Dermatographia: overly

sensitive skin
Argyria (blue skin) is a permanent condition
caused by ingestion of silver.

Human Pappiloma
Virus (HPV) infection
(warts)

Blaschko's lines are an invisible pattern built into

human DNA. Many inherited and acquired diseases of
the skin or mucosa manifest themselves according to
these patterns, creating the visual appearance of
stripes.

Structure of Skin
Epidermis (including cuticle)
Dermis
Accessory structures
Above, beneath or within are special
function organs
Sweat and sebaceous glands
Hair
Nails
Subcutaneous layer

Integumentary
system functions:
Protection
Excretion
Temperature maintenance
Nutrient storage
Vitamin D3 synthesis
Sensory detection

Skin Characteristics
Heaviest single organ of the body (16% of total
body weight)
1.2-2.3 m2 of surface area contacting external
environment
Variable skin thickness - on the back 4mm thick;
scalp 1.5mm thick
Skin is heterogeneous (multiple substructures),
anisotropic (directionally dependent) and a nonlinear viscoelastic material

Ross, Michael. Histology: A text and Atlas. Pensylvania: Wojciech Pawlina, 2003.

Temperature and
Skin

Xu, F., Lu, T. J., & Seffen, K. A. (2008). Biothermomechanics of skin tissues.
Journal of the Mechanics and Physics of Solids, 56: 1852-1884.

The Components of the Integumentary

System

The epidermis
Provides mechanical protection
Prevents fluid loss
Keeps microorganisms from invading the body

Characteristics of
Epidermis
Molded layer of dermis
Avascular
Varies in thickness like dermis
The thickness of the epidermis ranges
from 0.05 mm on the eyelids to 1.5 mm
on the palms and soles. (Habif: Clinical Dermatology, 3rd
ed., Copyright 1996 Mosby-Year Book, Inc.)

Thick, hard, and horny in nature

Thin Skin and Thick

Skin
The epidermis is composed of layers of
keratinocytes
Thin skin = four layers (strata)
Thick skin = five layers

Figure 5.2

Layers of the
epidermis:
Stratum Basale

(germinativum)

Stratum spinosum
Stratum granulosum
Stratum lucidum
Stratum corneum

Integument Layers

Pigmentation

Melanin
Closely packed
granules within
cells
Color varies
from reddishorange to black

Epidermal Ridges

The Epidermal Ridges

of Thick Skin

Figure 5.3

Fingerprints
In 1929, Harold Cummins published a paper "The Topographic
History of the Volar Pads In The Human Embryo". In his paper he
describes how the growth of epidermal (friction) ridges is
dependant on "two major development circumstances, namely,
variations in the histology of different regions and differential
growth incident to the production of irregular reliefs of the volar
surfaces".

He goes on to say...

"The various configurations are not determined by self-limited

mechanism within the skin. The skin possesses the capacity to
form ridges, but the alignments of these ridges are as responsive
Timeline of sand to sweeping
to stresses in growthDevelopmental
as are the alignments
by wind or wave."
http://www.ridgesandfurrows.homestead.com/Friction_Skin_Growth.html

Separating the
Layers

Martini, F. (2004)

Dermis
Durable, flexible and elastic

predominant collagen fibers are Type I & III

different types of collagen)

( there are 29

Thickness varies
Thicker on palms and soles
The dermis varies in thickness from 0.3 mm on
the eyelid to 3.0 mm on the back
(Habif: Clinical Dermatology, 3rd ed.,
Copyright 1996 Mosby-Year Book, Inc.)
Highly vascular
Contains the lymphatics and sensory nerves of
epidermis pass through

Dermal
Organization
Papillary layer
Contains blood vessels, lymphatics, sensory nerves of epidermis

Reticular layer
Contains network of collagen and elastic fibers to resist tension

Dermal Circulation

Dermal Circulation
and innervation
Cutaneous plexus arteries found in subcutaneous
layer/ papillary dermis
Cutaneous sensory receptors (light touch, pressure)

Unencapsulated Sensory Organs

Encapsulated Sensory Organs

Marieb, E. N. (2001). Human Anatomy & Physiology (5th Ed. ). San Francisco:Benjamin Cummings.

