Chapter 5

The Integumentary System

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Integumentary System
n The body’s covering
n Includes: skin, hair, oil and sweat glands, nails, and
sensory receptors.
n Skin: cutaneous membrane
n Functions:
q 1. Regulates body temperature.

q 2. Stores blood.

q 3. Protects body from external environment.

q 4. Detects cutaneous sensations.

q 5. Excretes and absorbs substances.

q 6. Synthesizes vitamin D.

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Structure
n Two main parts
q Epidermis - surface epithelial layer
q Dermis - deeper connective tissue layer
n Subcutaneous (subQ) layer or hypodermis
lies deep to dermis; is not part of the skin
q contains nerve endings pacinian
(lamellated) corpuscles that are
sensitive to pressure.

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Integumentary System

Copyright 2010, John Wiley & Sons, Inc.

Epidermis
n Keratinized stratified squamous epithelium
n Cell types (4):
q Keratinocytes
q Melanocytes
q Langerhans cells
q Merkel cells

Sectional view of skin

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Epidermal Cells
n Keratinocytes
q 90% of epidermal cells
q 4-5 layers
q Produce keratin
q Protects skin
q Waterproofs skin

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Epidermal Cells
n Melanocytes
q Make up 8% of epidermal cells
q Transfer pigment to keratinocytes
q Produce melanin
q Melanin is a yellow-red or brown-black pigment
that contributes to skin color and absorbs damaging
ultraviolet (UV) light.

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Epidermal Cells

n Langerhans cells
q aka epidermal dendritic cells
q Immune response

n Merkel cells
q Consist of tactile disc and neuron
for touch sensation

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Epidermal Layers
n Four Layers (strata)
q Stratum basale (stratum germinativum)
n Includes stem cells; new cells arise here
q Stratum spinosum: 8-10 cell layer
n Cells beginning to look flattened
n provides both strength and flexibility to the skin
q Stratum granulosum makes keratin
n Losing cell organelles and nuclei
n lipid-rich secretion acts as water sealant
q Stratum corneum: flattened dead cells
n Cells here consist mostly of keratin.
n Cells here are shed and replaced from below.

Copyright 2010, John Wiley & Sons, Inc.

Epidermal Layers
n Stratum Lucidum
q Present only in thick skin areas of fingertips,
palms, and soles
q consists of four to six rows of clear, flat, dead
keratinocytes with large amounts of keratin
q provides an additional level of toughness

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Layers of the epidermis

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Skin Grafts
n transfer of a patch of healthy skin taken from a
donor site to cover a wound.
n Autograft - skin taken from the same individual
n Isograft - identical twin
n Autologous skin transplantation - individual’s
epidermis are removed, and the keratinocytes
are cultured in the laboratory to produce thin
sheets of skin

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Psoriasis
n chronic skin disorder in which keratinocytes divide
and move more quickly than normal from the s.
basale to the s. corneum.
n abnormal keratin, which forms flaky, silvery scales at
the skin surface,
n Tx - various topical ointments and ultraviolet
phototherapy

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Dermis
n second, deeper part of the skin
n composed of dense irregular connective
tissue containing collagen and elastic fibers
n Divided to
q papillary region - thin superficial
q reticular region - thick deeper

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Epidermal ridge pattern
n surfaces of the palms, fingers, soles, and toes have a
series of ridges and grooves
n part genetically determined and is unique for each
individual
n basis for identification

https://www.google.com/search?q=adermatoglyphia&client=safari&channel=mac_bm&source=ln
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h=839#imgrc=4Hdr11PM1dcMuM:

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Skin Color
n Melanin: dark color
q Pheomelanin - yellow to red
q Eumelanin - brown to black
q Darkness depends on amount of melanin
produced.
q Provides some protection against UV rays
n Carotene: yellow orange
q Precursor of vitamin A
q In stratum corneum and adipose layers-
n Hemoglobin in blood: pink-red
q Depends on blood flow
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 Melanocytes
n melanin-producing cells, synthesize melanin from the
amino acid tyrosine in the presence of an enzyme called
tyrosinase.
n Synthesis occurs in an organelle called a melanosome .
n Exposure to ultraviolet (UV) light increases the
enzymatic activity with thus increases melanin
production.
n nevus or a mole - benign localized overgrowth of
melanocytes

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Albinism and Vitiligo
n Albinism is the inherited inability of an individual to
produce melanin.
q have melanocytes that are unable to synthesize
tyrosinase
n Vitiligo is the partial or complete loss of
melanocytes from patches of skin produces irregular
white spots.

