SKIN

Integument System

Now everything so far has been just an introduction. Now Anatomy class begins! Well discuss the organ systems of the body one by one. For each system, well discuss its function, the individual organs, its tissues, and clinical significance.

Integument System

Integument System

Organs
Skin Hair Nails Glands

Integument System

Functions

Protection

Abrasion Infection UV light Dehydration

Thermal Regulation

Sensory Reception Vitamin D Production Communication (raised eyebrows)

Insulation (fat keeps you warm) Cooling (sweating cools you down)

NOTE Vitamin D is made in the dermis of the skin, after exposure to sunlight. Its function is to allow calcium to be absorbed from the foods you eat so your blood calcium levels are normal.

The Skin and the Hypodermis Skin our largest organ

Accounts for 7% of body weightit weighs twice

as much as your brain! Divided into three distinct layers

Epidermis (epi means above something) Dermis Hypodermis (hypo means deep to something)
Remember, the term SKIN refers to all three layers: epidermis, dermis, and hypodermis.

Skin Structure

Figure 5.1

EPIDERMIS Primarily made up of keratinized stratified squamous epithelium The EPIDERMIS is the layer that gives strength to the skin. Varies in thickness from a few cells (eyelids) to dozens of cells thick (palms and soles of feet) It does not have any vascularization (blood supply), so it relies on absorbing oxygen and nutrients from the blood vessels in the dermis deep to it. The nails are made in the epidermis.

Layers of the Epidermis

Stratum corneum (most superficial layer of epidermis) Stratum lucidum (only in thick skin) Stratum granulosum Stratum spinosum Stratum basale (the deepest layer of epidermis)

Epidermal Cells and Layers of the Epidermis

Figure 5.3

STRATUM BASALE: has 3 types of cells

The cell type that makes the epidermis is a KERATINOCYTE Keratin is a protein made by these cells. Keratin is waterproof and strong MELANOCYTES produce MELANIN (dark brown pigment) Everyone has the same number of melanocytes But they dont all make the same amount of pigment, so
people have different skin colors.

MACROPHAGES (Merkel cells): ingest and destroy dead cells, foreign debris, bacteria.

STRATUM BASALE:

This is the only layer of the epidermis where the cells are dividing. As new cells are made in the S. Basale, the older cells get pushed up and become the next layer (S. Spinosum)

Epidermal Cells and Layers of the Epidermis

Figure 5.3

STRATUM SPINOSUM

They are now attached to each other by desmosomes, which are pointy/spiny (spinosum) The cells are still alive, but they no longer divide in this layer The stratum spinosum provides the strength to the epidermis

Epidermal Cells and Layers of the Epidermis

Figure 5.3

STRATUM GRANULOSUM

As more new cells are made in the S. basale, the S. spinosum layer is pushed up to become the S. granulosum layer. The cells in the S. granulosum begin to die because they are now too far from nutrient source (in dermis). The cells now have a grainy appearance, so this layer is called the stratum granulosum.

KERATIN Keratin is a waxy protein substance only found in the epidermis. It makes up the nails, hair, and is also in each superficial skin cell. It can absorb water, so keratin swells when soaking wet. It makes the skin look wrinkled when you are in the tub too long. The water evaporates when you dry off, and pulls more water out of your body, so soaking in the tub will dry your skin outunless you put lotion on right away to keep the water in the epidermal and dermal layers. Lotions will not penetrate to the dermis, just water.

Epidermal Cells and Layers of the Epidermis

Figure 5.3

STRATUM CORNEUM

As more new cells are made in the S. basale, the cells are all pushed up again, and the S. granulosum layer becomes the S. Corneum. In this layer, the dead cells fill up with KERATIN. The cells lose their nucleus and fuse to squamous (flat) sheets, which are eventually shed from the surface. This process is called desquamation. The main difference between thick skin and thin skin relates to the thickness of the Stratum corneum. It takes about 6 weeks for a cell to move from the stratum basale to the distal edge of the stratum corneum and shed We lose half a million cells per hour; 1.5 grams a day That can be a major source of dust in the house Dust allergies are actually from the feces and saliva of dust mites which eat the dead skin. One house has 3 million poops per day from dust mites!

Epidermal Cells and Layers of the Epidermis

Figure 5.3

STRATUM LUCIDUM
This layer is only on the palms and soles It is just deep to the S. corneum and superficial to the S. granulosum

This THIN layer provides protection from UV radiation.

Why do black-skinned people have lighter colored palms and soles? Only the Stratum Basale has pigment-containing cells, but the stratum lucidum contributes the color of protein, which is an orange- tan color. In the palms and soles, the stratum lucidum is present. The tan colored protein blocks the underlying melanocytes from view.

Conditions of the Epidermis

If you frequently rub one area of the skin, it stimulates cell division = callous

If you rub the skin too hard, the stratum basale tears away from the basement membrane, and causes a gap, which fills with fluid: BLISTER. The epidermis then dies because its too far away from nutrients. Thats why the top of a blister dries up.

If the blisters are small (less than 5 mm in diameter), they are known as vesicles; if they are larger (greater than 5 mm in diameter), they are termed bullae.

