Essentials of Human Anatomy

Skin

Dr Fadel Naim
Ass. Prof. Faculty of Medicine 1
IUG
 Anatomy of Skin

• Skin (integument) is body’s largest organ

• Approximately 1.6 to 1.9 m2 in average-sized adult
• Integumentary system describes the skin
and its appendages—the hair, nails, and
skin glands
• Thin and thick skin
– “Thin skin”—covers most of body surface
(1 to 3 mm thick)
– “Thick skin”—soles and palms
(4 to 5 mm thick)

Slide 2
 Functions of Skin

Functions of Integumentary System

A. Regulation of Body Temperature
B. Protection from Dehydration and Infection
C. Respond to Temperature, Pressure, Pain
D. Excretion of Water, Salts, Urea (nitrogenous waste)
E. Synthesis Vitamin D (essential for Ca + P absorption)
F. First Defensive Barrier of Immune Response
 Functions of the Skin
• Protection
– Physical barrier to microorganisms
– Barrier to chemical hazards
– Reduces potential for mechanical trauma
– Prevents dehydration
– Protects (via melanin) excess UV exposure

Slide 4
 Functions of the Skin
• Sensation
– Skin acts as a sophisticated sense organ
– Somatic sensory receptors detect stimuli that
permit us to detect pressure, touch,
temperature, pain, and other general
sensations

Slide 5
 Functions of the Skin
• Flexibility
– Skin is supple and elastic, thus permitting
change in body contours without injury
• Excretion
– Water
– Urea/ammonia/uric acid

Slide 6
 Functions of the Skin
• Hormone (Vitamin D) production
– Exposure of skin to UV light converts
7-dehydrocholesterol to cholecalciferol—
a precursor to vitamin D
– Blood transports precursor to liver and
kidneys, where vitamin D is produced
– Process and end result fulfill the necessary
steps required for vitamin D to be classified as
a hormone

Slide 7
 Functions of the Skin
• Immunity
– Phagocytic cells destroy bacteria
– Langerhans cells trigger helpful immune
reaction working with “helper T cells”

Slide 8
 Functions of the Skin
– Heat loss
• approximately 80% of heat loss occurs through the
skin; remaining 20% occurs through the mucosa of
the respiratory, digestive, and urinary tracts

Slide 9
 Layers of Skin

• Epidermis
• Dermis
• Subcutaneous layer
• beneath dermis
• not part of skin
 Epidermis
• Lacks blood vessels
• Keratinized
• Thickest on palms and soles (0.8-1.4mm)
• Melanocytes provide
• Rests on basement membrane
melanin
• Stratified squamous
Structure of the Skin
• Epidermis
– Cell types
• Keratinocytes— constitute over 90% of cells present;
principal structural element of the outer skin
• Melanocytes— pigment-producing cells (5% of the total);
contribute to skin color; filter ultraviolet light
• Langerhans cells— dendritic (branched) antigen-presenting
cells (APCs), they play a role in immune response

Slide 12
 Epidermis

Layers of Epidermis
• stratum corneum
• stratum lucidum
• stratum granulosum
• stratum spinosum
• stratum basale
 Structure of the Skin
• Epidermis
– Cell layers
• Stratum germinativum (growth layer)—
describes the stratum spinosum and stratum
basale together
– Stratum basale (base layer)—single layer of
columnar cells; only these cells undergo mitosis, then
migrate through the other layers until they
are shed
– Stratum spinosum (spiny layer)—cells arranged in 8
to 10 layers with desmosomes that pull cells into spiny
shapes; cells rich in RNA

Slide 14
 Structure of the Skin
– Cell layers
• Stratum granulosum (granular layer)—cells
arranged in 2-4 layers and filled with keratohyalin
granules; contain high levels of lysosomal
enzymes
• Stratum lucidum (clear layer)—cells filled with
keratin precursor called eleidin; absent in thin skin
• Stratum corneum (horny layer)—most superficial
layer; dead cells filled with keratin (barrier area)

Slide 15
 Structure of the Skin
– Epidermal growth and repair
• Turnover or regeneration time refers to time
required for epidermal cells to form in the stratum
basale and migrate to the skin surface—about 35
days
• Shortened turnover time will increase the thickness
of the stratum corneum and result in callus formation
• Normally 10% to 12% of all cells in stratum basale
enter mitosis daily
• Each group of 8 to 10 basal cells in mitosis with
their vertical columns of migrating keratinocytes
is called an epidermal proliferating unit, or EPU

Slide 16
 Structure of the Skin
• Dermal-epidermal junction
– A definite basement membrane,
specialized fibrous elements, and a
polysaccharide gel serve to “glue” the
epidermis to the dermis below
– The junction serves as a partial barrier to
the passage of some cells and large
molecules

