure of a Hair (cont.)

● Three parts of hair shaft:
 – Medulla: central core of large cells and air spaces
– Cortex: several layers of flattened cells surrounding medulla
– Cuticle: outer layer consisting of overlapping layers of single cells

Structure of a Hair (cont.)

● Hair pigments are made by melanocytes in hair follicles
– Combinations of different melanins (yellow, rust, brown, black) create all the hair
colors
● Red hair has additional pheomelanin pigment
● Gray/white hair results when melanin production decreases and air bubbles
replace melanin in shaft

Structure of a Hair Follicle

● Extends from epidermal surface to dermis
● Hair bulb: expanded area at deep end of follicle
● Hair follicle receptor (or root hair plexus): sensory nerve endings that wrap around
bulb
– Hair is considered a sensory touch receptor
● Wall of follicle composed of:
– Peripheral connective tissue sheath
● Derived from dermis
● Also called fibrous sheath
– Glassy membrane: thickened basal lamina
– Epithelial root sheath
● Derived from epidermis

Structure of a Hair Follicle (cont.)

● Hair matrix: actively dividing area of bulb that produces hair cells
– As matrix makes new cells, it pushes older ones upward
● Arrector pili: small band of smooth muscle attached to follicle
– Responsible for “goose bumps”
● Hair papilla
– Dermal tissue containing a knot of capillaries that supplies nutrients to growing
hair

Types and Growth of Hair

● Vellus hair: pale, fine body hair of children and adult females
● Terminal hair: coarse, long hair
– Found on scalp and eyebrows

– At puberty
● Appear in axillary and pubic regions of both sexes
 ● Also on face and neck of males
● Nutrition and hormones affect hair growth
● Follicles cycle between active and regressive phases
– Average 2.25 mm growth per week
– Lose 90 scalp hairs daily

Clinical – Homeostatic Imbalance 5.4

● In women, ovaries and adrenal glands produce small amounts of androgens (male
sex hormones), but tumors on these organs can cause abnormally large amounts of
androgens
● Can result in excessive hairiness, called hirsutism, as well as other signs of
masculinization
● Treatment is surgical removal of tumors

Hair Thinning and Baldness

● Alopecia: hair thinning in both sexes after age 40
● True (frank) baldness
– Genetically determined and sex-influenced condition
– Male pattern baldness caused by follicular response to DHT
(dihydrotestosterone)

Clinical – Homeostatic Imbalance 5.5

● Hair thinning can be induced by several factors:
– Acutely high fever
– Surgery
– Severe emotional trauma
– Certain drugs (such as antidepressants, blood thinners, steroids, and
chemotherapeutic drugs)
– Protein-deficient diets
– Alopecia areata: immune system attacks follicles
– Some hair loss is reversible, but others (such as from burns or radiation) are
permanent

5.6 Nails
● Scale-like modifications of epidermis that contain hard keratin
● Act as a protective cover for distal, dorsal surface of fingers and toes
● Consist of free edge, nail plate, and root
● Nail bed is epidermis underneath keratinized nail plate
● Nail matrix: thickened portion of bed responsible for nail growth

Nails (cont.)
● Nail folds: skin folds that overlap border of nail
● Eponychium: nail fold that projects onto surface of nail body
● Also called cuticle
● Hyponychium: area under free edge of plate that accumulates dirt
● Nails normally appear pink because of underlying capillaries
– Lunule: thickened nail matrix, appears white
● Abnormal color or shape can be an indicator of disease

5.7 Sweat Glands

● Also called sudoriferous glands
● All skin surfaces except nipples and parts of external genitalia contain sweat glands
– About 3 million per person
● Two main types
– Eccrine (merocrine) sweat glands
– Apocrine sweat glands
● Contain myoepithelial cells
– Contract upon nervous system stimulation to force sweat into ducts

Eccrine (Merocrine) Sweat Glands

● Most numerous type
● Abundant on palms, soles, and forehead
● Ducts connect to pores
● Function in thermoregulation
– Regulated by sympathetic nervous system
● Their secretion is sweat
– 99% water, salts, vitamin C, antibodies, dermcidin (microbe-killing peptide),
metabolic wastes

Apocrine Sweat Glands

● Confined to axillary and anogenital areas
● Secrete viscous milky or yellowish sweat that contains fatty substances and proteins
– Bacteria break down sweat, leading to body odor
● Larger than eccrine sweat glands with ducts emptying into hair follicles
● Begin functioning at puberty
– Function unknown but may act as sexual scent gland

Apocrine Sweat Glands (cont.)

