NORMAL ANATOMY AND PHYSIOLOGY

Our skin is the largest organ of the human body. The integument or skin
makes up 15% to 20% of the body’s weight. Intact skin is the body’s primary
defense system. It protects us from invasion by organisms, helps to regulate body
temperature, manufactures vitamins and provides our external appearance. skin
has three primary layers (i.e., epidermis or outer layer; the dermis or inner layer
and the hypodermis or subcutaneous layer) as well as epidermal appendages (i.e.,
eccrine glands, apocrine glands, sebaceous glands, hair follicles and nails).

The skin is the most prominent organ containing epithelium, which is

composed of cells that provide a continuous barrier between the body contents and
the outside the environment. Epithelial cells also cover the Gastrointestinal tract,
pulmonary airways and alveoli, renal tubules and the urinary system, and the ducts
that empty onto the surface of the skin of the GI and respiratory systems. Epithelial
cells allow the selective transport of ions, nutrients, and metabolic wastes and have
a permeability to water that is partially regulated.

Structure of the Integumentary System

EPIDERMIS

The epidermis consists of four distinct layers: the stratum corneum, the
stratum granulosum, the stratum spinosum and the stratum basale. The stratum
corneum is the outermost covering and consists of 15-20 layers. Stratum
granulosum consists of flattened nucleated cells containing distinctive cytoplasmic
inclusions called keratohyalin granules. Stratum spinosum is comprised of several
layers of a polyhedral type cell that lie above the germinal layer of cells.stratum
basale is germinative layer of the epidermis.
 The epidermis is the thin, stratified layer that is in direct contact with the
external environment. The thickness of the epidermis ranges from 0.04mm on the
eyelids to 1.6mm on the palms and soles. Desmosomes (point of intracellular
attachment that are vital for cell-to-cell adhesion) are found in the epidermis.
Keratinocytes, the principal cells of epidermis, produce keratin in a complex
process. The cells begin in the basal layer and change constantly, moving upward
through the epidermis. On the surface, they are sloughed off or lost by abrasion.
Thus the epidermis constantly regenerates itself, providing a tough keratinized
barrier.

Epidermal appendages

Epidermal appendages are down growths of epidermis into the dermis. They
consist of eccrine glands, apocrine glands, sebaceous glands, hair and nails.

Eccrine glands- produce sweat and play an important role in the thermoregulation.
They are more numerous on the palms, soles, forehead and axillae. These are
stimulated by heat as well as by exercise and emotional stress. The eccrine gland
also responds to sympathetic and parasympathetic stimulation.

Apocrine glands- occur primarily in the axillae, breast, areolae, anogenital area, ear
canals, and eyelids. Mediated by adrenergic innervations, secrete a milky substance
that becomes odoriferous when altered by skin surface bacteria.

Sebaceous glands- are found throughout the skin except on the palms and soles
and are most abundant on the face, scalp, upper back, and chest. Androgen is
responsible for sebaceous gland development.

Hair- is a nonviable protein end product found on all skin surfaces except the palms
and soles. About 50-100 hairs are lost each day.

Nails- are horny scales of epidermis. The nail matrix is the source of specialized,
nonkeratinized cells. They differentiate into keratinized cells, which make up the
nail protein. A damaged nail matrix, which may result from trauma or aggressive
maincuring, produces distorted nail.

DERMIS

The dermis, a dense layer of tissue beneath the epidermis, gives the skin
most of its substance and structure. The dermis contains fibroblasts, macrophages,
mast cells and lymphocytes. The skin’s lymphatic, vascular, and nerve supplies,
which maintain equilibrium in the skin, are in the dermis.

The dermis is divided into two parts: papillary and reticular. The papillary
dermis, which contains increased amounts of collagen, blood vessels, sweat glands,
and elastin, is in contact with the epidermis. The reticular dermis also contains
collagen but with increased amounts of mature elastic tissue. The dermis houses
many specialized cells, blood vessels, and nerves.

Dermis - Specialized Structures

• Nerve endings

• Blood vessels

• Sweat glands
 • Oil glands - keep skin waterproof, usually discharges around hair
shafts

• Hair follicles - produce hair from hair root or papilla

Each follicle has a small muscle (arrectus pillorum) which can pull the hair upright
and cause goose flesh

HYPODERMIS

The subcutaneous layer is a specialized layer of connective tissue. It is

sometimes called the adipose layer because of its fat content. This layer is absent in
some sites, such as eyelids, scrotum, areola and tibia. Subcutaneous fat is
generally thickest on the back and buttocks, giving shape and contour over the
bone. This layer functions as insulation from extremes of hot and cold, as a cushion
to trauma, and as a source of energy and hormone metabolism.

FUNCTION OF THE INTEGUMENTARY SYSTEM

PROTECTION

The skin protects the body’s against many forms of trauma. The intact tough
epidermal layer is a mechanical barrier. Bacteria, foreign matter, other organisms
and chemicals penetrate it with difficulty. The oily and slightly acid secretions of its
sebaceous glands protect the body further by limiting the growth of many
organisms.

HOMEASTASIS

Skin forms a barrier that prevents excessive loss of water and electrolytes
from the internal environment and also prevents the subcutaneous tissues from
drying out. The effectiveness of this impermeable membrane is readily recognized
when one observes the extreme loss of fluids that occurs with damage to the skin,
as with burns and other injuries. Insensible loss of water and electrolytes occurs
only though pores in this effective barrier.

THERMOREGULATION

Body temperature represents the balance between heat regeneration and

heat loss processes. The skin, with its ability to alter the rate of heat loss, is the
major point of regulation of body temperature. The rate of heat loss depends
primarily on the surface temperature of the skin, which is in turn a function of the
skin’s blood flow.

The flow of blood to the skin is derived in two processes. Direct perfusion is
from capillary beds entering in lateral directions. Skin is also perfused vertically
from vessels that enter from the muscle and fascia supporting it.

In general, the vessels dilate during warm temperatures and constrict during
cold. The hypothalamus is partly responsible for regulating skin blood flow,
particularly to the extremities, the face, ears, and the tip of the nose. Maintenance
of the thermal balance allows the internal temperature of the body to remain at
approximately 37 degree Celsius.
SENSORY PERCEPTION

Apart from sight and hearing, the major human sensory apparatus is in the
skin. Sensory fibers responsible for pain, touch and temperature form a complex
network in the dermis. The skin contains specialized receptors to detect
discriminative touch and pressure. Touch is sensed by Meissner’s corpuscles;
pressure by Merkel cells and Ruffini endings; vibration by Pacinian corpuscles; and
hair movement by hair follicle endings.

A second grouping of nerves communicates information about temperature

and pain to the somatosensory cortex via the anterolateral pathways. Temperature
is sensed by specific thermoreceptors in the edpidermis, and pian is sensed by free
nerve endings throughout the edpidermal, dermal, and hypodermal layers.

VITAMIN D REPRODUCTION

The epidermis is involved in synthesis of vitamin D. In the presence of

sunlight or ultraviolet radiation, a sterol found on the malpighian cells is
converted to form cholecalciferol (Vitamin D3). It assists in the absorption of
calcium and phosphate from ingested foods.

PROCESSING OF ANTIGENIC SUBSTANCES

Langerhans cells are scattered among the keratinocytes located primarily in

the epidermis; however, they can also be seen in the dermis. These cells originate
in the bone marrow and migrate to the epidermis. Langerhans cells play a role in
the cell-mediated immune responses of the skin through antigen presentation.

Cells in both the epidermis and dermis of the skin are important in the
immune function. Skin is now recognized not only as a physical barrier but also as a
participant in immunologically mediated defense against various antigens.