Vesicles

Bullae

Conditions of the Epidermis Skin Cancer: This is the most common cancer in the USA, and the major risk factor of all skin cancers is exposure to ultraviolet light. Three major types: 1) BASAL CELL CARCINOMA 2) SQUAMOUS CELL CARCINOMA 3) MELANOMA
The second most common type of cancer is lung cancer. The least common (of the common cancers) is leukemia.

Conditions of the Epidermis

1)

BASAL CELL CARCINOMA: Cancer of the blood vessels in the dermis. The most common type of skin cancer, accounts for about 75% of the skin cancers. Almost never metastasizes or crosses the basement membrane, so is almost never fatal. It is the most easily cured: surgical removal, no chemotherapy or radiation usually needed. Symptoms are minor: shiny nodules, usually on nose, face, or other sun exposed areas.

Conditions of the Epidermis

1)

BASAL CELL CARCINOMA: Cancer of the blood vessels. Almost never metastasizes or crosses the basement membrane Looks like shiny nodules
Figure 5.11

Basal Cell carcinoma

Reconstructive Surgery for Basal Cell Carcinoma

Basal cell carcinoma, when left untreated.

This 74-year-old man developed an enlarging tumor on his left medial canthus 3 years ago. He had been unable to wear his glasses for two years and sought medical attention when this tumor offended other members of his church. Ulceration, crusting, and drainage developed recently. The tumor was 12 centimeters in diameter, malodorous, and draining a foul serous fluid. Surgical excision was easier than expected, because the tumor was attached by a pedicle which spared the orbit.

Conditions of the Epidermis 2) SQUAMOUS CELL CARCINOMA 25% of all skin cancers Will metastasize if not treated.

Actinic Keratosis
A premalignant condition of thick, scaly, or crusty patches of skin. It is more common in fair-skinned people, in sun-exposed areas of skin.
20% of these lesions progress to squamous cell carcinoma. They begin as flat, dry, scaly areas, and later grow into tough, wart-like lesions.

Conditions of the Epidermis 3) MELANOMA: cancer of the melanocytes of the epidermis; least common (about 1% of skin cancer) Highly metastatic, causes 75% of skin cancer deaths. Asymmetrical, sharp but irregular borders and edges Not uniform in color.

The warning signs in moles: ABC's: A is for Asymmetry, where one side of the mole looks different than the other side. B is for Border, where the border is jagged or irregular instead of smooth and regular. C is for Color, where the mole contains more than one color.

The medical term for a mole = nevus (plural = nevi) The medical term for a freckle or any other pigmented area that is flat and does not stick upwards from the skin = macula

Conditions of the Skin

Eczema Atopic dermatitis Contact dermatitis Seborrheic dermatitis Psoriasis Vitelligo

Eczema

Itchy red skin that comes and goes. Caused by an autoimmune reaction. The most frequently occuring form of eczema is ATOPIC DERMATITIS.

Atopic dermatitis

Triggered by allergens like soaps, cosmetics, clothing, detergents, jewelry, or sweat. Can be triggered by changes in weather or stress. Tends to run in families. Treatment is lubricant creams daily and steroid creams during outbreaks.

Contact dermatitis

Localized reaction from an allergy to something you touch. Common allergens are plastic shoes, latex gloves, detergents, perfume, makeup, jewelry, etc. People with a history of allergies are more likely to get contact dermatitis from these objects.

Contact Dermatitis

Seborrheic dermatitis

In Children, it is called Cradle Cap In Adults, it is called severe dandruff Caused by an allergy to the fungus that we all have around our hair roots. The skin cells proliferate in an attempt to shed the fungus. The results is severe dandruff that does not respond to regular dandruff shampoo. Treatment is shampoo with ketoconazole (steroid) or coal tar. Usually works for one year, then you have to switch to another product for a year, then switch back.

Seborrheic dermatitis

Psoriasis

An autoimmune disease of the skin (the bodys immune system thinks the skin is foreign so it attacks it). Causes silvery flaking of skin, especially knees, elbows, scalp. It is not itchy There are treatments, but no cure. Treatments include shampoo with coal tar or steroids.

Psoriasis

Laser treatment for psoriasis lesions

Vitelligo

An autoimmune disease of the skin Destroys melanocytes, especially in areas of

friction (eyelids, mouth, hands) Causes depigmentation.

DERMIS: 1) PAPILLARY LAYER (Papillary = Pimple. Has bumps) 2) RETICULAR LAYER

Dermis

Figure 5.1

Dermis
1) PAPILLARY LAYER (Papillary = Pimple. Has bumps) The papillary layer of the dermis; LOOSE connective tissue. Has ridges to increase surface area for contact with the epidermis The papillary layer in the DERMIS is what forms our fingerprints. Surgeons make incisions on the body based on the lines of cleavage of the skin formed by the papillary layer of the DERMIS

Skin lines of cleavage

Lines of cleavage

Dermis

Figure 5.1

Dermis 2) RETICULAR LAYER DENSE IRREGULAR Connective Tissue Gives the dermis its strength. Remember, the epidermis is the strongest layer of the SKIN, but the reticular layer of the dermis is the strongest layer of the DERMIS. This layer has lots of COLLAGEN and ELASTIN (elastic fibers) The DERMIS is where most of the bodys collagen is found. Stretch marks are caused from tiny tears in the collagen of the DERMIS. Leather is made of this layer.

