This is composed of the skin and its appendages

>>> ANATOMY >>>

Skin/Integument/Cutaneous Membrane Largest organ (Surface area= 12-20 ft2) Thinnest organ (0.5 5 mm thick)

I.

2 MAIN LAYERS (overview)

A. EPIDERMIS- outer, thinner layer omposed of epithe!ia! tissues "#ascu!ar $riginated from the ectoderm

*Dermal-E i!ermal "un#tion- area %et&een the epidermis and the dermis $. DERMIS- inner, thi#ker layer omposed of dense connecti#e tissue 'ascu!ar "#erage thickness( )mm $riginated from the mesoderm

*%y o!ermis/Sub#utaneous layer/Su er&i#ial &as#ia "reo!ar and adipose tissue

II.

TYPES BASED ON THICKNESS OF THE EPIDERMIS

C. 'hin- #o(ers most art o& the bo!y Some epiderma! strata ma*%e a%sent +e&er ce!! !a*ers,stratum D. 'hi#k- #o(ers the (olar arts an! areas sub)e#te! to &ri#tion "!! 5 epiderma! strata are present -ach stratum is stratified .erma! papi!!ae are raised to form fingerprints or footprints /air is a%sent

III. LAYERS
E. EPIDERMIS *. CE++ ',PES a. -eratino#ytes- 001 of epiderma! ce!!s +i!!ed &ith 2eratin (tough and fi%rous protein) 3ost important ce!!s in the epidermis b. Melano#ytes- 51 of epiderma! ce!!s ontri%ute co!or to the skin .ecrease the amount of 4' that enters the skin #. +angerhans #ells- found in deep !a*ers of the epidermis +rom the %one marro& 5ork &ith the T/ ce!!s to initiate specific immune response .. CE++ +A,ERS a. Stratum #orneum /%orny layer0 3ost superficia! !a*er 4pper !a*er is composed of dead stratified s6uamous epithe!ium *top!asm of ce!!s ha#e %een rep!aced &ith -ERA'I1 (&ater-repe!!ent protein) +unction( %!ocks harmfu! chemica!s and micro%es from entering the skin b. Stratum lu#i!ium /Clear layer0 2eratinoc*tes are c!ose!* packed and c!ear 4sua!!*7 nuc!ei are a%sent e!!s are fi!!ed &ith -L-8.89 (ge!-!ike transitor* product of 2eratoh*a!in) "%sent in thin skin :resent in #o!ar areas +unction( %!ocks &ater penetration or !oss #. Stratum granulosum /2ranular layer0

5here keratini;ation starts omposed of 2-) !a*ers of ce!!s e!!s ha#e <keratoh*a!in= (precursor of keratin) e!!s are &ithout nuc!eus and degenerating >ich in !*sosoma! en;*mes 3a*%e a%sent in thin skin

!. Stratum s inosum /S iny layer0 ?-10 !a*ers of irregu!ar!* shaped ce!!s >ich in >9" (needed for s*nthesis of 2->"T89) e. Stratum basale /$ase layer0 1 ro& of co!umnar ce!!s >egenerates the other !a*ers **Stratum germinati(um- S. spinosum @ S. %asa!e on!* !a*er capa%!e of mitosis *DERMA+-EPIDERMA+ "31C'I41 composed of %asement mem%rane7 fi%ers and po!*saccharide ge! +49 T8$9S( 1. ements the epidermis to the under!*ing dermis 2. :ro#ides mechanica! support for the epidermis A. Ser#es as a partia! %arrier to some ce!!s and !arge mo!ecu!es from the dermis ). :re#ents harmfu! chemica!s or micro%es from entering the dermis 5. DERMIS a!so ca!!ed < orium= <true skin= Structure( o omposed of 2 !a*ers( :api!!ar* !a*er- thinner !a*er composed of !oose connecti#e tissue >eticu!ar !a*er- thicker !a*er composed of dense connecti#e tissue o Thicker than the epidermis ) mm on #o!ar parts 0.5 mm on e*e!ids and penis +unctions( o :ro#ides mechanica! strength to the skin o >eser#oir for &ater and important e!ectro!*tes o >ecei#es stimu!i from the eBterna! en#ironment o >egu!ates %od* temperature i. Pa illary layer superficia! !a*er that proCects into the epidermis ridges of this !a*er forms the creases of the fingers and toes uni6ue in each indi#idua! omposition( !oose connecti#e tissue @ net&ork of co!!agen and e!astin Reti#ular layer deep !a*er in anima!s7 this !a*er is processed to produce !eather composition( .ense connecti#e tissue (co!!agen pro#ides strengthD e!astin makes the skin stretcha%!e and e!astic) Se#era! structures are present in the dermis( Ske!eta! 3usc!e- in the skin of the face and sca!p o :ermits facia! eBpressions Smooth musc!e o "rrector pi!i,pi!orum- associated &ith hair fo!!ic!es ontro!s mo#ement of the hair 5hen it contracts7 it pu!!s the fo!!ic!e and its hair to an erect position and it e!e#ates the skin a%o#e to produce a <goose %ump= o remaster 3usc!e- e!e#ates the testes upon eBposure to co!d temperature o .artos musc!e- causes &rink!ing of the scrotum o Smooth musc!e in the dermis of the areo!a- causes erection of the nipp!es Ease of epiderma! g!ands /air fo!!ic!e E!ood #esse!s 9er#e endings o +ree 9er#e endings 9ociceptor- primar* sensor* receptors for pain7 heat and co!d Secondar* function( receptor for itching7 tick!ing7 touch7 mo#ement7 mechanica! stretching

