THE INTEGUMENTARY SYSTEM

dr Heru Sutanto K
The integumentary system is an organ system consisting
of the skin, hair, nails, and exocrine glands. The skin is
only a few millimeters thick yet is by far the largest organ
in the body. The average persons skin weighs 20 kgs and
has a surface area of almost 60 square meters. Skin
forms the bodys outer covering and forms a barrier to
protect the body from chemicals, disease, UV light, and
physical damage. Hair and nails extend from the skin to
reinforce the skin and protect it from environmental
damage. The exocrine glands of the integumentary
system produce sweat, oil, and wax to cool, protect, and
moisturize the skins surface.
The integumentary system is made up of the skin and its
appendages (such as the nails and the hair); its primary
function is to protect the body from damage; it is also
involved in temperature regulation and in the sense of
touch. Upon exposure to sunlight, the integumentary
system is also the primary vehicle for synthesis of vitamin
D.

Anatomy of the Integumentary System
Epidermis
The epidermis is the most superficial layer of the skin that
covers almost the entire body surface. The epidermis
rests upon and protects the deeper and thicker dermis
layer of the skin. Structurally, the epidermis is only about
a tenth of a millimeter thick but is made of 40 to 50 rows
of stacked squamous epithelial cells. The epidermis is an
avascular region of the body, meaning that it does not
contain any blood or blood vessels. The cells of the
epidermis receive all of their nutrients via diffusion of
fluids from the dermis.
The epidermis is made of several specialized types of
cells. Almost 90% of the epidermis is made of cells known
as keratinocytes. Keratinocytes develop from stem cells at
the base of the epidermis and begin to produce and store
the protein keratin. Keratin makes the keratinocytes very
tough, scaly and water-resistant. At about 8% of
epidermal cells, melanocytes form the second most
numerous cell types in the epidermis. Melanocytes
produce the pigment melanin to protect the skin from
ultraviolet radiation and sunburn. Langerhans cells are the
third most common cells in the epidermis and make up
just over 1% of all epidermal cells. Langerhans cells role
is to detect and fight pathogens that attempt to enter the
body through the skin. Finally, Merkel cells make up less
than 1% of all epidermal cells but have the important
function of sensing touch. Merkel cells form a disk along
the deepest edge of the epidermis where they connect to
nerve endings in the dermis to sense light touch.
The epidermis in most of the body is arranged into 4
distinct layers. In the palmar surface of the hands and
plantar surface of the feet, the skin is thicker than in the
rest of the body and there is a fifth layer of epidermis.
The deepest region of the epidermis is the stratum basale,
which contains the stem cells that reproduce to form all of
the other cells of the epidermis. The cells of the stratum
basale include cuboidal keratinocytes, melanocytes, and
Merkel cells. Superficial to stratum basale is the stratum
spinosum layer where Langerhans cells are found along
with many rows of spiny keratinocytes. The spines found
here are cellular projections called desmosomes that form
between keratinocytes to hold them together and resist
friction. Just superficial to the stratum spinosum is the
stratum granulosum, where keratinocytes begin to
produce waxy lamellar granules to waterproof the skin.
The keratinocytes in the stratum granulosum are so far
removed from the dermis that they begin to die from lack
of nutrients. In the thick skin of the hands and feet, there
is a layer of skin superficial to the stratum granulosum
known as the stratum lucidum. The stratum lucidum is
made of several rows of clear, dead keratinocytes that
protect the underlying layers. The outermost layer of skin
is the stratum corneum. The stratum corneum is made of
many rows of flattened, dead keratinocytes that protect
the underlying layers. Dead keratinocytes are constantly
being shed from the surface of the stratum corneum and
being replaced by cells arriving from the deeper layers.
Dermis
The dermis is the deep layer of the skin found under the
epidermis. The dermis is mostly made of dense irregular
connective tissue along with nervous tissue, blood, and
blood vessels. The dermis is much thicker than the
epidermis and gives the skin its strength and elasticity.
Within the dermis there are two distinct regions: the
papillary layer and the reticular layer.
The papillary layer is the superficial layer of the dermis
that borders on the epidermis. The papillary layer contains
many finger-like extensions called dermal papillae that
protrude superficially towards the epidermis. The dermal
papillae increase the surface area of the dermis and