The dermis is also the area where all the glands of the body are located. A transdermal patch (nicotine patch, etc) must diffuse all the way from the epidermis into the dermis to reach the blood vessels there. The blood vessels in the dermis are what gives a pink color to Caucasian people.

Dermis Conditions What happens when you get cut? Bleed, then clot Macrophages eat foreign bodies and dead cells Fibroblasts lay down collagen to repair the wound. If they produce more than normal, you get a SCAR. If skin is cut with the grain, scar is not bad. Against the grain, the scar is worse. Some people are more prone to scar tissue than others.

Keloid Scars Keloid Scars Thick, red, sometimes painful scars More common in African American, Native American, and Asian races Treatment with cortisone injections Keloid scar formers can get internal adhesions also

Keloid Scars

Another type of scar tissue is called an adhesion. This is scar tissue in the deeper layers of the body, such as right outside of the intestines, outside of the ovaries, etc. Some people form adhesions spontaneously from the organs rubbing against each other. If the adhesions cause symptoms, they might need a surgery to clean them away. Here are some photos of deep tissue adhesions.

Cutting the adhesions away

Dermis Conditions Stretch Marks Caused by sudden weight gain (pregnancy) Expansion of skin, collagen fibers in the dermis separate = stretch marks.

Do Lasers Remove Stretch marks?

Claim Lasers are used to stimulate new collagen growth and fill the stretch mark from the bottom up. The laser energy is absorbed in the dermal layer of the skin stimulating the production of new collagen. As the new collagen thickens and plumps the skin, it fills in the stretch mark from below.

Rebuttal Although some physicians claim that lasers are effective in removing stretch marks, the American Medical Association states that there is no evidence to support this. Most plastic surgeons think that lasers are ineffective in treating this problem. Lasers are effective in removing, vaporizing, and breaking down tissues. They do not generally repair tissues. Stretch marks represent torn tissue. Hence, improvement should not be expected from laser treatment. Moreover, clinical studies have shown no improvement in stretch marks after laser treatment.

Scurvy

Scurvy is a disease resulting from a deficiency of

vitamin C, which is required for the synthesis of collagen in humans. The chemical name for vitamin C, ascorbic acid, is derived from the Latin name of scurvy. Scurvy often presents itself initially as symptoms of malaise (feeling ill) and lethargy (very tired), followed by formation of spots on the skin and pale, bleeding gums.

Scurvy

Spots are most abundant on the thighs and legs, and a person with the ailment looks pale. As scurvy advances, there can be open, suppurating (weeping) wounds, loss of teeth, and can go on to be fatal.

Scurvy

Scurvy was at one time common among soldiers and sailors who were unable to obtain perishable fruits and vegetables. Most animals can make their own vitamin C, so they dont get scurvy. Vitamin C is destroyed by the process of pasteurization, so babies fed with ordinary bottled milk sometimes suffer from scurvy if they are not provided with adequate vitamin supplements. Virtually all commercially available baby formulas contain added vitamin C for this reason.

Foods high in vitamin C Citrus fruits such as oranges or lemons, blackcurrants, guava, kiwifruit, papaya, tomatoes, bell peppers, and strawberries. It can also be found in some vegetables, such as carrots, broccoli, potatoes, cabbage, spinach and paprika.

HYPODERMIS: This is the fat layer. It varies tremendously in thickness: Shins = thin; Buttocks = thick. Functions 1) Stores fat 2) Cushions 3) Insulation from cold because of heat produced by blood vessels in this layer.

Dermis

Figure 5.1

Hypodermis Conditions

Hypodermis is not connected to the muscle under it. Therefore, exercising muscle will not burn off fat only in that area. Fat is burned off equally over entire body. Losing 10 lbs is like loosing off whole body. More noticeable in face than in hips. By the way, theres no such thing as cellulite. The term was invented by marketers. It is NOT a special type of fat. Its just fat, the same as every other fat. It looks like wrinkled, orange peel skin because the collagen fibers on top of it bind it down like a net. There is no such thing as a cream to get rid of adipose. (Dont confuse cellulite with cellulose, a plant fiber)

Cellulite is just fat, protruding around fascia fibers

LIPOSUCTION This is a surgical procedure where the patient has fat sucked out of the hypodermis layer. Liposuction is dangerous because hypodermis is very vascular, can bleed too much.

BURNS: Three types: FIRST DEGREE: Minor burn to the epidermis; sunburn SECOND DEGREE: Dermis separates from epidermis; blister THIRD DEGREE: Hypodermis is burned. (most severe type of burn)

2 and 3 burns over a large part of the body gives a survival chance proportional to the amount of skin left. 60% burn = 60% chance of dying.

Estimating Burns Using the Rule of Nines

Figure 5.10a

Third Degree Burn

Why are deep burns so dangerous? 1) Infection 2) Dehydration: nothing to keep fluid in body.

