THE INTEGUMENTARY SYSTEM

 Helps maintain a constant body temperature, protects the body, and provides sensory information about the
surrounding environment.
 Dermatology: the medical specialty that deals with the diagnosis and treatment of integumentary system
disorders.

A. STRUCTURE OF THE SKIN:

 SKIN: covers the external surface of the body and is the largest organ of the body in both surface area and weight

Three Main Parts:

1. Epidermis
 Composed of keratinized stratified squamous
epithelium

 Functions:
1. Regulates body temperature
2. Stores blood
3. Protects body from external environment
4. Detects cutaneous sensations
5. Excretes and absorbs substances
6. Synthesizes vitamin D

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  Four Principal Types of Cells:
a) Keratinocytes
 About 90% of epidermal cells
 Arranged in four or five layers and produce the protein keratin
 Produce lamellar granules, which release a water-repellent sealant that
decreases water entry and loss and inhibits the entry of foreign materials

b) Melanocytes
 About 8% of the epidermal cells are melanocytes, which develop from the
ectoderm of a developing embryo and produce the pigment melanin
 Their long, slender projections extend between the keratinocytes and transfer
melanin granules to them.
 Melanin is a yellow-red or brown-black pigment that contributes to skin olor and
absorbs damaging ultraviolet (UV) light.
 Once inside keratinocytes, the melanin granules cluster to form a protective veil
over the nucleus, on the side toward the skin surface. In this way, they shield the
nuclear DNA from damage by UV light.

c) Langerhans cells
 Arise from red bone marrow and migrate to the epidermis where they constitute
a small fraction of the epidermal cells
 They participate in immune responses mounted against microbes that invade the
skin, and are easily damaged by UV light.
 Their role in the immune response is to help other cells of the immune system
recognize an invading microbe and destroy it.

d) Merkel cells
 Least numerous of the epidermal cells.
 They are located in the deepest layer of the epidermis, where they contact the
flattened process of a sensory neuron
 Detect touch sensations.

 Layers of the Epidermis

a) Stratum Basale
 Deepest layer, composed of a
single row of cuboidal or
columnar keratinocytes that
contain scattered tonofilaments
 Stem cells undergo cell division to
produce new keratinocytes
 Melanocytes and Merkel cells
associated with Merkel discs are
scattered among the
keratinocytes

b) Stratum Spinosum
 Arranged in 8 to 10 layers of
many-sided keratinocytes fitting
closely together.
 This arrangement provides both
strength and flexibility to the
skin.

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  Langerhans cells and projections of melanocytes are also present in this layer.

c) Stratum Granulosum
 Three to five rows of flattened keratinocytes, in which organelles are beginning
to degenerate
 Keratohyalin: protein which converts tonofilaments into keratin, and lamellar
granules, which release a lipid-rich, water-repellent secretion.

d) Stratum Lucidum
 Present only in skin of fingertips, palms, and soles
 Consists of three to five rows of clear, flat, dead keratinocytes with large
amounts of keratin

e) Stratum Corneum
 Twenty-five to thirty rows of dead, flat keratinocytes that contain mostly keratin

 Keratinization
 Newly formed cells in the stratum basale are slowly pushed to the surface. As the cells
move from one epidermal layer to the next, they accumulate more and more keratin.

 Psoriasis: a common and chronic skin disorder in which keratinocytes divide and move more
quickly than normal from the stratum basale to the stratum corneum. The immature
keratinocytes make an abnormal keratin, which forms flaky, silvery scales at the skin surface,
most often on the knees, elbows, and scalp (dandruff).

2. Dermis
 Second, deeper part of the skin composed of a strong connective tissue containing collagen and
elastic fibers
 This woven network of fibers has great tensile strength
 Has the ability to stretch and recoil easily.
 The few cells present in the dermis include predominantly fibroblasts, with some macrophages,
and a few adipocytes near its boundary with the subcutaneous layer.
 Blood vessels, nerves, glands, and hair follicles are embedded in the dermal layer.
 Two Regions:
a) Papillary
 Superficial portion of the dermis
 Consists of areolar connective tissue with
thin collagen and fine elastic fibers
 Contains dermal ridges that house
capillaries, Meissner corpuscles, and free
nerve endings

b) Reticular
 Deeper portion of the dermis
 Consists of dense irregular connective tissue
with bundles of thick collagen and some
coarse elastic fibers
 Spaces between fibers contain some adipose
cells, hair follicles, nerves, sebaceous glands,
and sudoriferous glands

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  The combination of collagen and elastic fibers in the reticular region provides the skin with
strength, extensibility, and elasticity.