ii.

>oot hair p!eBuses- net&ork of free ner#e endings that surround the hair fo!!ic!e +unction( detect hair mo#ement 3eke!Fs .isks- !ight,discriminati#e touch (su%t!e sensation &hich can %e !ocated eBact!* on the skin surface) -ncapsu!ated 9er#e endings- primari!* touch and pressure receptors :acinian orpusc!es- crude touch (can recogni;e the sensation %ut eBact !ocation is hard to determine) Large mechanoreceptors found in the deep dermis of the skin (in #o!ar areas) and Coint capsu!es throughout the %od* .etects deep pressure7 high fre6uenc* #i%ration and stretch

3eissnerFs corpusc!e- egg-shaped mechanoreceptors "!so ca!!ed <Tacti!e orpusc!e= :rimar* receptor for !ight touch 9umerous in hair!ess skin areas (nipp!es7 fingertips7 !ips) 'ariants of 3eissnerFs orpusc!e( 2rauseFs -nd Eu!%s o -gg-shaped %ut sma!!er than 3eissnerFs o "!so ca!!ed <3ucocutaneous orpusc!es= o :rimar* receptor for !ight touch and !o& fre6uenc* #i%ration o 9umerous in mucous mem%ranes than in the skin o Secondar* function( < o!d >eceptor= (stimu!ated %* temperatures !o&er than 1?G ) >uffiniFs orpusc!es- deep!* !ocated in the dermis o :rimar* receptor for crude and persistent touch o Secondar* function( </eat receptors= (stimu!ated %* temperatures ranging from 20-)0G ) LangerFs !ea#age Lines- patterns made %* %und!es of co!!agen fi%ers in the dermis o Surgica! incisions are made para!!e! to these c!ea#age !ines so the &ound &ont %e su%Cected to too much stress

>>> PHYSIOLOGY >>>

I . F!NCTIONS OF THE SKIN
*. PR4'EC'I41 a. %. c. d. e. Prote#ts un!erlying tissues against mi#robes/#hemi#als 677 &rom me#hani#al in)ury 677 &rom !ehy!ration by re(enting e(a oration o& internal bo!y &lui!s 677 un8ante! entry o& &lui!s &rom the e9ternal en(ironment Melanin rote#ts us &rom harm&ul e&&e#ts o& 3:

.. SE1SA'I41- skin contains mi!!ions of sensor* ner#e endings so it functions as a sense organ ;. M4:EME1' </4 I1"3R,- skin is e!astic so it a!!o&s contraction of musc!es &,o tearing,%reaking =. E>CRE'I41- certain &aste materia!s are secreted &ith s&eat (urea7 sa!t7 ammonia7 uric acid)(minor ro!e in o#era!! eBcretion of %od* &astes) ?. E1D4CRI1E 531C'I41- 4' con#erts @-!ehy!ro9y#holesterol (found in skin ce!!s) to #hole#al#i&erol i. ii. #hole#al#i&erol is then transported in the %!ood to the !i#er and kidne* &here it is con#erted to Cal#i&erol (promotes a a%sorption7 de#. $f %ones and teeth) H.ark skinned peop!e produce !ess 'it. .