Therefore, they need a skin graft. Skin grafts can be from a cadaver, animal,
artificial, or from another part of the same persons body. Skin grafts cause lots of scarring.

Skin graft mesher

DECUBITUS ULCERS (bed sore) Epidermis is destroyed, underlying tissue is exposed. How decubitus ulcers form: If youre sitting down, weight of the body presses against blood vessels, no blood flow to skin of buttocks. In you, its ok, because youll be walking around again in a half hour. But if it goes on longer than a couple of hours because one cant move, tissues cant get oxygen. Ulcer forms, can get gangrene (tissue death). It can also become systemic (bacteria enter the wound, travel in the blood), which can cause death. Whose fault is it? The nurses, for not moving the patient every couple of hours.

Decubitus Ulcers

Cellulitis

Cellulitis is a localized or diffuse inflammation of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin. Cellulitis can be caused by normal skin flora (bacteria) or by exogenous bacteria, and often occurs where the skin has previously been broken: cracks in the skin, cuts, blisters, burns, insect bites, surgical wounds, intravenous drug injection or sites of intravenous catheter insertion. Skin on the face or lower legs is most commonly affected by this infection, though cellulitis can occur on any part of the body. The mainstay of therapy remains treatment with appropriate antibiotics, and recovery periods last from 48 hours to six months.

SKIN COLOR; Caused by four things: 1) MELANIN: (dark brown pigment). More melanin, darker the skin. 2) CAROTENE: (a yellowish/orange pigment found only in plants). Accumulates more in the skins of Asians and Native Americans. 3) SKIN THICKNESS: thinner skin see blood vessels, looks pinker 4) HEMOGLOBIN: The DERMIS contains the blood vessels that give Caucasians the pink color to the skin. Even veins are red because blood is red. But when you look at veins through the adipose layer (the hypodermis), they look blue.

Carotene
Dietary sources of carotene (These are also high in Vitamin A) sweet potatoes carrots cantaloupe melon mango apricots spinach broccoli

CONTUSION: Bruise Why does a bruise look black and blue? The vessels in the hypodermis are ruptured, and the blood leaks out; looks blue. As it ages, the hemoglobin breaks down to a green color, then a yellow color. The color of the bruise depends on the age of the bruise.

CYANOSIS: Bluish color to skin. Caused by superficial blood vessel constriction in the dermis or lack of blood flow to skin Occurs for two reasons: 1) Cold 2) Not enough oxygen in body to go around. The oxygen is conserved for the vital organs, so oxygen to skin and nails is shut down.

Cyanosis

WRINKLES Over time, collagen fibers align themselves more and more as they are always being pulled in the same direction: smile, frown. As you age, the skin begins to sag because the body makes less elastin. Pinch your grandmas skin. Does it bounce back, or ooze back? What can be done about wrinkles? Not much. A face lift clips off extra skin. Creams dont work. Trying to fix a collagen problem with a cream is like trying to shampoo your carpet by putting the cleaner on the roof!

BOTOX This is a deadly poison which paralyses the muscles, making them sag. That releases the tension, and relaxes the skin line. In 3 months, new muscle cells are made, so wrinkles come back, and need new injection.

Botox Before and After: scam photos; the patient was told to crinkle the eyes in the before shot.

Botox Before and After: realistic photos

COLLAGEN INJECTION Collagen is injected into hypodermis. Can last a couple of years.

MOISTURIZER CREAMS The secret ingredient of all moisturizers is WATER. They work superficially on the epidermis. Although keratin is waterproof, it swells when wet. So, if you put a moisturizer on skin, stratum corneum expands, and hides wrinkles. You get the same effect by soaking in the tub and putting on any lotion, and thats cheaper than expensive creams.

TATTOOS Pigment is injected into the dermis. If the needle is sterile, theres no health risk. However, the pigment diffuses with time. What looks good in your 20s will look like a blob when youre 50. Laser treatment is just burning the ink out of the dermis; may leave a scar. Depending on the color of the tattoo ink, it may only cause it to fade.

Laser Tattoo Removal

Laser Tattoo Removal

Laser Tattoo Removal

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Hemangioma

Hemangioma: enlargement of the lining of blood vessels Laser treatment works well

Strawberry Hemangioma

Laser treatment of blood vessel problems

HAIR

HAIR There are about 2 million hairs on the body; 200,000 on the scalp.

Arrector pillae

Hair root

Hair papilla

Hair matrix

Longitudinal Section of Base of Follicle

Figure 5.5c, d

ARRECTOR PILLI: tiny muscles that make the hairs stand up during goosebumps. HAIR PAPILLAE: what is destroyed by electrolysis, so hair wont grow back. The HAIR MATRIX is the leading edge of the papillae. It is actually skin cells (keratinocytes) which are rapidly dividing. When they die, the new ones push them out, forming the hair. Hair is just dead skin cells. The HAIR ROOT is just the base of the hair. The hair matrix is the part of the follicle that is the site of hair growth and the location of the melanocytes that determine hair color. Hair that goes grey has lost its melanin pigment.