contain many nerves and blood vessels that are projected
toward the surface of the skin. Blood flowing through the
dermal papillae provide nutrients and oxygen for the cells
of the epidermis. The nerves of the dermal papillae are
used to feel touch, pain, and temperature through the
cells of the epidermis.
The deeper layer of the dermis, the reticular layer, is the
thicker and tougher part of the dermis. The reticular layer
is made of dense irregular connective tissue that contains
many tough collagen and stretchy elastin fibers running in
all directions to provide strength and elasticity to the skin.
The reticular layer also contains blood vessels to support
the skin cells and nerve tissue to sense pressure and pain
in the skin.
Hypodermis Deep to the dermis is a layer of loose
connective tissues known as the hypodermis, subcutis, or
subcutaneous tissue. The hypodermis serves as the
flexible connection between the skin and the underlying
muscles and bones as well as a fat storage area. Areolar
connective tissue in the hypodermis contains elastin and
collagen fibers loosely arranged to allow the skin to
stretch and move independently of its underlying
structures. Fatty adipose tissue in the hypodermis stores
energy in the form of triglycerides. Adipose also helps to
insulate the body by trapping body heat produced by the
underlying muscles.
Hair
Hair is an accessory organ of the skin made of columns of
tightly packed dead keratinocytes found in most regions of
the body. The few hairless parts of the body include the
palmar surface of the hands, plantar surface of the feet,
lips, labia minora, and glans penis. Hair helps to protect
the body from UV radiation by preventing sunlight from
striking the skin. Hair also insulates the body by trapping
warm air around the skin.
The structure of hair can be broken down into 3 major
parts: the follicle, root, and shaft. The hair follicle is a
depression of epidermal cells deep into the dermis. Stem
cells in the follicle reproduce to form the keratinocytes
that eventually form the hair while melanocytes produce
pigment that gives the hair its color. Within the follicle is
the hair root, the portion of the hair below the skins
surface. As the follicle produces new hair, the cells in the
root push up to the surface until they exit the skin. The
hair shaft consists of the part of the hair that is found
outside of the skin.
The hair shaft and root are made of 3 distinct layers of
cells: the cuticle, cortex, and medulla. The cuticle is the
outermost layer made of keratinocytes. The keratinocytes
of the cuticle are stacked on top of each other like
shingles so that the outer tip of each cell points away
from the body. Under the cuticle are the cells of the
cortex that form the majority of the hairs width. The
spindle-shaped and tightly packed cortex cells contain
pigments that give the hair its color. The innermost layer
of the hair, the medulla, is not present in all hairs. When
present, the medulla usually contains highly pigmented
cells full of keratin. When the medulla is absent, the
cortex continues through the middle of the hair.
Nails
Nails are accessory organs of the skin made of sheets of
hardened keratinocytes and found on the distal ends of
the fingers and toes. Fingernails and toenails reinforce
and protect the end of the digits and are used for scraping
and manipulating small objects. There are 3 main parts of
a nail: the root, body, and free edge. The nail root is the
portion of the nail found under the surface of the skin. The
nail body is the visible external portion of the nail. The
free edge is the distal end portion of the nail that has
grown beyond the end of the finger or toe.
Nails grow from a deep layer of epidermal tissue known as
the nail matrix, which surrounds the nail root. The stem
cells of the nail matrix reproduce to form keratinocytes,
which in turn produce keratin protein and pack into tough
sheets of hardened cells. The sheets of keratinocytes form
the hard nail root that slowly grows out of the skin and
forms the nail body as it reaches the skins surface. The
cells of the nail root and nail body are pushed toward the
distal end of the finger or toe by new cells being formed in
the nail matrix. Under the nail body is a layer of epidermis
and dermis known as the nail bed. The nail bed is pink in
color due to the presence of capillaries that support the
cells of the nail body. The proximal end of the nail near
the root forms a whitish crescent shape known as the
lunula where a small amount of nail matrix is visible
through the nail body. Around the proximal and lateral
edges of the nail is the eponychium, a layer of epithelium
that overlaps and covers the edge of the nail body. The
eponychium helps to seal the edges of the nail to prevent
infection of the underlying tissues.