● Modified apocrine glands
– Ceruminous glands: lining of external ear canal; secrete cerumen (earwax)
– Mammary glands: secrete milk
Sebaceous (Oil) Glands
● Widely distributed, except for thick skin of palms and soles
● Most develop from hair follicles and secrete into hair follicles
● Relatively inactive until puberty
– Stimulated by hormones, especially androgens
● Secrete sebum
– Oily holocrine secretion
– Bactericidal (bacteria-killing) properties
– Softens hair and skin

Clinical – Homeostatic Imbalance 5.6

● Whiteheads are blocked sebaceous glands
– If secretion oxidizes, whitehead becomes a blackhead
● Acne is usually an infectious inflammation of the sebaceous glands, resulting in
pimples (pustules)
● Overactive sebaceous glands in infants can lead to seborrhea, known as “cradle
cap”
– Begins as pink, raised lesions on scalp that turn yellow/brown and flake off

5.8 Functions of Skin

● Skin is first and foremost a barrier
● Its main functions include:
– Protection
– Body temperature regulation
– Cutaneous sensations
– Metabolic functions
– Blood reservoir
– Excretion of wastes

Protection
● Skin is exposed to microorganisms, abrasions, temperature extremes, and harmful
chemicals
● Constitutes three barriers:
– Chemical barrier
– Physical barrier
– Biological barrier

Protection (cont.)
● Chemical barrier
– Skin secretes many chemicals, such as:
● Sweat, which contains antimicrobial proteins
● Sebum and defensins, which kill bacteria
 ● Cells also secrete antimicrobial defensin
– Acid mantle: low pH of skin retards bacterial multiplication
– Melanin provides a chemical barrier against UV radiation damage

Protection (cont.)
● Physical barrier
– Flat, dead, keratinized cells of stratum corneum, surrounded by glycolipids, block
most water and water-soluble substances
– Some chemicals have limited penetration of skin
● Lipid-soluble substances
● Plant oleoresins (e.g., poison ivy)
● Organic solvents (acetone, paint thinner)
● Salts of heavy metals (lead, mercury)
● Some drugs (nitroglycerin)
● Drug agents (enhancers that help carry other drugs across skin)

Protection (cont.)
● Biological barriers
– Epidermis contains phagocytic cells
● Dendritic cells of epidermis engulf foreign antigens (invaders) and present to
white blood cells, activating the immune response
– Dermis contains macrophages
● Macrophages also activate immune system by presenting foreign antigens to
white blood cells
– DNA can absorb harmful UV radiation, converting it to harmless heat

Body Temperature Regulation

● Under normal, resting body temperature, sweat glands produce about 500 ml/day of
unnoticeable sweat
– Called insensible perspiration
● If body temperature rises, dilation of dermal vessels can increase sweat gland
activity to produce 12 L (3 gallons) of noticeable sweat
– Called sensible perspiration; designed to cool body
● Cold external environment
– Dermal blood vessels constrict
– Skin temperature drops to slow passive heat loss

Cutaneous Sensations
● Cutaneous sensory receptors are part of the nervous system
– Exteroreceptors respond to stimuli outside body, such as temperature and touch
– Free nerve endings sense painful stimuli
Metabolic Functions
● Skin can synthesize vitamin D needed for calcium absorption in intestine
● Chemicals from keratinocytes can disarm some carcinogens
● Keratinocytes can activate some hormones
– Example: convert cortisone into hydrocortisone
● Skin makes collagenase, which aids in natural turnover of collagen to prevent
wrinkles

Blood Reservoir
● Skin can hold up to 5% of the body’s total blood volume
● Skin vessels can be constricted to shunt blood to other organs, such as an
exercising muscle