Hair Loss

Hair loss in men and women is due to the presence of a male hormone (an androgen) called DHT. Men who have gene for baldness show male pattern baldness. Women who have the baldness gene dont have as much of the male hormone; they just get thinning of the amount of hair. Women get the baldness gene from their father, and men get the gene from their mothers. A man can tell if he will go bald by looking at his mothers father.

Hair Loss

Hereditary hair loss and premature greying are some of the most common genetic conditions. Hereditary baldness, in men also known as male pattern baldness, is not exclusively a male concern. An estimated 25% of women suffer from female pattern baldness but, since their hair loss is diffuse, it is not as easily recognizable as the male form.

Life Cycle of Hair

For most hair loss treatments to be effective, the hair's growth phase has to be interrupted and the hair shed. Only the new budding hair that comes out of a hair follicle after a short resting period can be of noticeably better quality than its predecessor. This replacement can sometimes come in a shock wave called shedding and it is frequently misunderstood by hair loss sufferers as a negative reaction to the new treatment and so the treatment is then discontinued.

Life Cycle of Hair

The life cycle of hair is divided into three phases. The actively growing (anagen) phase, the transitional (catagen) phase and the resting (telogen) phase. Growth phase: 3-6 years, growing 10mm a month. About 85% of the hair on any head at any given time is in the growth phase. At the end of this period, blood supply to the hair bulb slows down and eventually stops. As a result, the hair ceases to grow and moves into the transitional phase, which lasts only about two weeks. Resting phase:,hair just sits on the head for about three months. Then, it falls out, to be replaced by the next budding hair in the growth phase which begins to grow from the same hair follicle.

Life Cycle of Hair

These replacement hairs get finer and thinner due to an increase in an androgen hormone (DHT) as a person ages. In most settings of baldness, the hair follicle finally shuts down and refuses to produce more hair to replace the ones that have fallen out. Good treatment enables you to maintain the hair you have remaining. The maximum improvement you can expect is to regain the hair you have lost in the last three years. Do not wait for too long. The later you start treating the baldness, the less successful your treatment will be. Do not let your follicles die. You need at least the vellus hair (peach fuzz) to start with.

Hair Loss Medicines

Current antiandrogen modes of action include

(a) preventing the creation of DHT (b) preventing DHT from binding to the receptor site (c) blocking activity in the androgen receptor itself.

There are two FDA-approved oral medicines for treating hair loss: Finasteride (Propecia) and Minoxidil (Rogaine).

Hair Loss Medicines

Finasteride (Propecia) It is the first and only FDA-approved pill proven to treat male pattern hair loss on the vertex and middle front of head. The great majority of dermatologists agree that this is currently the No.1 cure for hair loss. In tests, 66% of men grew hair in back and 42% grew hair up front. Almost all the rest stopped losing hair. It cannot be used by women. Dutasteride is another pill that may be receiving FDA approval soon. It appears to be at least as powerful as finasteride, but it is more expensive.

Hair Loss Medicines

MINOXIDIL (Rogaine) comes as a pill and a topical foam that are
both used by the patient. It is available over the counter. Minoxidil is a vasodilator that was originally used to treat severe blood pressure. Its bizarre side effects, such as the ability to reverse or slow down the balding process, were accidentally discovered in the late 1970s. Minoxidil promotes enhanced follicular size, resulting in larger hair shaft diameters. It also stimulates and prolongs the growth phase of the hair growth cycle. It takes 4 months to notice results Rogaine's effectiveness is established in front and back for women but only in back (vertex) for men. After 1 year of use, 48% reported moderate to dense re-growth of hair, 36% reported minimal re-growth, and 16% reported no re-growth. Once started, topical minoxidil treatment is a lifetime commitment if the treatment proves effective. If regular application of topical minoxidil is halted, all hair grown in response to the therapy will be rapidly lost over the next 3 to 6 months.

Hair Loss Medicines

SPIRONOLACTONE is a diuretic used to lower high blood pressure. In addition, it possesses antiandrogenic properties as it binds to the androgen receptor in the hair follicle and thus prevents it from interacting with DHT. Hence, spironolactone is also used to treat acne, hirsutism (excess body hair) and hair loss in women. It is not for oral use by men, because it causes impotence, loss of sex drive, and breast development.

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Split end of hair

Head louse

Eyelash Mite

Eyelash Mites

Chemotherapy causing hair loss

Chemotherapy causes hair loss because the drugs target any cell that is rapidly dividing. Since the hair roots divide rapidly, they are killed off along with the cancer cells. The stomach lining is also rapidly dividing, so they also get nausea. Fun fact: Men without hair on their chests are more likely to keep the hair on their head, but are more likely to get cirrhosis of the liver. Men with hairy chests are more likely to go bald.

Electrolysis

Electrolysis involves sticking a fine wire into the follicle and administering an electrical current to kill the hair papillae. Treatments are repeated weekly for up to 18 months. Hair follicles that are in the telogen phase are more difficult to destroy than hair follicles in the anagen phase. Shaving approximately 3 days before an electrolysis treatment ensures that the hairs that are visible and encourage them to enter into the anagen phase. Finally, side effects can include pain, infection, keloid formation (for people who are susceptible), hyperpigmentation, or hypopigmentation.