Sudoriferous Glands
Sudoriferous glands are exocrine glands found in the
dermis of the skin and commonly known as sweat glands.
There are 2 major types of sudoriferous glands: eccrine
sweat glands and apocrine sweat glands. Eccrine sweat
glands are found in almost every region of the skin and
produce a secretion of water and sodium chloride. Eccrine
sweat is delivered via a duct to the surface of the skin and
is used to lower the bodys temperature through
evaporative cooling.
Apocrine sweat glands are found in mainly in the axillary
and pubic regions of the body. The ducts of apocrine
sweat glands extend into the follicles of hairs so that the
sweat produced by these glands exits the body along the
surface of the hair shaft. Apocrine sweat glands are
inactive until puberty, at which point they produce a thick,
oily liquid that is consumed by bacteria living on the skin.
The digestion of apocrine sweat by bacteria produces body
odor.
Sebaceous Glands
Sebaceous glands are exocrine glands found in the dermis
of the skin that produce an oily secretion known as
sebum. Sebaceous glands are found in every part of the
skin except for the thick skin of the palms of the hands
and soles of the feet. Sebum is produced in the sebaceous
glands and carried through ducts to the surface of the skin
or to hair follicles. Sebum acts to waterproof and increase
the elasticity of the skin. Sebum also lubricates and
protects the cuticles of hairs as they pass through the
follicles to the exterior of the body.
Ceruminous Glands
Ceruminous glands are special exocrine glands found only
in the dermis of the ear canals. Ceruminous glands
produce a waxy secretion known as cerumen to protect
the ear canals and lubricate the eardrum. Cerumen
protects the ears by trapping foreign material such as
dust and airborne pathogens that enter the ear canal.
Cerumen is made continuously and slowly pushes older
cerumen outward toward the exterior of the ear canal
where it falls out of the ear or is manually removed

Cross section of the skin

Skin is the outside covering of body tissue, which protects
inner cells and organs from the outside environment. The
skin is the largest organ of the body, and its cells are
continuously replaced, as they are lost to normal wear
and tear. The skin is composed of three integrated layers:
the epidermis, the dermis and the sub-cutis.
The thickness of the epidermis and the dermis varies over
different parts of the body. It is thickest on the palms of
the hands and feet, where friction is needed for gripping,
and it is thinnest on the eyelids, which must be light and
flexible. The epidermis also grows into fingernails, toenails
and hair.
The dermis, or true skin, is thick and sturdy. It is rich in
nerves, blood vessels, and sweat glands. It shields the
internal tissues of the body from harm and repairs injured
tissue. This layer consists mostly of collagen, which
originates from cells called fibroblasts and is one of the
strongest proteins found in nature. It gives skin durability
and resilience.
The subcutis, joined to the bottom of the dermis, is the
deepest layer of the skin. It contains lipocytes, which
produce lipids for the subcutaneous tissue to make a fatty
layer, which cushions muscles, bones and inner organs
against shocks, and acts as an insulator and source of
energy during lean times. The skin registers sensation
constantly and supports a teeming, unseen population of
tiny organisms. Although the skin can respond to the most
delicate touch, it does harden from use; it also molds into
varied shapes. So tough and durable is the skin that when
a 2,000-year-old Egyptian mummy was fingerprinted, the
ridges were perfectly preserved.