Excretion
● Skin can secrete limited amounts of nitrogenous wastes, such as ammonia, urea,
and uric acid
● Sweating can cause salt and water loss

5.9 Skin Cancer and Burns

● Skin can develop over 1000 different conditions and ailments
● Many internal diseases reveal themselves on skin
● Most common disorders are infections
● Less common, but more damaging, are:
– Skin cancer
– Burns

Skin Cancer
● Most skin tumors are benign (not cancerous) and do not spread (metastasize)
● Risk factors
– Overexposure to UV radiation
– Frequent irritation of skin
● Some skin lotions contain enzymes that can repair damaged DNA
● Three major types of skin cancer
– Basal cell carcinoma
– Squamous cell carcinoma
– Melanoma

Skin Cancer (cont.)

● Basal cell carcinoma
– Least malignant and most common
 – Stratum basale cells proliferate and slowly invade dermis and hypodermis
– Cured by surgical excision in 99% of cases

Skin Cancer (cont.)

● Squamous cell carcinoma
– Second most common type; can metastasize
– Involves keratinocytes of stratum spinosum
– Usually is a scaly reddened papule on scalp, ears, lower lip, or hands
– Good prognosis if treated by radiation therapy or removed surgically

Skin Cancer (cont.)

● Melanoma
– Cancer of melanocytes; is most dangerous type because it is highly metastatic
and resistant to chemotherapy
– Treated by wide surgical excision accompanied by immunotherapy
– Key to survival is early detection: ABCD rule
● A: asymmetry; the two sides of the pigmented area do not match
● B: border irregularity; exhibits indentations
● C: color; contains several colors (black, brown, tan, sometimes red or blue)
● D: diameter; larger than 6 mm (size of pencil eraser)

Burns
● Tissue damage caused by heat, electricity, radiation, or certain chemicals
– Damage caused by denaturation of proteins, which destroys cells
● Immediate threat is dehydration and electrolyte imbalance
– Leads to renal shutdown and circulatory shock
● To evaluate burns, the Rule of Nines is used
– Body is broken into 11 sections, with each section representing 9% of body
surface (except genitals, which account for 1%)
– Used to estimate volume of fluid loss

Burns (cont.)
● Burns can be classified by severity
– First-degree
● Epidermal damage only
– Localized redness, edema (swelling), and pain
– Second-degree
● Epidermal and upper dermal damage
– Blisters appear
– First- and second-degree burns are referred to as partial-thickness burns
because only the epidermis and upper dermis are involved
Burns (cont.)
● Burns can be classified by severity (cont.)
– Third-degree
● Entire thickness of skin involved (referred to as full-thickness burns)
● Skin color turns gray-white, cherry red, or blackened
● No edema is seen and area is not painful because nerve endings are
destroyed
● Skin grafting usually necessary

Burns (cont.)
● Burns are considered critical if:
– >25% of body has second-degree burns
– >10% of body has third-degree burns
– Face, hands, or feet bear third-degree burns
● Treatment includes:
– Debridement (removal) of burned skin
– Antibiotics
– Temporary covering
– Skin grafts

Developmental Aspects of the Integumentary System

● Fetal: by end of 4th month, skin of fetus is developed
– Lanugo coat: delicate hairs in 5th and 6th month
– Vernix caseosa: sebaceous gland secretion that protects skin of fetus while in
watery amniotic fluid

Developmental Aspects of the Integumentary System

● Infancy to adulthood: skin thickens and accumulates more subcutaneous fat; sweat
and sebaceous gland activity increases, leading to acne
– Optimal appearance during 20s and 30s
– After age 30, effects of cumulative environmental assaults start to show
– Scaling and dermatitis become more common

Developmental Aspects of the Integumentary System

● Aging skin
– Epidermal replacement slows; skin becomes thin, dry, and itchy (decreased
sebaceous gland activity)
– Subcutaneous fat and elasticity decrease, leading to cold intolerance and
wrinkles
– Increased risk of cancer due to decreased numbers of melanocytes and dendritic
cells
 – Hair thinning
● Ways to delay aging:
– UV protection, good nutrition, lots of fluids, good hygiene