Piebaldism: a rare autosomal dominant disorder of melanocyte development, causing a congenital white patch of hair.

HAIR FOLLICLES

Fun Fact: How does heat straighten hair?

There are three types of bonds that make up hair. Salt bonds are broken by heat. When the heat hits the hair the salt bonds break. When the hair cools the bonds rebuild themselves in its new shape. Chemicals can be applied to hair to straighten it or to curl it. The chemicals break the stronger bonds in the hair and cause the bonds to reform in the desired position. Coloring hair strips the color from the shaft and replaces it with a dye. The new color may fade with time.

Structures Associated With Hair Follicles

1.

SEBACEOUS GLANDS

1. 2.

Found all over the body Produce sebum (oil that coats the hair and epidermis)
When you wash it away, the skin gets dry. The best moisturizer is lanolin, which is made from sheep sebum.

PIMPLES

Some of the largest sebaceous glands are associated with the smallest hairs (face). Pimples begin when oil gland ducts (sebaceous glands) become blocked by viscous (thick) sebum and the gland swells. The sebum in the gland is exposed to oxygen and turns black, called a blackhead. The black part of a blackhead is oxidized sebum. In puberty, there is an increase in hormones, and an increase in gland secretion, leading to pimples.

Pimple

Sebaceous and Sweat Glands

Figure 5.1

Skin - Acne and skin aging:

http://www.skintactix.com/free_radical_damage.htm http://www.skintactix.com/acne_&_premature_skin_aging.htm

Acne Vulgaris

Acne develops as a result of blockages in hair follicles. Hyperkeratinization and formation of a plug of keratin and sebum (a microcomedo) is the earliest change. Enlargement of sebaceous glands and an increase in sebum production occur with increased androgen (DHEA-S) production at adrenarche. The microcomedo may enlarge to form an open comedone (blackhead) or closed comedone (milia).
136

Acne Vulgaris

Comedones are the direct result of sebaceous glands' becoming clogged with sebum, a naturally occurring oil, and dead skin cells. In these conditions, the naturally occurring largely commensal bacterium Propionibacterium acnes can cause inflammation, leading to inflammatory lesions (papules, infected pustules, or nodules) in the dermis around the microcomedo or comedone, which results in redness and may result in scarring or hyperpigmentation.
137

Clinical Manifestations

Closed comedone (Whitehead): when a pore clogs up beneath the skin and closes. Open comedone (Blackhead): when a pore clogs up and reaches the surface of the skin, but stays open. Papules: inflamed, tender lesions that pop up as small, pink bumps on the skin.

Pustules:

pimples topped by white or yellow pus-filled lesions. and nodules - large, inflamed, pus filled lesions deep under the skin that can cause pain and scarring.

Cysts

Acne Vulgaris Lesions

Lesions can be described in 3 categories, as
follows:

1. Comedonal: The open comedo appears as a flat or

slightly raised lesion with a central darkcolored follicular impaction of keratin and lipid.
Open comedone (blackhead)

The closed comedo is a pale, slightly

elevated, small papule without a visible orifice and is a potential precursor for the larger inflammatory lesions.
Closed comedone (whitehead)

Acne Vulgaris Lesions (cont)

2. Inflammatory: Inflammatory lesions
vary from small papules with an inflammatory areola to pustules to large, tender, fluctuant nodules (nodular).
Inflammatory

3. Scars: These appear as depressed

or hypertrophic papules of varying sizes and shapes.
Scars acne

Acne Vulgaris: Cause

GENETIC

The tendency to develop acne runs in families.

PSYCHOLOGICAL

It is associated with increased stress levels

DIETARY

A high glycemic load diet is associated with

worsening acne. There is also a positive association between the consumption of milk and a greater rate and severity of acne. Other associations such as chocolate and salt are not supported by the evidence. However, products with these ingredients often contain a high glycemic load.

HORMONAL

141

Acne Vulgaris: CAUSE

HORMONAL CAUSES Hormonal activity, such as menstrual cycles and puberty, may contribute to the formation of acne. During puberty, an increase in male sex hormones called androgens cause the follicular glands to grow larger and make more sebum. Use of anabolic steroids may have a similar effect.

142

Acne Vulgaris

Development of acne vulgaris in later years is uncommon, although this is the age group for rosacea, which may have similar appearances. True acne vulgaris in adult women may be a feature of an underlying condition such as pregnancy and disorders such as polycystic ovary syndrome or the rare Cushing's syndrome.

143

Acne Vulgaris

Menopause-associated acne occurs as production of the natural anti-acne ovarian hormone estradiol fails at menopause. The lack of estradiol also causes thinning hair, hot flushes, thin skin, wrinkles, vaginal dryness, and predisposes to osteopenia and osteoporosis as well as triggering acne (known as acne climacterica in this situation).