Biophysical and Neurological

Mechanisms of PAIN

Xu, F., Lu, T. J., & Seffen, K. A. (2008). Biothermomechanics of skin tissues.
Journal of the Mechanics and Physics of Solids, 56: 1852-1884.

 Small terminal vessels that collect interstitial

fluid and macromolecules
They return via larger vessels

Carry lymphocytes, Langerhans cells and

macrophages to regional lymph nodes
Begin as blind-ended, endothelial-lined tubes
or loops just below the papillary dermis
They drain into superficial plexus below the
subpapillary venous plexus

Stretch marks

Caused by excessive stretching of the dermis

Patterns of collagen and elastic fibers form lines of
cleavage

Langers Lines
Illustrated

Grays Anatomy, 1985, 30th Ed.

Skin Tension
Cleavage lines correspond to creases in
the skin surface for most of the body
Patterns are typical but not exact from
person to person but are more similar for
individuals with comparable body
morphology

Age-Related
Changes in Skin
Overall structural changes

skin dryness
roughness
wrinkling
laxity and decreased skin elasticity

Overall functional changes

decline in skin barrier function

decline in mechanical protection (tearing)
decline in sensory perception
increase in wound healing time
decrease in immunologic responsiveness,
thermoregulation, and Vitamin D production

Merck Manual of Geriatrics, 3rd ed. (2000). Keryn Lane (Ed.) Ch. 122, pp. 1231-1237

Hypodermis

Stabilizes skins position against underlying organs

and tissues

Martini, F. (2004)

Extent of Injury in
Wound Healing
Partial disruption of the integument requires
only epithelialization [Prathiba & Gupta. Cutaneous wound healing:
Significance of proteoglycans in scar formation. Current Science, 2000; 78(6): 1-5]

Wounds that compromise the epidermis and

dermis undergo a complex and regulated
process or series of events

Wound Healing

wound healing is temperature sensitive with the ideal being in

the core temp range of 37 degrees Centigrade.
http://www.woundcaresolutions-telemedicine.co.uk/therapies/essentials-of-wound-healing

Wound Healing

[Prathiba & Gupta. Cutaneous wound healing: Significance of proteoglycans in scar

formation. Current Science, 2000; 78(6): 697-701]

Wound
Healing
PMN =
polymorphonuclear =
WBC = neutrophil

Differentiating
Tissue Types

https://www.studyblue.com/notes/note/n/6-wound-healing/deck/3378600

Evolution
of a Clot
and Scab

https://www.studyblue.com/notes/note/n/6-wound-healing/deck/3378600

[Prathiba & Gupta. Cutaneous wound healing: Significance of proteoglycans in scar

formation. Current Science, 2000; 78(6): 697-701]

Temperature and
Skin

Xu, F., Lu, T. J., & Seffen, K. A. (2008). Biothermomechanics of skin tissues.
Journal of the Mechanics and Physics of Solids, 56: 1852-1884.

Needle Puncture
Force
Hollow

microneedles
required an average
puncture force of about
1.65N
Solid mocroneedles required
less force (1.29N)

Appendages of the
Skin
Nails
Hairs
Sudoriferous glands
Sebaceous glands

Nails (Ungues)
Grays (1985) defines nails as, flattened,
elastic structures of a horny texture placed
upon the dorsal surfaces of the terminal
phalanges of the fingers and toes (p.
1350).

Nail Structure
Nail body covers the nail bed
Nail production occurs at the nail root
Eponychium (cuticle) overlies root
Free edge of nail extends over hyponychium

Figure 5.13

Hair (Pili) Sites

Can be found on all parts of the body
except palms of hand, soles of feet, dorsal
surfaces of terminal phalanges, glans penis,
inner surface of prepuce and labia

Hair Structure
Root (radix pili)
Hair bulb & papilla
Hair follicle

Outer dermic (multi)layer

Fibrous tissue, very vascular and innervated
Continuation of dermis
Inner epidermic
Adheres close to root
Consists of two strata, outer and inner root sheaths

Shaft (scapus pili)

Medulla (inner most part of shaft)

Cortex (main part of shaft)
Cuticle (single second layer)

Cortex and Medulla

FYI: Hair lacking the medulla tends to be short and curly (wooly)
http://education.vetmed.vt.edu/Curriculum/VM8054/Labs/Lab15/EXAMPLES/Exhair02.htm