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Skin Color as a Diagnostic Clue
n Cyanotic – skin appear bluish, blood is not picking up an
adequate amount of oxygen from the lungs
q stopped breathing, mucous membranes, nail beds, and skin
appear bluish
n Jaundice - yellowish appearance of the skin is due to a
buildup of bilirubin.
q usually indicates liver disease
n Erythema - redness of the skin, engorgement of
capillaries in the dermis with blood due to skin injury
q exposure to heat, infection, inflammation, or allergic rxn
n Pallor - or paleness of the skin
q may occur in conditions such as shock and anemia.

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Accessory Structures
n Hair
n Skin glands
n Nails

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Hair
n Found on most skin surfaces
q Not on palmar surfaces of hand and fingers or plantar
surfaces of feet
n Made of fused keratinized cells
n Consists of shaft and root
n Surrounded by hair follicle
q Base is bulb which includes growing matrix producing
cells
n Nerves in hair root plexuses are sensitive to touch
n Arrector pili - muscle that pulls on hair
n Causes hair to stand on end
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Hair

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 Glands
n Sebaceous gland: secrete oily sebum
q Connected to hair follicles; keeps hair from drying out
n Sudoriferous (sweat) gland
q Eccrine sweat gland - wide distribution-
thermoregulation
q Apocrine sweat gland - axilla, groin, areolae, beard
q Contain other cell material
n Ceruminous (wax) gland
q Wax combines with sebum to produce cerumen or
earwax
q waterproofs the canal and prevents bacteria and fungi
from entering cells
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Nails
n Plates of packed hard dead keratinized cells
n Nail body (plate): major visible portion
n Free edge: part extending past finger or toe
n Root: portion of the nail that is buried in a fold
of skin
n lunula: crescent-shaped area of the proximal
end of the nail body

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Nails

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Nails

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FUNCTIONS OF THE SKIN
n Thermoregulation - the homeostatic
regulation of body temperature.
q thermoregulation in two ways:
q 1. by liberating sweat at its surface and by
adjusting the flow of blood in the dermis.
q 2.blood vessels in the dermis of the skin dilate;
consequently, more blood flows through the
dermis, which increases the amount of heat loss
from the body

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FUNCTIONS OF THE SKIN

n Blood reservoir
n dermis houses an extensive network of blood vessels that
carry 8–10% of the total blood flow in a resting adult.

n Protection
q Keratin protects underlying tissues from microbes,
abrasion, heat, and chemicals, and the tightly
interlocked keratinocytes resist invasion by
microbes.

Copyright 2010, John Wiley & Sons, Inc.

FUNCTIONS OF THE SKIN
Protection
n Lipids released by lamellar granules inhibit evaporation of
water, retard entry of water during showers and swims.
n Oily sebum keeps skin and hairs from drying out and
contains bactericidal chemicals.
n Acidic pH of perspiration retards growth of some microbes.
n Melanin helps shield against the damaging effects of UV.
n Epidermal Langerhans cells alert the immune system to
the presence of potentially harmful microbial invaders by
recognizing and processing them.
n macrophages phagocytize bacteria and viruses that
manage to bypass the Langerhans cells of the epidermis.

Copyright 2010, John Wiley & Sons, Inc.

FUNCTIONS OF THE SKIN
n Cutaneous sentations – include tactile
sensations—touch, pressure, vibration, and tickling—as
well as thermal sensations such as warmth and
coolness.
n Pain - usually is an indication of impending or actual
tissue damage.
n Nerve endings and receptors
q tactile discs of the epidermis

q corpuscles of touch in the dermis

q hair root plexuses around each hair follicle.

Copyright 2010, John Wiley & Sons, Inc.

FUNCTIONS OF THE SKIN
n Excretion : small amounts
q about 400mL of water evaporates through skin daily
q small amounts of salts, CO2, and two organic
molecules from the breakdown of proteins—
ammonia and urea.
n Absorption: water – negligible, but certain lipid-
soluble materials do penetrate skin
q Fat soluble vit (A, D, E, K), gases O2 and CO2
q Certain drugs that are absorbed by the skin may be
administered by applying adhesive patches to the
skin.
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 Transdermal Drug Administration
n (transcutaneous) drug administration, enables
a drug contained within an adhesive skin patch
to pass across the epidermis and into the blood
vessels of the dermis.
q Ex. Nitroglycerin - angina pectoris (chest pain)
q scopolamine - motion sickness
q estradiol - estrogen-replacement during menopause
q ethinyl estradiol and norelgestromin – contraceptive
q nicotine – smoking cessation
q fentanyl – relieve severe pain in cancer patients
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FUNCTIONS OF THE SKIN
n Vitamin D synthesis:
n requires activation of a precursor molecule in the
skin by UV rays in sunlight.
n Enzymes in the liver and kidneys then modify the
activated molecule, finally producing calcitriol, the
most active form of vitamin D.
n Calcitriol is a hormone that aids in the absorption of
calcium from foods in the GIT into the blood.
n about 10-15 minutes at least twice a week is
required for vitamin D synthesis.

