1

Section 1: Skin and subcutaneous tissues

Chapter 1

The structure and function of skin

The skin or integument is a double-layered membrane covering the exterior of the body and is continuous with the mucous membranes lining the bodys orices. It shows a marked
variation in thickness, measuring from less than 1 mm (on
the eyelid) to more than 4 mm (on the back). The wide
range of properties of the skin is summarized in Box 11.

Box 11 Properties of the skin

Maintains integrity of the body

Protects from injurious stimuli
Absorbs and excretes liquids
Regulates temperature
Waterproofs
Absorbs ultraviolet light
Metabolizes vitamin D
Detects sensory stimuli
Provides cosmetic functions
Acts as a barrier against microorganisms

From McKee PH, Calonje E, Granter SR (eds): Pathology of the Skin With
Clinical Correlations, 3rd ed. St. Louis, Mosby, 2005.

The skin can be divided into two parts, the epidermis (outer
layer) and dermis (inner layer), which rests on and is attached to the subcutaneous fat (Fig. 11).
The epidermis is comprised of four clearly dened layers, or
strata (Fig. 12):
1. Basal layer (stratum basale, stratum germinativum): mycotic activity of keratinocytes is conned to this layer, resulting in an epidermal turnover time of approximately
4 weeks. Melanocytes, which produce melanin pigment, are
found in this layer.
2. Prickle cell layer (stratum spinosum): contains polyhedral cells with intercellular attachments and Langerhans
cells (specialized antigen-presenting cells involved in contact hypersensitivity)
3. Granular cell layer (stratum granulosum): characterized
by loss of cell nuclei and acquisition of dense keratohyalin
granules
4. Keratin layer (stratum corneum): acellular layer containing keratin brils. It serves as a protective barrier. Its thickness varies with location (maximum thickness on palms
and soles, minimum thickness at exural sites).

Fig 11

Stratum corneum
Hair
Arrector pili muscle

Cross section through the skin, showing the

structures in the epidermis and subcutaneous
tissues.

Melanocytes
Sebaceous gland
Dermal papillae

Basal cell layer

Basement membrane

EPIDERMIS

DERMIS

SUBCUTANEOUS
TISSUE

Apocrine gland

Hair follicle

Eccrine gland

Fat tissue
Blood vessels

(From Swartz Swartz MH: Textbook of Physical Diagnosis, 5th ed. Philadelphia, WB Saunders, 2006.)

Chapter 1: The structure and function of skin

The dermis is the brous part of the skin, which provides

strength. It supports the epidermis and is composed of a brous connective tissue component (collagen and elastic
bers) in intimate association with ground substance.
Within the dermis are the epidermal appendages (surrounded by a connective tissue sheath), blood vessels and
nerves, and a cellular component, including mast cells, broblasts, myobroblasts, and macrophages. Smooth muscle is also represented in the erector pili muscles.

Fig 12
Normal skin from the ngertip showing the clearly dened layers of the
epidermis.
(From McKee PH, Calonje E, Granter SR [eds]: Pathology of the Skin With
Clinical Correlations, 3rd ed. St. Louis, Mosby, 2005.)