A. IMM31I',- !angerhans ce!!s act as macrophages of the skin @. 'EMPERA'3RE RE23+A'I41 8. %od* must maintain a constant temp. range 88. #ita! processes depend on norma! en;*me functioning 888. en;*mes can %e easi!* denatured %* heat 8'. to maintain an e#en temperature7 the amount of heat production = amount of heat !oss '. 8f heat production I heat !oss7 %od* temp increases a%o#e norma! (AJ.2G 7 ear!* morning AK.5G 7 !ate afternoon) '8. Skin p!a*s a critica! ro!e in heat !oss %* the ff. processes(

i. ii. iii.

i(. (.

E(a oration- heat energ* is spent %* e#aporating %od* &ater %umi!ity pre#ents e#aporation and therefore !essens the coo!ing effect deri#ed from it Ra!iation- transfer of heat from one surface to another &,o actua! contact %et&een the t&o o%Cects /eat radiates from the skin to near%* o%Cects that are coo!er than the skin /eat radiates from hot o%Cects to the skin Con!u#tion- transfer of heat to an* su%stance in contact &ith the %od* (-B. !othing7 Ce&e!r*7 ingested food or !i6uid) Con(e#tion- transfer of heat a&a* from a heated surface %* mo#ement of air or f!uid partic!es

.
1.

SKIN COLOR

2. A. ).

(i. ME+A1I1 skin co!or #ariations are primari!* caused %* different amounts of me!anin produced %* the me!anoc*tes (9ote( num%er of me!anoc*tes in a!! races are e6ua!) 3e!anoc*tes are the on!* ce!!s that #on(ert t*rosine into me!anin (dark-%ro&n pigment) &ith the he!p of the en;*me 'yrosinase on#ersion .epends on( Lenes- )-J pairs of genes contro! me!anin production o if tyrosinase is a%sent from %irth7 me!anoc*tes cannot form me!anin (&,c &ou!d !ead to a!%inism7 characteri;ed %* a%sence of pigment in hair7 skin7 e*es) Sun!ight- stimu!ates me!anoc*tes to produce more me!anin o faci!itates me!anin production " T/ ("drenocorticotropic hormone)- secreted %* the adenoh*poph*sis (anterior pituitar* g!and) o too much secretion &i!! darken the skin "ge- in o!der persons7 t*rosinase production is decreased (resu!ts in gra*ing hair) (ii. change change change -B( CAR4'E1E- *e!!o& pigment that a!so contri%utes co!or to the skin

o o o o

(iii. $+44D in %!ood #o!ume in skin capi!!aries can a!so inf!uence skin co!or is temporar* is more e#ident in indi#idua!s &ith !ess me!anin 8f %!ood #esse!s constrict (frightened state)7 %!ood #o!ume decreasesD skin ma* turn pa!e 8f %!ood #esse!s di!ate (&hen %!ushing)7 %!ood #o!ume increasesD skin ma* turn pinker,redder *anosis- in an a%norma! condition (during trauma7 accidents7 eBtreme inCur*)D the amount of deoB*genated %!ood increases so skin turns %!ue,gra*ish

I. APPENDAGES OF THE SKIN

I. %AIR $n!* a fe& areas of the skin are hair!ess (#o!ar7 !ips7 nipp!es7 some areas of the genita!ia) A mo feta! !ife7 fo!!ic!es %egin to de#e!op J mo feta! !ife7 fetus is co#ered &ith lanugo (L. !ana= fine &oo!D eBtreme!* fine and soft) Eefore %irth7 most !anugo hair is !ost 5-J mo7 an* !anugo hair that remains is !ost and rep!aced %* (ellus (stronger hair) :ellus appears on the sca!p7 e*e%ro&s7 e*e!ids) :u%ert*7 terminal hair de#e!ops (coarser) 8n ma!es- ?0-001 of #e!!us on chest and eBtremities is rep!aced &ith termina! hair7 termina! hair forms the %eard 8n fema!es- Less #e!!us is rep!aced &ith termina! hair eBcept in the pu%ic and aBi!!ar* areas A. S'R3C'3RE *. 5olli#le 8all- &ith 2 !a*ers a. .erma! >oot sheath %. -pithe!ia! >oot sheath i. -Bterna! -pithe!ia! >oot sheath ii. 8nterna! -pithe!ia! >oot sheath .. 2erminal matri9- cap-shaped c!uster of ce!!s at the %ottom of the fo!!ic!e a. responsi%!e for forming hair ;. Pa illa- part of the dermis a. ontains %!ood #esse!s that nourishes the germina! matriB =. Sha&t- #isi%!e part ?. Root- hidden in the fo!!ic!e A. Me!ulla- inner core of the hair @. Corte9- superficia! portion B. Cuti#le- co#ering !a*er C. Seba#eous glan!s- secrete se%um into each hair fo!!ic!e

