THE INTEGUMENTARY SYSTEM

SKIN
 Waterproof, washable, stretchable, permanent press, able to repair small cuts and minor
burns, and with proper care, is guaranteed to last a lifetime. Too good to be true!
 Covers the entire body
 Varies in thickness - from 1.5 - 4.0 mm
 Content
1. Blood vessels
2. Nerve
3. Sweat glands
4. Sebaceous glands
5. Sensory receptors
6. Cells
 Three distinct regions
1. Epidermis
2. Dermis
3. Hypodermis

Epidermis
 Thick keratinized stratified squamous epithelium
 Four distinct cell types
1. Keratinocytes
2. Melanocytes
3. Merkel cells
4. Langerhans' cells
 Four - five distinct layers
1. Stratum basale
2. Stratum spinosum
3. Stratum granulosum
4. Stratum lucidum (only in certain areas)
5. Stratum corneum

Cells of the Epidermis

Keratinocytes
1. Produces keratin - a fibrous protein
2. Protective in function
3. Tightly connected by desmosomes
4. Arises from the stratum basale
5. Undergoes continuous mitosis
6. Pushed toward the skin's surface

Melanocytes
1. Synthesizes melanin (skin pigment) and is found in the stratum basale
2. Spider shaped with numerous branching processes
3. Melanin production  moves to the end of these processes  transferred to
neighboring keratinocytes  melanin granules accumulate on the superficial or
"sunny" side of the nucleus of the keratinocyte  forming a pigment layer or shield
that protects the nucleus from UV radiation
4. Individuals of different racial ethnicity differ in the activity of melanin metabolism
within the keratinocytes

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Langerhans cells
1. Star-shaped
2. Arise from bone marrow and migrate to the epidermis
3. Function as macrophage and help activate our immune system
Merkel cells
1. Present in small numbers
2. Located at the epidermal-dermal junction
3. Closely associated with a disc-like sensory nerve ending = Merkel disc
4. Function as a sensory receptor to touch

Layers of the Epidermis

A. Stratum Basale (Basal layer)
 Deepest layer
 Firmly attached to the underlying dermal layer
 Has a single row of cells - youngest keratinocytes
 Many mitotic nuclei are seen
 Also known as stratum germinativum
 Melanocytes can be seen in this layer (10-25% of the cell population, most abundant)
 Merkel cells are also seen in this layer

B. Stratum Spinosum (Prickly layer)

 Several cell layers thick
 Contains intermediate filaments - mainly tension-resisting bundles of keratin filaments
 Keratinocytes are flattened (somewhat) and irregular in shape
 The name is deceiving - these cells do not possess spike or spiny projection, but on routine
histological staining, these cells shrink while the desmosomes hold tightly giving it a prickly-
like appearance
 Langerhans' cells are most abundant in this layer
 Melanocytes can be seen in this layer

C. Stratum Granulosum (Granular layer)

 A thin layer of 3 - 5 cell layers
 Keratinocytes are flattened; nuclei and organelles begin to disintegrate; they accumulate
keratohyalin granules
 Keratohyaline granules contain waterproofing glycolipid

D. Stratum Lucidum (Clear layer)

 The thin translucent band just above the stratum granulosum
 Few rows of clear cells, flattened, dead keratinocytes, with indistinct boundaries
 Present only in thick skin

E. Stratum Corneum (Horny layer)

 Outermost layer
 A broad zone of 20 - 30 cell layers thick
 Account for the 3/4 of the epidermis’s thickness
 Keratin is abundant and protects the skin against abrasion and penetration
 Glycolipid form a waterproofing layer between these cells
 Very durable
 Cells in this layer are dead - so the saying "Beauty is only skin deep" is somewhat
paradoxical!