Slide 17
 Structure of the Skin
• Dermis
– Sometimes called “true skin”—much thicker
than the epidermis and lies beneath it
– Gives strength to the skin
– Serves as a reservoir area for storage of
water and electrolytes

Slide 18
 Dermis
• On average 1.0-2.0mm thick
• Contains dermal papillae
• Binds epidermis to underlying tissues
• Irregular dense connective tissue
• Muscle cells
• Nerve cell processes
• Specialized sensory receptors
• Blood vessels
• Hair follicles
• Glands
 Structure of the Skin
• Dermis
– Contains various structures:
• Arrector pili muscles and hair follicles
• Sensory receptors
• Sweat and sebaceous glands
• Blood vessels
– Rich vascular supply plays a critical role in
temperature regulation

Slide 20
 Structure of the Skin
• Dermis
– Layers of dermis:
• Papillary layer— composed of dermal papillae that
project into the epidermis; contains fine
collagenous and elastic fibers; contains the
dermal-epidermal junction; forms a unique
pattern that gives individual fingerprints
• Reticular layer— contains dense, interlacing
white collagenous fibers and elastic fibers to
make the skin tough yet stretchable; when
processed from animal skin, produces leather

Slide 21
 Lines of Cleavage

• Tension lines in the skin identify the predominant

orientation of collagen fiber bundles.
• Clinically and surgically significant because cuts
can result in slow healing and increased
scarring.
 Structure of the Skin

• Dermis remains a scar

• Dermal growth and repair
• The dermis does not continually shed and regenerate itself
as does the epidermis

Slide 24
 Subcutaneous Layer

• hypodermis
• loose connective tissue

• adipose tissue
• insulates
• major blood vessels
 Structure of the Skin
• Hypodermis
– Also called subcutaneous layer or superficial
fascia
– Deep to the dermis, forming connection
between the skin and other structures
– Not part of the skin

Slide 26
Slide 27
 Skin Color
Genetic Factors Physiological Factors
• varying amounts of • dilation of dermal blood
melanin vessels
• varying size of melanin • constriction of dermal blood
granules vessels
• albinos lack melanin • accumulation of carotene
• jaundice
Environmental Factors
• sunlight
• UV light from sunlamps
• X rays
• darkens melanin
 Skin Color
– Melanin
• Basic determinant of skin color is quantity, type, and distribution of melanin
– Beta carotene
• (group of yellowish pigments from food) can also contribute to skin color
– Hemoglobin
• color changes also occur as a result of changes in blood flow
– Redder skin color when blood flow to skin increases
– Cyanosis—bluish color caused by darkening of hemoglobin when it
loses oxygen and gains carbon dioxide (Figure 6-9)
– Bruising can cause a rainbow of different colors to appear in the skin
– Other pigments
• from cosmetics, tattoos, and bile pigments in jaundice

Slide 29
 Basis of Skin Color
• The color of skin and mucous membranes can provide
clues for diagnosing certain problems, such as

– Jaundice
• yellowish color to skin and whites of eyes
• buildup of yellow bilirubin in blood from liver disease
– Cyanosis
• bluish color to nail beds and skin
• hemoglobin depleted of oxygen looks purple-blue
– Erythema
• redness of skin due to enlargement of capillaries in dermis
• during inflammation, infection, allergy or burns

Slide 30
Skin glands

Sebaceous glands
• Secrete sebum—oily substance that keeps hair
and skin soft and pliant; prevents excessive water
loss from the skin
• usually associated with hair follicles
• Lipid components have antifungal activity
• Simple, branched glands
• Found in dermis except in palms and soles
• Secretion increases in adolescence; may lead to
formation of pimples and blackheads
Slide 31
 Sweat Glands

• Widespread in skin

• Originates in deeper dermis

Or hypodermis
• Eccrine glands

• Apocrine glands
• Ceruminous glands
• Mammary glands
 Sweat Glands

• Eccrine glands

– Most numerous sweat glands; quite small

– Distributed over total body surface with
exception of a few small areas
– Simple, coiled, tubular glands
– Function throughout life
– Secrete perspiration or sweat; eliminate
wastes; and help maintain a constant core
temperature

Slide 33
 Sweat Glands

• Apocrine glands
– Located deep in subcutaneous layer
– Limited distribution—axilla, areola of breast,
and around anus
– Large (often more than 5 mm in diameter)
– Simple, branched, tubular glands
– Begin to function at puberty
– Secretion shows cyclic changes in female
with menstrual cycle

Slide 34
 Sweat Glands
Ceruminous glands

• Modified apocrine sweat glands

• Simple, coiled, tubular glands
• Empty contents into external ear canal alone or with
sebaceous glands
• Mixed secretions of sebaceous and ceruminous glands
called cerumen (wax)
• Function of cerumen to protect area from dehydration;
excess secretion can cause blockage of ear canal and
loss of hearing