a.

+unctions( i. Lu%ricate hair ii. 2eep it from %ecoming dr* and %ritt!e

$. %AIR C4+4R orteB is composed of stratified keratini;ed ce!!s /air co!or is due to #ar*ing amounts of me!anin deposited in these keratini;ed ce!!s (high amount=%!ackD moderate=%ro&nD !o&=%!ond) 4ni6ue t*pe of me!anin containing +e is responsi%!e for red hair 5hite hair- resu!ts from a decrease in me!anin content *Melanin makes the hair stronger C. S'RAI2%' or C3R+, %AIR depends on the shape of the fo!!ic!e opening *. Straight- round .. <a(y- o#a! ;. Curly- spira! %AIR 2R4<'%, +4SS A1D REP+ACEME1' 5e are constant!* shedding and rep!acing our hair /air is shed &hen its gro&th is comp!ete *. Sca!p hair- 0.) mm,da* for A-5 *rs .. -*e%ro&s- 1-A mo "fter a short period of rest (A-) mo)7 the root produces a ne& hair -ach hair has its o&n !ife c*c!e so no area sheds a!! of its o!d hair at the same time /air gro&s faster( *. at night .. in &arm &eather ;. in *oung persons (1J-2)*o) =. %!ack hair gro&s faster than %!ond H +re6uent cutting or sha#ing does not stimu!ate hair gro&th Life span *. Sca!p hair- A-5 *ears .. -*e%ro& and e*e!ash- 10 &ks "#erage sca!p contains 1257000 hairs $n the a#erage &e !ose 50-100 hairs,da* :atterned Ea!dness= genes @ high amount of testosterone Ea!dness caused %* disease7 stress7 ma!nutrition etc.

II.

1AI+S omposed of hea#i!* keratini;ed epiderma! ce!!s A. S'R3C'3RE *. 1ail bo!y- #isi%!e part7 cornified dead ce!!s .. Root- !ies in a groo#e hidden %* the cutic!e ;. +unula (Litt!e 3oon)- crescent shaped &hite area near the root =. 1ail be!- under the nai! %od* a. ontains a%undant %!ood #esse!s so it appeared pink ?. E ony#hium- cutic!eD at the %ase of the nai! $. 1AI+ 2R4<'% 9ai! gro&s %* mitosis of ce!!s in the S. germinati#um %eneath the nai! root and !unu!a 0.5 mm,&k +ingernai!s gro& faster than toenai!s 9ai!s gro& faster in the summer than in the &inter

1AI+ DISEASE 4ny#holysis- caused %* minor trauma to !ong nai!s - separation of the nai! from the 1AI+ $ED starting at the dista! end of the affected nai! III. S-I1 2+A1DS A. S<EA' or S3D4RI5ER43S- most numerous of the skin g!ands *. E##rine/Mero#rine a. 3ost numerous7 important s&eat g!ands %. .istri%uted o#er the tota! %od* surface eBcept the !ips7 ear cana!7 nai! %eds7 g!ans penis c. Simp!e7 coi!ed7 tu%u!ar d. Ease is in the h*podermis e. S&eat rich in sa!ts7 ammonia7 urea7 uric acid etc. f. 1 in2 of the pa!m= A7000 s&eat g!ands g. 9umerous on so!es of the feet7 forehead7 upper torso .. A o#rine a. !ocated deep in the h*podermis of the armpit7 areo!a7 pigmented areas around the anus %. Simp!e7 %ranched7 tu%u!ar

c. d. e. f. g. h. -

Larger than - >89onnected &ith hair fo!!ic!es Secretion is more #iscous and co!ored than - >89Eecomes functiona! at pu%ert* $dor assoc. &ith apocrine is caused %* contamination &ith skin %acteria 8n &omen- secretions is connected to the menstrua! c*c!e