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Dermis
 The region below the epidermis
 A layer of connective tissue
 Strong and flexible
 Cells: fibroblasts, macrophages, mast cells, and white blood cells
 Matrix is rich in collagen, elastin, and reticular fibers
 Richly supplied with nerve fibers, blood vessels, and lymphatic vessels
 Hair follicles, sweat, and sebaceous glands reside in the dermal layer
 Two distinct layers of the dermis:
1. Papillary layer
a. Thin superficial layer
b. Loose connective tissue
c. An abundance of blood vessels
d. Have dermal papillae
2. Reticular layer
a. Account for 80% of the dermis
b. Dense irregular connective tissue
c. Thick bundles of interlacing collagen fibers - most run parallel to the skin

Hypodermis
 Subcutaneous tissue deep to the dermis
 Consists mainly of adipocytes and some areolar connective tissue
 Anchors the skin to the underlying tissue (muscles)
 Allows the skin to slide freely over the underlying tissues
 Acts as a shock absorber and insulates deeper tissues from heat loss

Appendages of the Skin

I. Sweat (Sudoriferous) Glands
 Distributed over the entire skin except for the nipples and parts of the external genitalia
 Approximately 2.5 million per person
 Two types of sweat glands
1. Eccrine
2. Apocrine

A. Eccrine Sweat Glands

 More numerous and abundant on the palms, soles, and forehead
 Simple, coiled, tubular glands
 Secretory part lies in the dermis
 Ducts extend to open into pores at the skin's surface
 Secretion = sweat
 Sweat = hypotonic filtrate of the blood that passes through the secretory cells of the sweat
glands and is released by exocytosis
o 99% water with some salts (sodium chloride - NaCl), vitamin C, antibodies,
metabolic wastes (urea, uric acid, ammonia), and lactic acid (the chemical that
attracts mosquitoes)
o The exact composition is dependent on heredity
o Sweat pH ranges between 4 - 6
 Regulated by the sympathetic division of the autonomic nervous system
 Assists in thermoregulation and prevent overheating

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B. Apocrine Sweat Glands
 Confined to the axillary (armpit) and anogenital areas
 Larger than eccrine glands
 Ducts empty into hair follicles
 Secretion components = eccrine secretion + fatty substances and proteins
o Quite viscous and has a milky or yellowish color
o Secretion is odorless, however, when the organic molecules are decomposed by
bacteria on the skin, it takes on a musky and generally unpleasant odor = the
basis of body odor
 Begins to function at puberty under the influence of androgens
 Output increases on hot days but has no role in thermoregulation
 Precise function = not known
 Activated by the sympathetic nerve fibers during pain and stress
 Activity increases with sexual foreplay
 They enlarge and recede with the phases of a woman's menstrual cycle
 May be analogous to sexual scent glands of other animals

C. Ceruminous Glands
 Modified apocrine glands
 Found in the lining of the external ear canal
 Secretion = sticky substance = cerumen or earwax
 Function: deter insects and block entry of foreign materials

D. Mammary Glands
 Specialized sweat glands
 Secretes milk
 Although part of the integumentary system, it is often discussed along with the female
reproductive system

II.Sebaceous (Oil) Glands

Simple alveolar glands
Found all over the body except the palms and soles
Secretion = sebum (lipids and cell fragments secretion)
The cells accumulate lipid  become engorged  burst
Functionally they are holocrine glands
Secreted into the hair follicle and occasionally the pore on the skin
Function: Sebum softens and lubricates the hair and skin and prevents hair from becoming
brittle, also, slows the rate of water loss on a humid day
 It is bactericidal
 Stimulated by hormones, especially androgens
 Inactive until puberty

Nails
 Scale-like modifications of the epidermis
 Found on distal parts of the fingers and toes
 Useful tools to help pick up a small object and to scratch an itch
 Contain hard keratin
 Anatomy: body (free edge and root), nail bed (a deeper layer that extends beneath the nail),
nail matrix (responsible for nail growth), lunula (little moon), nail folds, eponychium (cuticle)

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Hairs and Hair Follicles
Structure of a Hair
 Hairs are flexible strands produced by hair follicles
 Mainly keratinized cells
 Shaft - the part that projects from the skin
 Root - part embedded in the dermis
 Each hair has three concentric layers of keratinized cells
1. Medulla - central core (absent in fine hairs)
2. Cortex - bulky layer surrounding the medulla
3. Cuticle - the outermost layer