3. Hypodermis
 The hypodermis is a layer directly below the dermis and serves to connect the skin to the
underlying fascia of the bones and muscles.
 The hypodermis consists of well-vascularized, loose, areolar connective tissue and adipose tissue,
which functions as a mode of fat storage and provides insulation and cushioning for the
integument.

Epidermal Ridges
 They appear either as straight lines or as a pattern of loops and whorls, as on the tips of the digits.
 Produced during the third month of fetal development as downward projections of the epidermis into
the dermis between the dermal papillae of the papillary region.
 Increase the surface area of the epidermis and thus increase the grip of the hand or foot by increasing
friction. Because the ducts of sweat glands open on the tops of the epidermal ridges as sweat pores, the
sweat and ridges form fingerprints upon touching a smooth object.
 Dermatoglyphics: study of pattern that is genetically determined and is unique for each individual.
Normally, the ridge pattern does not change during life, except to enlarge, and thus can serve as the basis
for identification.

The Structural Basis of Skin Color

 Melanin, hemoglobin, and carotene are three pigments that impart a wide variety of colors to skin.
 Melanin
 The amount of melanin causes the skin’s
color to vary from pale yellow to reddish
brown to black.
 Two forms:
 Pheomelanin
 Eumelanin
 Melanocytes, the melanin-producing cells,
are most plentiful in the epidermis of the
penis, nipples of the breasts, area just around
the nipples, face, and limbs and mucous membranes
 Because the number of melanocytes is about the same in all people, differences in skin
color are due mainly to the amount of pigment the melanocytes produce and transfer to
keratinocytes.
 Freckles: accumulation of melanin in patches
 Mole: a round, flat, or raised area that represents a benign localized overgrowth of
melanocytes that usually develops in childhood or adolescence
 Melanosome: an organelle that synthesizes melanocytes from the amino acid tyrosine
 Exposure to ultraviolet (UV) light increases the enzymatic activity within melanosomes
and thus increases melanin production. Both the amount and darkness of melanin
increase upon UV exposure, which gives the skin a tanned appearance and helps, protect
the body against further UV radiation.

 Hemoglobin
 Oxygen-carrying pigment in red blood cells
 Dark-skinned individuals have large amounts of melanin in
the epidermis. Consequently, the epidermis has a dark
pigmentation and skin color ranges from yellow to reddish-
brown to black.

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  Light-skinned individuals have little melanin in the epidermis. Thus, the epidermis
appears translucent and skin color ranges from pink to red depending on the oxygen
content of the blood moving through capillaries in the dermis.

 Carotene
 A yellow-orange pigment that gives egg yolk and
carrots their color.
 Used to synthesize pigments needed for vision, is
stored in the stratum corneum and fatty areas of the
dermis and subcutaneous layer in response to
excessive dietary intake.

 Albinism is the inherited inability of an individual to produce melanin.

 Vitiligo: the partial or complete loss of melanocytes from patches of skin produces irregular white spots.
 Cyanosis: bluish color of the mucous membranes, nail beds and skin when blood is not picking up an
adequate amount of oxygen from the lungs, as in someone who has stopped breathing.
 Jaundice: due to a buildup of the yellow pigment bilirubin in the skin.
 Erythema: redness of the skin, is caused by engorgement of capillaries in the dermis with blood due to
skin injury, exposure to heat, infection, inflammation, or allergic reactions.
 Pallor: occur in conditions such as shock and anemia.

Tattooing and Body Piercing

 Tattooing: is a permanent coloration of the skin in which a foreign pigment is deposited with a needle
into the dermis
 Tattoos are created by injecting ink with a needle that punctures the epidermis and moves between 50
and 3000 times per minute and deposits the ink in the dermis.
 Body piercing: the insertion of jewelry through an artificial opening

B. ACCESSORY STRUCTURES OF THE SKIN

HAIR: composed of columns of dead, keratinized epidermal cells bonded together by extracellular proteins
o Anatomy of a Hair
 Hair Follicle: epidermal penetration of
the dermis where strands of hair
 Three Concentric Layers of Cells:
1) Internal root sheath:
surround the root of the
growing hair and extend
just up to the hair shaft.
They are derived from
the basal cells of the hair
matrix

2) External root sheath: an

extension of the
epidermis that encloses
the hair root. It is made
of basal cells at the base
of the hair root and
tends to be more
keratinous in the upper
regions.