144

Propionibacterium acnes

When a pore is blocked, P. acnes, an anaerobic bacterium, overgrows and secretes chemicals that break down the wall of the pore and form an acne lesion (folliculitis). This leads to the possible spilling of bacteria such as Staphylococcus aureus into the broken skin.
Preliminary research shows healthy pores are only colonized by P. acnes while unhealthy ones universally include the non-pore-resident Staphylococcus epidermidis, amongst other bacterial contaminants. 145

Propionibacterium acnes

Under normal conditions, P. acnes is beneficial: creates low pH skin environment hostile to pathogens. P. acnes can be killed by benzoyl peroxide, tetracyclines , Clindamycin, azithromycin, Fluoroquinolones such as nadifloxacin, ciprofloxacin, ofloxacin and levofloxacin. These are normally prescribed 500 mg by mouth, three times weekly for 4 to 6 weeks. There are also many antibacterial preparations, including clove oil, PCMX, and chlorhexidine gluconate. Tetracycline-resistant P. acnes is now quite common.

146

BOILS (Furuncles) Unlike pimples, boils are caused by bacteria that enter a gland and invade into the hypodermis. They are local infections that swell to a size that is larger than pimples. They are not blackheads.

Boil

Most boils run their course within four to ten days. For most people, self-care by applying a warm compress or soaking the boil in warm water can help alleviate the pain and hasten draining of the pus ("bringing the boil to a head"). Once the boil drains, the area should be washed with antibacterial soap and bandaged well. In serious cases, prescription oral or topical antibiotics are used.

2. NAILS The EPIDERMIS gives rise to the nails. The nails are made of keratin (no collagen or calcium) Taking calcium wont make the nails any stronger because there is no calcium in keratinocytes. At the nail matrix, there is rapid division of keratinocytes (cells that make keratin), and as they die, the skin moves up and creates the nail.

Structure of a Nail

The proximal nail fold creates the cuticle. The cuticle is called the eponychium. The white half-moon visible under the proximal part of a fingernail is the lunula.
Figure 5.9

GLANDS ECCRINE (MEROCRINE) SWEAT GLANDS. APOCRINE GLANDS

PUBIC HAIR GLANDS MAMMARY GLANDS

CERUMINUS GLANDS

1.

ECCRINE (MEROCRINE) SWEAT GLANDS. These are found all over the body, and produce a watery secretion which evaporates and cools the body.
glands.

-Fun Facts: A pair of human feet contains 250,000 sweat -There is about one trillion bacteria on each of your feet. -Your body gives off enough heat in 30 minutes to bring half
a gallon of water to a boil.

Sebaceous and Sweat Glands

Figure 5.1

Anhidrosis: Lack of sweat glands Hyperhydrosis: Excessive sweating Microwave removal of sweat glands http://miradry.com/patients/what-miradry-solution

2.

APOCRINE GLANDS are associated with pubic hairs in the axilla and pubic region, as well as the mammary glands. The ones associated with pubic hairs produce a secretion to coat the hairs. The hairs function as a wick to draw the secretions to the surface. These glands also produce a type of protein (a hormone once it is inhaled) known as a PHEROMONE.

 Pheromones function for sexual attraction.

There is no conscious odor. The smell from the axilla is from bacteria that are attracted by the gland. Expensive perfumes have pheromones. Guess where they get them from? The anal glands of male cats! They are designed to attract females. They are used so women will buy expensive perfume. Pheromones also function to regulate menstrual cycles of females. If you put several women in one room for months, their menstrual cycles will all start to occur at the same time.

3. MAMMARY GLANDS are apocrine glands. They secrete milk. Each breast has dozens of glands with their own duct to the surface in the nipple and areola. In a woman who is not lactating, the majority of tissue is adipose. To change the size of breasts, lose or gain weight!

4. CERUMINUS GLANDS are only found in the ear, and they produce wax.

They keep the ear canal from drying out They discourage insects from crawling in; they
dont like walking on the wax.

GLANDS Summary EXOCRINE GLANDS secrete substances into a duct that leads to the surface of the skin or into a lumen. ENDOCRINE GLANDS secrete hormones into the blood. They are ductless. A GOBLET CELL is a unicellular gland that secretes mucus. A PLASMA CELL is a type of blood cell that secretes antibodies. Well talk more about that when we get to the cardiovascular system.

CANCER Cancer starts out as a mutation in one gene in one cell. Then the mutated cell starts dividing itself rapidly and taking over the whole area.

Cancer

Cancer

LEUKEMIA is a cancer in blood-forming cells. LYMPHOMA is a tumor developing in lymphatic tissues. CARCINOMA is a tumor developing in any part of the epithelium. MELANOMA is a tumor developing in the pigment-producing cells of the skin. SARCOMA is a tumor developing in muscles, bones, organs, and connective tissues.

Cancer
CHARACTERISTICS OF CANCER CELLS 1. LACK DIFFERENTIATION Normal cells have specialized functions, but cancer cells do not differentiate and do not contribute to the function of the body. 2. ABNORMAL NUCLEI They have large or multiple nuclei with mutated chromosomes. 3. FORM TUMORS Cancer cells grow and divide rapidly until they accumulate and form a lump of cancer cells called a tumor. A BENIGN tumor is an accumulation of non-cancerous cells because they stay in their own capsule (encapsulated) and do not invade.