Structure of a Hair Follicle

Hair follicles extend from the epidermal surface into the dermis
 The deep end of the follicle expands to form a hair bulb
 Root hair plexus (sensory nerve ending) wraps around each hair bulb
 Connective tissue root sheath
 Epithelial root sheath = external root sheath + internal root sheath
 Follicle wall = epithelial root sheath + connective tissue root sheath
 Connective tissue papilla
 Arrector pili: smooth muscle

Skin Color
• Three pigments contribute to skin color
1. Melanin
2. Carotene
3. Hemoglobin
A. Melanin
 A polymer of tyrosine (an amino acid)
 Color ranging from yellow to black
 Synthesis is dependent on tyrosinase, an enzyme
 The racial difference reflects the relative kind and amount of melanin made
B. Carotene
 Yellow to the orange pigment found in carrots
 Accumulates in the stratum corneum and adipocytes in the hypodermis
 Color is most obvious in the palms and soles
 The yellowish tinge of the skin found in Asian is due to melanin and not carotene
Hemoglobin
 Pinkish hue was seen in fair-skinned individuals

Pathology Definitions
 Erythema (redness): indicates fever, hypertension, inflammation, or allergy
 Cyanosis (cyan = dark blue): bluish coloration of the skin due to lack of oxygen
 Pallor (blanching): under emotional stress (fear, anger, and others) the skin becomes pale,
may also signify anemia (decrease in red blood cells) or hypotension
 Jaundice: yellowing of the skin, usually indicates severe liver pathology or biliary disease
 Bronzing: an almost metallic appearance - often seen in patients with Addison's disease
(hypofunction of the adrenal cortex)
 Black and blue marks (bruises): due to blood that has escaped from the circulation and
clotted beneath the skin often secondary to trauma

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Physiology of the Integumentary System
I. Protection
Three types of barriers
1. Chemical
2. Physical
3. Biological
A. Chemical Barrier
 Skin secretion and melanin
 Low pH value - retard bacterial multiplication
 Sebum is bactericidal
 Pigment shield to prevent UV damages
B. Physical Barrier
 Provided by the hardness of keratin
 Waterproofing
 Prevents water loss and entry of some substances
 Substances able to penetrate the skin: lipid-soluble substances (oxygen, carbon dioxide,
vitamins A, D, E, K, and steroids), oleoresins (proteins from plants-poison ivy and poison
oak), organic substances (acetone, dry-cleaning fluids, paint thinner), salts, heavy metals
(lead, mercury, and nickel), and drugs (topical)
C. Biological Barrier
 A function of the Langerhans cells and macrophages
 Immune response to foreign substances = antigens

II. Body Temperature Regulation

III. Metabolic Functions
1. Vitamin D synthesis
2. Metabolizes carcinogenic substances
3. Activates steroids hormones
4. Synthesis of important proteins and collagenase
IV. Blood Reservoir
V. Excretion
1. Nitrogen-containing wastes (ammonia, urea, and uric acid)
2. Water and sodium

Trauma
Burns
1. First degree
2. Second degree (moist, have blisters, and are exquisitely painful to touch)
3. Third-degree (dry, white, leathery, and anesthetic)
• Rule of 9
• Management of burned patients
1. 4cc per Kg x % of burned area (up to 50%) + 2000 ml = volume of fluids
2. On the first day-half of the calculated volume goes in the first 8 hours, the remaining half
is given over the remaining 16 hours - and use crystalloids
3. On the second day - give half of the original volumes over 24 hours and use colloids
4. On the third day - no need, should see massive diuresis

Pathology
Skin Cancer
1. Basal cell carcinoma
2. Squamous cell carcinoma

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 3. Malignant melanoma
Generalities
• Light skin
• Exposure to sun
• History
1. Where they come from
2. Occupation/hobbies
3. Non-healing ulcer
• Basal cell: above the upper lip and slow growing
• Squamous cell: below the upper lip and fast-growing
• Melanoma: pigmented (no time frame and tend to metastasize to obscure places)
*No self-respecting tumor would have the time frame to metastasize to obscure places,
but melanoma does and will do so
Diagnosis: biopsy for all
Treatment
1. Surgical excision (leave it to the surgeon and not the derm-neophytes )
2. Radiation may be required in some cases
3. Grafting