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 3) Glassy membrane: a thick, clear connective tissue sheath covering the hair root,
connecting it to the tissue of the dermis

 Hair shaft: superficial portion of the hair which projects above the surface of the skin

 Hair root: portion of the hair deep to the shaft that penetrates into the dermis, and sometimes
into the subcutaneous layer
 Hair root plexuses: dendrites of neurons surrounding each hair follicle that are sensitive
to touch and generate nerve impulses if their hair shafts are moved
 Three Concentric Layers of Cells:
1) Inner medulla: composed of two or three rows of irregularly shaped cells
2) Middle cortex: forms the major part of the shaft and consists of elongated cells
3) Cuticle: the outermost layer, consists of a single layer of thin, flat cells that are
the most heavily keratinized

 Hair bulb: an onion-shaped structure at the base of each hair follicle and its surrounding dermal
root sheath

 Hair matrix: a layer of mitotically active basal cells inside the bulb that is responsible for the
growth of existing hairs, and they produce new hairs when old hairs are shed

 Hair papilla: made of connective tissue and contains blood capillaries and nerve endings from the
dermis

 Arrector pili: smooth muscle connected to a hair root that contracts in response to nerve signals
from the sympathetic nervous system, making the external hair shaft “stand up.”

o Hair Growth
 Three Phases:
1) Anagen phase: cells divide rapidly at the root of the hair, pushing the hair shaft up and
out and the length of this phase is measured in years, typically from 2 to 7 years.
2) Catagen phase: lasts only 2 to 3 weeks, and marks a transition from the hair follicle’s
active growth
3) Telogen phase: hair follicle is at rest and no new growth occurs

o Types of Hairs
 Lanugo: very fine, nonpigmented, downy hairs produced usually by the fifth month of
development that cover the body of the fetus
 Vellus: are short, fine, pale hairs that are barely visible to the naked eye
 Terminal hairs: replace vellus hairs in the axillae and pubic regions of boys and girls and they
replace vellus hairs on the face, limbs, and chests of boys, which leads to the formation of a
mustache, beard, hairy arms and legs, and a hairy chest.
 During adulthood, about 95% of body hair on males is terminal hair and 5% is vellus hair; on
females, about 35% of body hair is terminal hair and 65% is vellus hair.

o Hair Color
 Melanin is synthesized by melanocytes scattered in the matrix
of the bulb and passes into cells of the cortex and medulla of
the hair.
 Dark-colored hair: contains mostly eumelanin
 Blond and Red hair: contains variants of pheomelanin
 Gray hair: contains only a few melanin granules

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  White hair: results from the lack of melanin and the accumulation of air bubbles in the shaft.
 Hair coloring: is a process that adds or removes pigment.
 Temporary hair dyes: coat the surface of a hair shaft and usually ash out within 2 or 3
shampoos.
 Semi-permanent dyes penetrate the hair shaft moderately and do fade and wash out of
hair after about 5 to 10 shampoos.
 Permanent hair dyes: penetrate deeply into the hair shaft and don’t wash out.

o Hirsutism: a condition of excessive body hair

o Alopecia: partial or complete lack of hair that may result from genetic factors, aging, endocrine disorders,
chemotherapy, or skin disease

SKIN GLANDS

o Sebaceous gland: a type of oil gland that is found all over the body and helps to lubricate and waterproof
the skin and hair.
 Sebum: a mixture of triglycerides, cholesterol, proteins, and inorganic salts that coats the surface
of hairs and helps keep them from drying and becoming brittle, prevents excessive evaporation
of water from the skin, keeps the skin soft and pliable, and inhibits the growth of some bacteria

o Sudoriferous glands cells of these glands release sweat, or perspiration, into hair follicles or onto the
skin surface through pores
 Two Main Types:

o Ceruminous glands: modified sweat glands in the external ear that produce a waxy lubricating secretion
 Cerumen: a yellowish material formed from the combined secretion of the ceruminous and
sebaceous glands that provides a sticky barrier which impedes the entrance of foreign bodies
and insects and waterproofs the ear canal and prevents bacteria and fungi from entering cells
NAILS: are plates of tightly packed, hard, dead, keratinized epidermal cells that form a clear, solid covering over
the dorsal surfaces of the distal portions of the digits

