ANATOMY

The skin is the body's largest organ, composed of a layer of cells on the surface called the
epidermis, and a deeper layer of connective tissue known as the dermis. Skin is useful for:

1. Protection against injury and loss of fluids, eg in minor burns

2. Regulation of body temperature through the sweat glands and blood vessels
3. Sensation through the skin nerve and the end of the sensory end, for example for pain.

The superficial fascia consists of rare connective tissue and fat. This superficial fascia
(hypodermis) lies between the deep dermis and deep fascia and contains sweat glands, blood
vessels, lymph (lymph nodes) and skin nerves. The deep fascia is a denser, denser connective
tissue that is more regularly arranged and useful for establishing deep structures (eg muscles)
in place. Microscopically the skin consists of 3 layers of epidermis, dermis and subcutaneous
fat.

HISTOLOGY

1. Epidermis

Epidermis consists of 5 layers of keratin-producing cells (keratinocytes), namely:

1) The basal stratum (stratum germinativum) consists of a layer of cuboid or basophilic

cylindrical cells located above the basal lamina at the epidermis-dermis border
 2) Stratum spinosum, consisting of cuboid or somewhat flat cell with middle core and
cytoplasm with branches filled with filament
3) Stratum granulosum, consisting of 3-5 layered polygonal cell layers whose cytoplasm
contains coarse basophilic granules
4) Stratum lusidum, more visible on thick skin, this layer is transparent and consists of a
thin layer of epidermis eosinophilic cells that are very flat
5) The stratum corneum, this layer consists of 15-20 layers of non-core berkeratin flat
cell with a cytoplasm filled with filarious birefringen scleroprotein ie keratin.

2. Dermis

The dermis consists of two layers with unreal borders, stratum papilare on the outside and
a deeper reticular stratum.

1) Stratum papillar consists of loose connective tissue, fibroblasts and other connective
tissue cells present in this stratum such as mast cells and macrophages. From this
layer, special collagen lining fibers slip into the basal lamina and extend into the
dermis. The collagen fibers bind the dermis to the epidermis and are called binding
fiber.
2) The reticular stratum is composed of an irregular solid connective tissue (especially
type I collagen) and therefore has more fibers and fewer cells than the stratum of
papillary.

Dermis is rich with blood vessels and lymph nets. In certain areas of the skin, blood can
flow directly from the arteries into the veins through anastomosis or arteriovenous
shunting. This sharpness plays a very important role in temperature regulation. In addition
to these components, the dermis contains several epidermal derivatives, namely the hair
follicles of sweat glands and sebaceous glands.

3. Fascia superficialis
This layer consists of a loose connective tissue that loosely binds the skin to the
underlying organs that allow the skin to shift above it, the hypodermis often
containing fat cells varying in number according to the body area and sizes varying
according to the nutritional status in question. This layer is also referred to as
subcutaneous tissue and if thick enough is called adiposus paniculus.

PHYSILOGY

The skin has a variety of functions to fit the body with the environment. The skin function is
as:

1. Protector
The horn tissue of the outermost epidermal cells limits the entry of objects from the
outside and excessive fluid from the body. Melanin that gives skin a color protects the
skin from the bad effects of violet ultraviolet rays.
2. Temperature control
 In cold temperatures, blood circulation in the skin is reduced to maintain body
temperature. At the time of hot temperature, blood circulation in the skin increases
and there is evaporation of sweat from the sweat glands, so that the body temperature
can be maintained not too hot.
3. Absorbent
The skin can absorb certain materials such as gases and fat-soluble substances, but
water and electrolytes are difficult to enter through the skin. Fat-soluble substances
more easily enter the skin and enter the bloodstream, because it can mix with the fat
that covers the skin surface. Entrance of these substances through hair follicles and
only a few through the mouth of sweat glands.
4. The sense of taste
The sense of taste in the skin occurs due to stimulation of the sensory nerves in the
skin. The basic sensory functions are feeling pain, touch, heat and cold
5. Function of shaking (secretory function)
Skin is covered by two types of shaking, namely sebum and sweat. The sebum sap is
produced by the sebaceous glands and sweat is produced by the sweat glands. Sebum
is a kind of fatty substance that makes the skin become supple.

Ref: Harahap, Marwali.2000.Ilmu Penyakit Kulit.Jakarta: FK UI

White spot mechanism

Melanin is formed by melanocytes with tyrosinase enzyme plays an important role in

the formation process. As a result of the action of the tironase enzyme, thyroxine is converted
to 3.4 dihydroxiferyl alanine (DOPA) and then into dopaquinone, which is then converted,
after going through several stages of transformation into melanin. The tyrosinase enzyme
formed in the ribosome, transferred in the rough bulb of the rough endoplasmic reticulum,
melanocytes accumulated in vesicles formed by the golgi complex. 4 distinct stages of
formation of mature melanin granules.

Stage 1: A vesicle is surrounded by a membrane and indicates the beginning of the

process of the enzyme activity of tyrosinase and the formation of fine granular
substance; on the periphery. The electron-dense strands have a neat arrangement of
tyrosinase molecules in a protein matrix.
Stage 2: Vesicles (melanosomes) are oval and show on the inside of the filaments
with a distance of about 10 nm or a distance of the same distance. Melanin is stored in
a protein matrix.
Stage 3: Increased melanin formation makes fine structure somewhat hard to see.
Stage 4: Mature melanin granules can be seen with a light microscope and melanin
perfectly fills the vesicles. No Utrastructure is visible. A mature granule is elliptical,
with a length of 1 m and a diameter of 0.4 m.
 Picture: melanin formation mechanism

When melanin granules are formed migration within the expansion of the melanocyte
cytoplasm and transferred to the cells in the stratum germinativum and spinosum of the
epidermis. This transfer process has been observed directly on tissue culture of the skin.
Granul melanin is essentially injected into keratinocytes. When in keratinocytes, melanin
granules accumulate in the cytoplasm in the upper region of the nucleus (supranuclear),
thus protecting the nucleus from the damaging effects of solar radiation. Despite the
melanocytes that make up melanin, but epithelial / keratinocyte cells become warehouses
and contain more melanin, than melanocytes themselves. In keratinocytes, melanin
granules combine with lysosomes - the reason why melanin disappears in upper epithelial
cells. Important factors in the interaction between keratinocytes and melanocytes that
cause skin pigmentation:

1) The speed of melanin granule formation in melanocytes

2) Transfer of granules into keratinocytes
3) His final placement in keratinocytes

Reference: Alya Amila Fitrie.Histologi Dari Melanosit.Fakultas Kedokteran Bagian

Histologi.Universitas Sumatera Utara