Copyright 2010, John Wiley & Sons, Inc.

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Aging
n Adolescence: can develop acne
n Most effects in dermis, with visible signs of
aging by about age 40. These include:
q Loss of collagen fibers
q Loss of elasticity
q Loss of immune responses
q Decreased melanocyte functions:
n gray hair, skin blotches
q Thinning of skin and hairs (pattern baldness)
n Anti-aging treatments

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 HOMEOSTATIC IMBALANCES
n Skin cancer
q three common forms of skin cancer.
q Basal cell carcinomas - 78% of all skin cancers
q tumors arise from cells in the stratum basale and
rarely metastasize.
q Squamous cell carcinomas - 20% of all skin
cancers, arise from the stratum spinosum, and have
a variable tendency to metastasize.
q Malignant melanomas - arise from melanocytes
and account for about 2% of all skin cancers.
q metastasize rapidly and can kill a person within
months of diagnosis.
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 Early warning signs of malignant melanoma
n A (asymmetry) - irregular shapes, two very different
looking halves.
n B (border) – irregular notched, indented, scalloped, or
indistinct—borders.
n C (color) - uneven coloration, contain several colors.
n D (diameter) - about the size of a pencil eraser.
n E (evolving) - change in size, shape, and color.

a) Normal nevus (mole) (b) Malignant melanoma

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Treatment of Skin CA
n Basal cell carcinoma - can be cured by surgical
excision in 99% of the cases
n Squamous cell CA - Prognosis is good if treated by
radiation therapy or removed surgically
n Malignant melanoma - Resistant to chemotherapy
q Treated by wide surgical excision accompanied by
immunotherapy
q Chance of survival is poor if the lesion is over 4 mm
thick

Copyright 2010, John Wiley & Sons, Inc.

Burns
n tissue damage caused by excessive heat, electricity,
radioactivity, or corrosive chemicals that denature
(break down) proteins in the skin.
n Burns are graded according to their severity.
q first-degree burn
q second-degree burn
q third-degree burn or full-thickness burn

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Burns
n First-degree – only the epidermis is damaged
q Symptoms include localized redness, swelling, and
pain, no blister
n Second-degree – epidermis and upper regions of
dermis are damaged
q redness, blister formation, edema, and pain result
n Third-degree – entire thickness of the skin is
damaged, burned area appears gray-white,
mahogany, or black;
q Most skin functions are lost, marked edema, and
the burned region is numb because sensory nerve
endings have been destroyed.

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Burns

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n Did you ever wonder why it is so
difficult to save the life of someone
with extensive third-degree burns?

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 American Burn Association’s
classification of burn injury
n Estimates the severity of burns
n Burns considered critical if:
q Over 25% of the body has second-degree burns,
q Over 10% of the body has third-degree burns
q There are third-degree burns on face, hands, or
feet
q When the burn area exceeds 70%, more than half
the victims die.

Copyright 2010, John Wiley & Sons, Inc.

Rule of Nine
n A quick means for estimating the SA affected by a burn
n 1. Count 9% if both the anterior and posterior surfaces of
the head and neck are affected.
n 2. Count 9% for both the anterior and posterior surfaces
of each upper limb (total of 18% for both upper limbs).
n 3. Count four times nine, or 36%, for both the anterior
and posterior surfaces of the trunk, including the
buttocks.
n 4. Count 9% for the anterior and 9% for the posterior
surfaces of each lower limb as far up as the buttocks
(total of 36% for both lower limbs).
n 5. Count 1% for the perineum.

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Copyright 2010, John Wiley & Sons, Inc.
References
n Tortora, G.J., & Derrickson, B. (2012). Principles of ANATOMY &
PHYSIOLOGY. (13th ed.). John Wiley & Sons, Inc., Hoboken (NJ)
n Tortora, G.J., & Derrickson, B. (2009). Principles of ANATOMY &
PHYSIOLOGY. (12th ed.). John Wiley & Sons, Inc., Hoboken (NJ)
n Marieb, E. (2009), Essentials of Human Anatomy and Physiology. 9th ed.
U.K. Pearson

Copyright 2010, John Wiley & Sons, Inc.