The integumentary system of the head
The integumentary system of the head and neck includes
the skin and hair of the face, head and neck. The skin of
the face is the part of the body, which is most often
exposed to sunlight, the elements, and environmental
pollutants; thus, it is more prone to acne and to becoming
dry or otherwise showing accumulated damage from these
influences than the skin on the rest of the body.
The top and upper sides of the head are typically the
single largest collection of hair on the human body Facial
hair includes the eyebrows and eyelashes; visible air also
grows between the nose and upper lip and along the
cheeks and lower edge of the jaw line and sometimes
extends down the neck. This facial hair is typically very
fine in women and somewhat thicker in men, although
this can vary.
The integumentary system of the head in male
The integumentary system of the head and neck in males
is made up of the skin and its appendages (such as the
hair); its primary function is to protect the body from
damage; it is also involved in temperature regulation and
in the sense of touch. Upon exposure to sunlight, the
integumentary system is also the primary vehicle for
synthesis of vitamin D.
The integumentary system of the head and neck includes
the skin and hair of the face, head and neck. The skin of
the face is the part of the body that is most often exposed
to sunlight, the elements, and environmental pollutants;
thus, it is more prone to acne and to becoming dry or
otherwise showing accumulated damage from these
influences than the skin on the rest of the body.
The top and upper sides of the head are typically the
single largest collection of hair on the human body. Facial
hair includes the eyebrows and eyelashes; visible air also
grows between the nose and upper lip and along the
cheeks and lower edge of the jaw line and sometimes
extends down the neck. This facial hair is typically
somewhat thicker in men, although this can vary.
The integumentary system of the upper torso
The integumentary system of the upper torso is made up
of the skin and its appendages (such as the hair); its
primary function is to protect the body from damage; it is
also involved in temperature regulation and in the sense
of touch. Upon exposure to sunlight, the integumentary
system is also the primary vehicle for synthesis of vitamin
D.
The integumentary system of the upper abdomen includes
the skin and hair of this region; the skin of this system
protects against damage to the organs contained within
the abdomen. While both men and women have hair on
their chests, this hair is usually quite fine on most women
and may be nonexistent. Men typically have much thicker
hair on their chests than women, and are also much more
likely to have visible hair on their backs.
The integumentary system of the lower torso
The integumentary system of the lower abdomen and
pelvis includes the skin and hair of this region. The skin of
this system protects against damage to the organs
contained within the abdomen. Additionally, the skin over
the genitals is the first line of defense against sexually
transmitted diseases and other diseases that affect these
reproductive organs. Both men and women have hair on
the lower abdomen that extends from the lower edge of
the chest to the pubis. Hair in the genital region is known
as pubic hair.
The integumentary system of the upper extremities
The integumentary system of the upper extremities
(including the shoulders, arms, hands and fingers)
includes the skin and hair, and nails of the upper
extremities. The skin of the hands and arms (especially
the hands) is more frequently exposed to sunlight and to
environmental toxins than other parts of the body.
Therefore, the hands are likely to show evidence of
accumulated damage from these influences as a person
ages.
Fingernails are located at the upper tip of each finger.
They protect the fingertips from injury and also enhance
the delicate movement and sensitivity of the fingertips,
although the nails themselves have no nerve endings.
The integumentary system of the lower extremities
The integumentary system of the lower extremities
includes the skin, hair and nails of the legs, feet, and toes.
The skin of this system is the first barrier against damage
to the muscles of the legs, feet, and toes. Both men and
women have hair on their legs and the tops of their feet,
but this hair is somewhat thicker and coarser in men than
in women. The toenails protect the toes from injury; they
also enhance the sensitivity of the tips of the toes,
although the nails themselves have no nerve endings.
FINGER NAILS
The fingernails are a sort of envelope composed of
keratin, a tough protein, which cover the top of the
terminal phalanges of a person's fingers. Nails are similar
to the claws that can be found in other animals. Each nail
is made up of a nail platethis is the top of the nail. It is
also made up of the nail matrix, a thin layer of tissue
upon which the nail plate rests and the site of the cells
that eventually become the nail plate. Each nail also has a
nail beda layer of skin that connects the nail matrix to
the hand. And lastly, each nail has the grooves that
surround the nail matrix.
Nails protect the tissues that they cover from injury. They
also enhance the delicate movement of fingertips and the
sensitivity of the fingertips, although the nail itself has no
nerve endings. The nail is an opposing force to the
fingertip. It allows the fingertip to receive even more
sensory input after it touches an object. Fingernails
usually grow at a faster rate than toenails. Nails grow
more quickly in higher temperatures. Since fingernails are
usually exposed, they receive more light and therefore
more warmth and air, which quickens their growth rate.
CUTICLE OR EPONYCHIUM
The cuticle or eponychium of the fingernail is a specialized
form of epidermis that is found over the base of the nails
of the fingers. It is a thin layer of skin that covers the nail
plate and nail root just before the nail emerges at the
surface, where the keratinized cells will be completely
developed. However, the cuticle is not made up of cells
but is rather a secretion of the epidermal cells, coating the
end of the skin on top of the nail body. It brings the skin
on the finger and the nail plate together to provide a
barrier thats waterproof. Beneath the eponychium is the
membranous pterygium, providing further protection to
the skin against bacteria and infection. The eponychium
folds over the top of and back in on the lower edge of the
epidermal cells at the junction with the nail. Just beyond
the cuticle, particularly on the thumb, the nail body may
be whitish or lighter in color in a small hemisphere called
a lunula