Cancer

Cancer

MALIGNANT tumors are cancerous cells that spread and invade.

Cancer
4. ANGIOGENESIS (INDUCE BLOOD VESSEL FORMATION) Since these tumors need nutrients, they create new blood vessels just for them to feed on. 5. METASTASIZE Pieces of the tumor break off and travel in the bloodstream to any new location, invade nearby tissues and continue their massive cell division and growth there. If there is a tumor in the lung, it is biopsied (the doctor surgically takes out a piece). If the cells are lung cells, it is lung cancer. But if the cells are pancreas cells, it is pancreatic cancer that has metastasized.

NUMBER OF CANCER CASES BY SITE AND SEX

Cancer
ORIGIN There are many factors that play a role in the development of cancer, including heredity factors, carcinogens, and mutagens. CARCINOGEN is an environmental agent that contributes to cancer Examples of a carcinogen are ultaviolet radiation, toxic chemicals, and viruses. MUTAGEN is an agent that increases chances of DNA change or mutation. Examples are x-rays and some medicines (thalidimide; caused birth defects).

Cancer 1. CARCINOGENS a) RADIATION is from overexposure to sunlight. b) ORGANIC CHEMICALS include tobacco, foods (salted pork), and pollutants 2. HEREDITY Particular types of cancers run in families, such as breast, lung, and colon cancer.

Cancer
DIAGNOSTIC PROCEDURES PAP SMEARS detect cervical cancers. They just swab the cervix and look at the cells under a microscope. MAMMOGRAMS are diagnostic procedures to detect breast cancer. The breast is just placed on a special type of machine like an x-ray. 20% of breast cancers are not detected by mammogram and can only be detected by ultrasound. Those at high risk for breast cancer should get an MRI instead of a mammogram, since the x-ray might induce cancer. COLONOSCOPY is a diagnostic procedure to detect colon cancer. A scope is inserted into the rectum so the doctor can look for polyps.

Cancer
The American Cancer Society says the following are signs of cancer: C-A-U-T-I-O-N Change in bowel or bladder habits (colon cancer) A sore that does not heal (skin cancer) Unusual bleeding or discharge Thickening or lump in breast or elsewhere (breast cancer) Indigestion or difficulty swallowing (GI system cancer) Obvious change in wart or mole (skin cancer) Nagging cough or hoarseness (lung cancer)

PREVENTION OF CANCER
1. BEHAVIORS

DONT smoke, sunbathe, drink alcohol, or get too many

x-rays. Smoking cigarettes is associated with many types of cancers, including cancer of the lung, larynx, throat, and urinary bladder.

DO be tested (self-breast exams and testicular self-exams every month, and Dr. check-ups), be aware of chemical hazards at work, and be aware that using estrogen for menopause symptoms must be combined with progesterone, otherwise there is an increased risk of cancer.

PREVENTION OF CANCER
2. DIET Avoid fats, salty, smoke-cured, pork, and pickled foods. Eat plenty of fiber, green leafy vegetables and fruits, and eat cabbage, broccoli, Brussels sprouts, and cauliflower, vitamins A and C.

For more information on smoke-cured meat, read the articles posted at

the bottom of our Lecture Unit 1 webpage. PREVENTION OF SKIN CANCER: A. use broad-spectrum sunscreen B. stay out of the sun altogether from 10-3 C. wear protective clothing D. wear sunglasses E. do not use tanning machines

TREATMENT OF CANCER
1. RADIATION When someone has surgery to remove a tumor, it is often followed by radiation because the cancer cells may have spread throughout the body. Cells that are in the process of dividing are the most likely cells to be killed by exposure to radiation. Since cancer cells are always in the process of dividing, exposing them to x-rays may kill them. The x-ray beam is coned down so just the tumor is exposed. However, scatter radiation kills off other cells that rapidly divide (stomach lining and hair follicles), so the side effects include baldness and nausea.

TREATMENT OF CANCER 2. CHEMOTHERAPY This is for cancer that has metastasized. It is also good for cancer of the blood (leukemia). The drugs are designed to specifically kill just the cancer cells, but it tends to also kill off the normal blood cells that are just being formed in the bone marrow. Thus, bone marrow transplants are also needed sometimes.

TREATMENT OF CANCER 3. BONE MARROW TRANSPLANTS Someone needs to volunteer to donate a small piece of bone from the crest of their hip. This bone marrow will contain healthy new blood cells that can repopulate the depleted bone marrow of the sick person. These cells are injected into the sick persons vein.

TREATMENT OF CANCER 4. IMMUNOTHERAPY Blood cells are taken from the sick person and are fused with an antibody that is specifically designed to seek out and destroy the cancer cell.

TREATMENT OF CANCER 5. GENE THERAPY This is new research, attempting to find a gene that will shrink tumors.

TREATMENT OF CANCER 6. COMPLEMENTARY THERAPIES This involves natural healing therapies such as biofeedback, acupuncture, and exotic foods. Its worth a try if youre going to die!