$. SE$ACE43S "ssoc &, hair fo!!ic!es (2,hair) +unctions of Se%um( *. 2eeps the hair and skin soft .. :re#ents eBcessi#e &ater !oss ;. /a#e antifunga! properties simp!e %ranched a!#eo!ar found in the dermis of %od* surface eBcept in #o!ar parts some direct!* open on the skin surface of g!ans penis7 e*e!ids7 !ips C. CER3MI143S 3odified ":$ >89- s&eat g!ands Simp!e7 coi!ed7 tu%u!ar .ucts open onto the ( *. free surface of the skin in the eBterna! ear cana! .. necks of hair fo!!ic!es in the eBterna! ear cana! CerumenD miBes secretions of oi! and ceruminous (%ro&n and &aB*)

II. PHYSIOLOGICAL AND ANATOMICAL ABNORMALITIES

I. $3R1 therma! inCur* caused %*( a. contact of the skin &ith some hot o%Cect of fire %. o#ereBposure to 4' c. contact &ith an e!ectric current or corrosi#e chemica!s depth of a %urn inCur* depends on the tissue !a*ers of the skin that are in#o!#ed

Classi&i#ation o& $urns 'y e o& $urn :artia!-Thickness Eurn 1. 3inor (1st .egree)7 t*pica! sun%urn Sur&a#e area A&&e#te! De th o& tissue !amage Ma)or e&&e#ts

M 101 of %od* surface

-pidermis is damaged %ut not destro*ed

2. Serious (2nd .egree)

I151 for an "du!t 101 for a hi!d

-pidermis and :art of the .ermis is destro*ed -ne& skin ma* regenerate

-mi!d s&e!!ing -reddening -minor discomfort -inCured !a*er pee!s off -hea!s &,o scarring (2 &ks) -reddening -edema -%!isters -s&e!!ing -greater pain than Ard degree %urn 5hite or charred appearance -insensiti#e to pain immediate!* after inCur* %ec. $f the destruction of ner#e endings -scarring is a serious pro%!em (surger* and skin grafts needed)

+u!!-Thickness Eurn A. Se#ere (Ard .egree)

I201 of %od* surface7 %urns of face7 e*es7 hands7 feet7 genita!s

"!! skin !a*ers destro*ed -3a* in#o!#ed under!*ing fascia7 musc!es7 %one -Skin cannot %e regenerated

II.

+ESI41S 1AME *. $leb, bulla .. Ma#ule ;. Pa ule E>AMP+E 2nd .egree %urn +reck!e7 f!at pigmented mo!e "cne7 meas!es DESCRIP'I41 +!uid-fi!!ed e!e#ation of the skin .isco!ored spot7 neither e!e#ated or sunken >aised7 sma!! pimp!es

=. Pustule ?. :esi#le A. <heal

"cne #u!garis7 sma!! poB E!ister hicken poB7 herpes simp!eB 3os6uito %ite /i#es

>aised7 pus-fi!!ed pimp!e Sma!! sac fi!!ed &ith serous f!uid Loca! s&e!!ing7 itching