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 o Nail bed: a specialized structure of the epidermis that is found at the tips of our fingers and toes

o Nail body: formed on the nail bed, and protects the tips of our fingers and toes as they are the farthest
extremities and the parts of the body that experience the maximum mechanical stress. Forms a back-
support for picking up small objects with the fingers

o Nail root: has a matrix of proliferating cells from the stratum basale that enables the nail to grow
continuously

o Nail fold: overlaps the nail on the sides helping to anchor the nail body

o Eponychium or Cuticle: a narrow band of epidermis that extends from and adheres to the margin (lateral
border) of the nail wall

o Lunula: a crescent-shaped region of the nail matrix that indicates nail growth

o Hyponychium: the area beneath the free edge of the nail furthest from the cuticle

o Nail matrix: the proximal portion of the epithelium deep to the nail root where cells divide by mitosis to
produce growth

C. TYPES OF SKIN

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 D. FUNCTIONS OF THE SKIN
Thermoregulation
o Liberating sweat at the skin’s surface and by adjusting the flow of blood in
the dermis.
o High environmental temperature or heat produced by exercise:
 Sweat production from eccrine sweat glands increases
 Evaporation of sweat from the skin surface helps lower body
temperature
 Blood vessels in the dermis of the skin dilate
 More blood flows through the dermis which increases the amount
of heat loss from the body
o Low environmental temperature:
 Production of sweat from eccrine sweat glands is decreased which
helps conserve heat
 Blood vessels in the dermis of the skin constrict which decreases
blood flow through the skin and reduces heat loss from the body

Blood Reservoir
o The dermis houses an extensive network of blood vessels that carry 8–10% of the total blood flow in a resting
adult. For this reason, the skin acts as a blood reservoir.

Protection
o The skin protects the rest of the body from the basic elements of nature such as
wind, water, and UV sunlight.
o It acts as a protective barrier against water loss, due to the presence of layers of
keratin and glycolipids in the stratum corneum.
o First line of defense against abrasive activity due to contact with grit, microbes,
or harmful chemicals
Cutaneous Sensations

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 o Sensations that arise in the skin, including tactile sensations—touch, pressure, vibration, and tickling—as
well as thermal sensations such as warmth and coolness.
o Pain: an indication of impending or actual tissue damage

Excretion and Absorption

o Despite the almost waterproof nature of the stratum corneum, about 400 mL of water evaporates through it
daily.
o Sweat is the vehicle for excretion of small amounts of salts, carbon dioxide, and two organic molecules that
result from the breakdown of proteins—ammonia and urea.
o The absorption of water-soluble substances through the skin is negligible, but certain lipid-soluble materials
do penetrate the skin
o Toxic materials that can be absorbed through the skin include organic solvents such as acetone and carbon
tetrachloride
o Since topical steroids, such as cortisone, are lipid-soluble, they move easily into the papillary region of the
dermis.

Synthesis of Vitamin D
o Synthesis of vitamin D requires activation of a precursor molecule in the skin by ultraviolet (UV) rays in
sunlight.
o Calcitriol: a hormone that aids in the absorption of calcium in foods from the gastrointestinal tract into the
blood.
o Only a small amount of exposure to UV light (about 10 to 15 minutes at least twice a week is required for
vitamin D synthesis.

E. DISEASES, DISORDERS AND INJURIES OF THE INTEGUMENTARY SYSTEM

DISEASES
1) Basal cell carcinoma: a form of cancer that affects the mitotically active stem
cells in the stratum basale of the epidermis. It is frequently found on the head,
neck, arms, and back, which are areas that are most susceptible to long-term
sun exposure.
 Tx: surgery, freezing, and topical ointments.

2) Squamous cell carcinoma: a cancer that affects the keratinocytes of the stratum spinosum and presents as
lesions commonly found on the scalp, ears, and hands.
 Tx: Surgery and radiation

3) Melanoma: a cancer characterized by the uncontrolled growth of melanocytes. Typically, a melanoma

develops from a mole. It is the most fatal of all skin cancers, as it is highly metastatic and can be difficult to
detect before it has spread to other organs.
 Tx: surgical excision and immunotherapy
 Doctors often give their patients the following ABCDE mnemonic to
help with the diagnosis of early-stage melanoma:
 Asymmetry – the two sides are not symmetrical
 Borders – the edges are irregular in shape
 Color – the color is varied shades of brown or black
 Diameter – it is larger than 6 mm
 Evolving – its shape has changed
Some specialists cite the following additional signs for the most serious form, nodular melanoma:
 Elevated – it is raised on the skin surface
 Firm – it feels hard to the touch
 Growing – it is getting larger