The free edge of the fingernail
The free edge of the fingernail (or distal edge) is located
beyond the nail body, where the fingernails terminate. It
is also beyond and detached from the nail bed. As with
the nail body, the nail edge consists of keratinized
epithelial cells, dead but pushed forward by the growing
nail cells within the nail matrix and nail root. At its
junction between the nail body, nail bed, and the
epidermis at the front of the finger, the free edge of the
nail is protectively sealed to the skin at the thin
onychodermal band (which is sometimes glassy in
appearance). The greater hyponychium, which is a layer
of protective epithelial cells sealing the distal end of the
nail bed to the epidermis to prevent bacterial or fungal
infection of the nail, joins the skin of the fingertip to the
free edge.

Hyponychium
The hyponychium of the fingernail is known as the quick
of the nail. Hyponychium is the name given to the
epithelium (a layer of thickened tissue) located
underneath the nail plate, at the intersection between the
spot where the skin of the fingertip meets the nail plate,
below the free edge of the nail. The hyponychium forms a
waterproof seal that helps to protect the nail bed from
injury or disease.

Lunula
The lunula of a fingernail is the whitish or paler
hemispheric portion of the nail body arcing upwards from
the cuticle or eponychium. It has the appearance of a
half-moon. Lunula is Latin for moon. All the nails have
lunulae, however, the lunula's appearance is most marked
in the thumb; and on the other nails the lunula may not
be visible at all, hidden beneath the cuticle and the skin
further back along the phalanges. The cells of the lunula
are the same keratinized cells that make up the rest of
the nail bed, but they are slightly less developed than the
other cells and less firmly attached to the nail bed,
resulting in its lighter appearance.

Nail Body
The nail body of a fingernail is the principle portion of the
human nail. Also known as the nail plate, it is made of
keratin that is translucent. It is the exposed portion of the
nail, growing from the nail matrix, beyond the nail root,
and out from beneath the cuticle or eponychium.
Laterally, the nail body is enclosed within the nail groove
by the flexible tissue of the paronychium, and it
terminates at the distal edge or free margin of the nail,
which hangs free of the nail bed. It looks pink because of
the blood vessels located under the nail.
At the junction of the nail body proper and the distal edge
of the nail is the hyponychium, a protective layer of
epithelial cells that seals the end of the nail bed and
epidermis to the nail at the onychodermal band. While the
nail is constantly growing, the nail body is nevertheless
firmly attached to the skin of the nail bed beneath it. The
layered cells of the nail body are keratin cells, like those
of the hair, flattened into a thin plate with longitudinal
grooves that may be barely visible. By the time they are
exposed to the air beyond the cuticle, these cells are
dead. The growing and dividing cells of the nail matrix and
nail root continually push the dead keratinized epithelial
cells of the nail body forward.