III. S4ME C4MM41 S-I1 DIS4RDERS A. A#ne (ulgaris (common acne) most common among teenagers (high hormone !e#e!sD high oi! production) oi! c!ogs a fo!!ic!e !ogs are ca!!ed either &hiteheads or %!ackheads a. !osed omedones (&hiteheads)- do not protrude7 co#ered %* the epidermis %. $pen omedones (%!ackheads)- protrude from the fo!!ic!e7 not co#ered %* the epidermis %!ocked fo!!ic!e ma* %ecome infected &ith %acteria %acteria con#erts se%um into free fatt* acids acids irritate the fo!!ic!e !ining e#entua!!*7 fo!!ic!e &i!! %urst a. &hen acid and se%um seep into the dermis7 the* &i!! cause inf!ammation %. appears as pus-fi!!ed pimp!e scratching &i!! spread the infection appears most!* on the face7 chest7 upper %ack7 shou!ders more se#ere in teenage ma!es %ec. of testosterone $. $e!sores/De#ubitus 3l#ers- common in %ed-ridden patients &eight of the %od* causes poor circu!ation ma* 1st appear as red spots &hich ma* %ecome purp!ish (indicates that %!ood #esse!s are %eing %!ocked) Skin ma* %reak (!ack of nutrients and oB*gen &i!! e#entua!!* ki!! the tissue) 8f !eft untreated7 2nd %acteria! infection is common So!( a. 3aintain c!ean!iness and dr*ness of surroundings %. hange the position of the patient fre6uent!* (promote %!ood circu!ation) C. $irthmarks /:as#ular 1e(us0 *. 1e(us &lammeus (<:ort-&ine Stain=) :ink to %!uish-red !esion ause is unkno&n .. %emangioma (<Stra&%err* 3ark=) "ffects the superficia! %!ood #esse!s 4sua!!* present at %irth %ut ma* a!so appear an*time after %irth 3a* gro& s!o&!* 3a* %ecome sma!!er 3a* disappear as the indi#idua! gro&s o!der D. Mole /1e(us0 in most cases7 is a %enign !esion that usua!!* appears %efore the age of 5 or J 3a* appear an*time up to a%out A0 *rs of age 3o!es that darkens7 en!arge7 %!eed or appear after the person is A0 shou!d %e checked (it ma*%e transformed into a cancerous gro&th) 8nherited E. Psoriasis inherited attacks can %e %rought on %* pregnanc*7 hormona! changes7 emotiona! stress7 co!d &eather7 trauma (:/- T) :h*sio!og* a. $ccurs &hen %asa! ce!!s mo#e to the S. corneum %efore the* mature () da*s instead of the usua! 2?) %. S. corneum %ecomes f!ak*7 !esions are red7 dr*7 e!e#ated7 co#ered &ith sca!* patches 4sua! sites( e!%o&s7 knees7 sca!p7 face7 face7 !o&er %ack

5. Allergi# res onses a!!ergens ma* sip through the skin or ma*%e inha!ed &i!! trigger p!asma ce!!s to produce anti%odies against the a!!ergen "nti%odies &i!! trigger mast ce!!s to produce histamine &,c &ou!d initiate the inf!ammator* response 2. <arts /:erru#ae0 caused %* papi!!oma #iruses usua!!* not pigmented eBcept for p!antar &arts (*e!!o&ish) contagious usua!!* disappear after a *ear ma*%e remo#ed through surger*

%. $ruises -

hard %!o& to the surface of the skin ma* %reak under!*ing capi!!aries re!eases %!ood to the dermis %!ack and %!ue co!or is %ecause skin ref!ects %!ue !ight and a%sor%s other co!ors ma* turn green,*e!!o& after se#era! da*s (indicates that spi!!ed %!ood %egun to decompose7 hemog!o%in deca*s to hemosi!erin N*e!!o&ishO)

I.

<431D %EA+I12 can take from 1 &eek to a month depending on the se#erit* of the cut -pidermis- &hen the epidermis is damaged7 %asa! ce!!s 6uick!* di#ide to form daughter ce!!s that fi!! the &ound .ermis- &hen the dermis is cut7 fi%ro%!asts %ecome acti#e and fi!! in the gap &, a dense mass of co!!agen fi%ers i. 8f the mass is sma!!7 it ma* %e e#entua!!* rep!aced %* norma! tissue ii. 8f the mass is deep7 or if ce!! damage is eBtensi#e7 it ma* remain as a dense fi%rous mass ca!!ed a S "> iii. "n unusua!!* thick scar that de#e!ops in the deep part of the dermis is ca!!ed a keloi! $+IS'ER 54RMA'I41 &hen skin is %urned or irritated7 %!ood #esse!s in the dermis &iden and p!asma !eaks out p!asma accumu!ates in the derma!-epiderma! region in a f!uid-fi!!ed pocket of %!ister <RI1-+ES 5rink!es are produced &hen E+AS'I1 !oses its stretcha%i!it* and degenerates into E+ACI1 This causes the dermis to %ecome more c!ose!* %ound to the musc!e tissue The !a*er %eneath the skin shrinks causing the skin to sag into &rink!es -Bposure to 4' faci!itates the &rink!ing process (4' causes the fi%ers to degenerate)

II.

III.