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 SKIN DISORDERS
1) Eczema: an allergic reaction that manifests as dry, itchy patches of skin that resemble rashes. It may be
accompanied by swelling of the skin, flaking, and in severe cases, bleeding.
 Tx: moisturizers, corticosteroid creams, and immunosuppressants

2) Acne: an inflammation of sebaceous glands that usually begins at puberty when the
sebaceous glands are stimulated by androgens
 Tx: Gently washing the affected areas once or twice daily with a mild soap,
topical antibiotics, topical drugs such as benzoyl peroxide or tretinoin, and
oral antibiotics

INJURIES
1) Burn: results when the skin is damaged by intense heat, radiation, electricity, or chemicals. The damage
results in the death of skin cells, which can lead to a massive loss of fluid. Dehydration, electrolyte imbalance,
and renal and circulatory failure follow, which can be fatal.
 Degree of Severity:
a) First-degree burn: is a superficial burn that affects only the epidermis. Although the skin
may be painful and swollen, these burns typically heal on
their own within a few days.

b) Second-degree burn: goes deeper and affects both the

epidermis and a portion of the dermis. These burns
result in swelling and a painful blistering of the skin. It
is important to keep the burn site clean and sterile to
prevent infection. If this is done, the burn will heal
within several weeks.

c) Third-degree burn: fully extends into the epidermis

and dermis, destroying the tissue and affecting the nerve
endings and sensory function. These are serious burns that
may appear white, red, or black

d) Fourth-degree burn: more severe, affecting the underlying muscle and bone.
.
 Photosensitivity: a heightened reaction of the skin after consumption of certain medications or contact
with certain substances such as exposure to ultraviolet radiation
o Among the medications or substances that may cause a photosensitivity reaction are certain
antibiotics, nonsteroidal anti-inflammatory drugs, certain herbal
supplements , some birth control pills, some high blood pressure
medications, some antihistamines, and certain artificial sweeteners,
perfumes, after shaves, lotions, detergents, and medicated cosmetics.
o Self-tanning lotions: topically applied substances, contain a color
additive that produces a tanned appearance by interacting with proteins
in the skin.
o Sunscreens: are topically applied preparations that contain various
chemical agents that absorb UVB rays, but let most of the UVA rays pass
through.
o Sunblocks: are topically applied preparations that contain substances
such as zinc oxide that reflect and scatter both UVB and UVA rays.
 Sun Protection Factor (SPF): measures the level of protection
both sunscreen and sunblock can provide against UV rays.

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 2) Scars and Keloids
o Scar: collagen-rich skin formed after the process of wound healing that differs from normal skin.
Scarring occurs in cases in which there is repair of skin damage, but the skin fails to regenerate the
original skin structure
o Keloid: an elevated, irregular darkened area of excess scar tissue caused by collagen formation during
healing. It extends beyond the original injury and is tender and frequently painful.
o Atrophic scars: scars that result from acne and chickenpox have a sunken appearance
 Tx: application of mineral oil and lotions may reduce the formation of scar tissue.
 Modern cosmetic procedures: dermabrasion, laser treatments, and filler injections

3) Bedsores and Stretch Marks

o Bedsores: caused by constant, long-term, unrelieved pressure on certain body parts that are bony,
reducing blood flow to the area and leading to necrosis
o Stretch mark: results when the dermis is stretched beyond its limits of elasticity, as the skin stretch to
accommodate the excess pressure

4) Calluses: occurs when the basal stem cells in the stratum basale are triggered to divide more often to
increase the thickness of the skin at the point of abrasion to protect the rest of the body from further
damage.

5) Abrasion: an area where skin has been scraped away

6) Blister: collection of serous fluid within the epidermis or between the epidermis and
dermis, due to short-term but severe friction

7) Frostbite: local destruction of skin and subcutaneous tissue on exposed surfaces as a

result of extreme cold

8) Hives: reddened elevated patches of skin that is often itchy. Most commonly caused by
infections, physical trauma, medications, emotional stress, food additives, and certain
food allergies.

9) Pruritus: itching, one of the most common dermatological disorders

10) Wart: mass produced by uncontrolled growth of epithelial skin cells caused by a papillomavirus

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