Hair Growth

Pilosebaceous Unit
Follicle
with hair
shaft

Sebaceous
gland

Arrector pili
muscle
(smooth
muscle)

This is a hematoxylin and eosin stained slide at 10x of the insertion of

sebaceous glands into hair shaft in a full, normal pilosebaceous unit
The arrector pili it typically at the base of the pilosebaceous unit

Sebaceous (Oil)
Glands

Holocrine (Oil)
Gland
Cellular
substance is
released
through
complete
cellular
breakdown
Oil gland
Sebum

Sudoriferous Gland
Structure
Single tube
Deep part
irregularly coiled
into an oval ball
(body)

Superficial duct
Passes through
dermis and cuticle
and opens onto
surface of skin

Grays Anatomy, 1985, 30th Ed.

Pheromones?
In a study published in Neuroscience Letters, Prehn, et al.
(2006), reported that subjects were unable to discriminate the
chemosensory stimuli of the human sweat samples from room
air.
Chemosensory anxiety signals (EMG of the eyeblink response)
were increased, as compared to the amplitude recorded in the
context of chemosensory stimuli from either exercise
(p = 0.018) or cotton pad (p = 0.012) control groups.
The study concludes that chemosensory anxiety signals may
pre-attentively prime defensive behavior.
Other studies

pheromones may play a role in the modulation of the timing of ovulation by

changing the frequency of pulsatile LH secretion (Kazuyuki et, al., 2001).

Sex-differentiated hypothalamic activation after smelling odorous sex

hormone-like compounds (Savic, et al., 2001)

Ceruminous Glands
specialized sudoriferous glands (sweat
glands) located subcutaneously in the
external auditory canal
Produce earwax that cleans and protects the
ear canal

Merocrine (Eccrine)
Gland
Secreted
substance is
accumulated
below the cell
surface and
then released.
Sweat glands
on general
skin surface.

Apocrine (Special
Sweat or Scent)
Glands
Secreted substance is

accumulated below the

cell surface and then
part of the cell breaks
off.

Contains proteins
and fats
Predominant Areas
Axillary
Anogenital
Mammary

Conditions Related to
the Skin
Acne vulgaris (pimples)
Basal Cell Carcinoma

Most common skin cancer

Cold Sores (Herpes)

Contact dermatitis
Impetigo
Psoriasis
Vitiligo

Basal Cell Carcinoma

http://www.skinsite.com/info_basal_cell_carcinoma.htm

Surgical Wound
from Melanoma

Herpes Simplex
Type I and 2
Herpes is
estimated to
affect some 80
million people
in America.

Image Source : DermNet

http://www.dermnet.org.nz/index.html
Image source: FotoArchive (selected by Dr. Bauer);
supervision: Prof. Dr. Simon
Image source: Case reports (selected by Prof. Dr.
Simon), Dermatologische Universittsklinik Erlangen;
supervision: Prof. Dr. Simon

lmpetigo
What is lmpetigo ?

This is an acute superficial

infection of the skin caused by
bacteria.
This infection is common in preschool children and young adults.

What are the signs of Impetigo ?

The infection appears as skin

blisters which later break down to
become superficial sores with
golden-yellow "stuck on" crusts on
the surface.

Common sites affected are

the face, arms, buttocks and

legs.

http://www.nsc.gov.sg/commskin/Impetigo/impetigo.html

Psoriasis
What is Psoriasis?

Psoriasis is an inflammatory
skin disease characterized by
an increased rate of skin cell
turnover resulting in thick
scales appearing on the skin.
The affected skin becomes dry
and unsightly. Itching is often
experienced in our hot and
humid climate.
As part of our skin, nails also
show changes like "pitting" of
their surface in up to half of
people with psoriasis. Joint
pains and swelling are
associated in 5% to as much
as 40% in more extensive
psoriasis.

http://www.nsc.gov.sg/commskin/Psoriasi/psoriasi.html

Vitiligo
What is vitiligo ?
Vitiligo is a skin disorder
which presents as white
spots and patches on
the skin. This is due to a
progressive loss of the
pigment, melanin, which
gives us our skin colour.
The loss of pigment
occurs when pigment
cells (melanocytes) are
destroyed and melanin
cannot be produced.
Vitiligo is not
contagious.

THE PROOF OF
GLOBAL WARMING

CAUSE: Increased Exposure to Ultraviolet Light