Nail root
The nail root of the fingernail is the base of the human
nail. Its also known as the germinal matrix. It is hidden
beneath the skin within the nail sinus and attached to the
growth matrix at the nail's medial terminal end. Like the
rest of the nail, it is made up of flattened keratin cells in a
plate-like shape, lightly grooved on the surfaces above
and below.
Within the nail root, the epithelial cells growing and
dividing at the growth matrix become keratinized-mixed
together and hardened with keratin, fibrous forms of
amino acids containing sulfur compounds. This
keratinization leads to the hardening of the nail bed and
lends the nail its strength. Growth within the nail root
adds about 3mm of nail bed each month, growing
continuously and pushing the dead cells of the nail body
(nail plate) forward along with the nail bed and into the
free edge of the nail.
The Eccrine glands
The eccrine glands are sweat glands that are not
connected to hair follicles. They function throughout life
by responding to elevated body temperature due to
environmental heat or physical exercise. These glands are
common on the forehead, neck, and back, where they
produce profuse sweating on hot days and when a person
is physically active. They also are responsible for the
moisture that may appear on the palms and soles when a
person is emotionally stressed.
The arrector pili
The arrector pili are a bundle of smooth muscle cells
attached to each hair follicle. This muscle is positioned so
that the hair within the follicle stands on end when the
muscle contracts. If a person is emotionally upset or very
cold, nerve impulses may stimulate the arrector pili
muscles to contract, causing gooseflesh or goose bumps.
Each hair follicle also has one or more sebaceous glands
associated with it
Dermis
The dermis layer, or true skin, is one of three integrated
skin layers. It is between the epidermis and subcutis. It is
thick, sturdy, and rich in nerves and blood vessels and in
sweat glands. It is thickest on the palms of the hands and
feet, where friction is needed for gripping, and it is
thinnest on the eyelids, which must be light and flexible.
It shields and repairs injured tissue. This layer consists
mostly of collagen, which originates from cells called
fibroblasts and is one of the strongest proteins found in
nature. It gives skin durability and resilience. The
subcutis, the third skin layer, joins to the bottom of the
dermis.
Epidermis
The epidermis layer is one of three integrated layers of
the skin. The dermis and subcutis are the other two. The
thickness of the epidermis and the dermis varies over
different parts of the body. It is thickest on the palms of
the hands and feet, where friction is needed for gripping,
and it is thinnest on the eyelids, which must be light and
flexible. The epidermis also grows into fingernails, toenails
and hair.
Hair Folicle
A hair follicle is a group of epidermal cells at the base of a
tube-like depression. Hair is present on all skin surfaces
except the palms, soles, lips, nipples, and various parts of
the external reproductive organs; however, it is not
always well developed. For example, it is very fine on the
forehead and the inside surface of the arm. Each hair
develops from a hair follicle. This follicle extends from the
surface into the dermis and may pass into the
subcutaneous layer. The cells at its base receive
nourishment from dermal blood vessels that occur in a
projection of connective tissue, called the derma papilla,
at the base of the follicle. As these epidermal cells divide
and grow, older cells are pushed toward the surface. The
cells that move upward and away from the nutrient supply
then die. Their remains constitute the shaft of a
developing hair. In other words, a hair is composed of
dead epidermal cells. A bundle of smooth muscle cells,
forming the arrector pili muscle, are attached to each hair
follicle. This muscle is positioned so that the hair within
the follicle stands on end when the muscle contracts. If a
person is emotionally upset or very cold, nerve impulses
may stimulate the arrector pili muscles to contract,
causing gooseflesh or goose bumps. Each hair follicle also
has one or more sebaceous glands associated with it.
The Meissners corpuscle
The Meissner's corpuscle is a set of nerves in the dermis.
It is a set of dermal receptors sensitive to light touch.
The Pacinian corpuscle
The Pacinian corpuscle is a set of nerves in the dermis.
This set of dermal receptors is stimulated by heavy
pressure.
Ruffini terminals
The ruffini ending or ruffini terminals refer to the endings
of encapsulated nerve endings found in subcutaneous
tissue and thought to mediate the sense of warmth.
Sebaceous gland
The sebaceous gland is part of the holocrine glands
(glands that release entire cells filled with secretory
products). The cells of the sebaceous glands produce
globules of a fatty material that accumulates, causing the
cells to swell and burst. The resulting mixture of fatty
material and cellular debris is called sebum.
The subcutis layer
The subcutis layer is one of three integrated layers of the
skin. It is joined to the bottom of the dermis (the second
layer) and is the deepest layer of the skin. It contains
lipocytes, which produce lipids for the subcutaneous tissue
to make a fatty layer that cushions muscles, bones and
inner organs against shocks, and acts as an insulator and
source of energy during lean times.