Slide 35
 Hair

• Distribution—over entire body except

palms of hands and soles of feet and a
few other small areas
• Fine and soft hair coat present before birth called
lanugo
• Coarse pubic and axillary hair that develops at
puberty called terminal hair

Slide 36
 Functions of Hair
• Protection
• Heat retention
• Prevents the loss of conducted heat from the
scalp to the surrounding air
• Facial expression
• Sensory reception
• Visual identification
• Chemical signal dispersal
 Hair Follicles

• Epidermal cells
• Tube-like depression
• Extends into dermis
• Hair root
• Hair shaft
• Hair papilla
• Dead epidermal cells
• Melanin
• Arrector pili muscle
A. Shaft - projects above surface of
epidermis
1. medulla - polyhedral cells with eleidin
2. cortex - elongated cells with/out
pigment
3. cuticle - outermost layer, like shingles
on roof
B. Root - below epidermis, penetrates
into the dermis
 
C. Hair Follicle - at the base a a single
hair 
1. external root sheath - basale and
spinosum extension
2. internal root sheath - internal hair
cell layers
3. bulb - base of hair cell
4. papilla - in the bulb, provides
nourishment for hair
5. matrix - origin of new hair cells
D. arrector pili - smooth muscle, cause
hair to rise
nerve bundle responds to touch
E. hair root plexuses
Slide 40
Slide 41
Slide 42
 Appearance of hair
• Color
– result of different amounts, distribution, types of melanin in
cortex of hair

• Growth
– hair growth and rest periods alternate; hair on head averages 5
inches of growth per year

• Sebaceous glands
– attach to and secrete sebum
(skin oil) into follicle

• Male pattern baldness results from combination of genetic

tendency and male sex hormones

Slide 43
 Hair Thinning and Baldness

• Alopecia – hair thinning in both sexes

• True, or frank, baldness
– Genetically determined and sex-influenced
condition
 Nails
– Consist of epidermal cells converted to hard
keratin
– Nail body—visible part of each nail
– Root—part of nail in groove hidden by fold of
skin, the cuticle
– Lunula—moon-shaped white area nearest
root

Slide 45
• Nail bed—layer of epithelium under nail body
– contains abundant blood vessels
• Appears pink under translucent nails
• Growth—nails grow by mitosis of cells in stratum germinativum
beneath the lunula; average growth about 0.5 mm per week, or
slightly over 1 inch per year

Slide 46
 Burns
• Tissue damage from excessive heat, electricity, radioactivity,
or corrosive chemicals that destroys (denatures) proteins in
the exposed cells is called a burn.

• Generally, the systemic effects of a burn are a greater threat

to life than are the local effects.

• The seriousness of a burn is determined by

– Its depth
– Extent
– Area involved
– The person’s age and general health.
• When the burn area exceeds 70%, over half of the victims die

Slide 47
 Burns

• Destruction of proteins of the skin

– chemicals, electricity, heat
• Problems that result
– shock due to water, plasma and plasma
protein loss
– circulatory & kidney problems from loss of
plasma
– bacterial infection

Slide 48
 Types of Burns
• First-degree
– only epidermis (sunburn)

Slide 49
 Types of Burns
• Second-degree burn
– destroys entire epidermis & part of dermis
– fluid-filled blisters separate epidermis & dermis
– epidermal derivatives are not damaged
– heals without grafting in 3 to 4 weeks & may scar

Slide 50
 Types of Burns
• Third-degree or full-thickness
– destroy epidermis, dermis & epidermal derivatives
– damaged area is numb due to loss of sensory nerves

Slide 51
Rule of Nines
 Cycle of Life: Skin
• Children
– Skin is smooth, unwrinkled, and characterized

by elasticity and flexibility

– Few sweat glands
– Rapid healing

Slide 53
 Cycle of Life: Skin
• Adults
– Development and activation of sebaceous
and sweat glands
– Increased sweat production
• Body odor
– Increased sebum production
• Acne

Slide 54
 Cycle of Life: Skin
Aging
• Skin repair processes take longer due to
reduced number and activity of stem cells.
• Skin forms wrinkles and becomes less resilient.
• Skin’s immune responsiveness is diminished.
• Skin becomes drier due to decreased
sebaceous gland activity.
• Altered skin and hair pigmentation.
 Cycle of Life: Skin
Aging
• Sweat production diminishes.
• Blood supply to the dermis is reduced
leading to impaired thermoregulation.
• Hair thinning and loss.
• Integumentary production of vitamin D3
diminishes.
• Development of skin cancers.
Skin and Aging Process
 Skin Cancer

• The most common type of cancer.

• The greatest risk factor is exposure to UV
rays of the sun.
• The highest incidence is in people who
have had severe sunburns, especially as
children.
 Skin Cancer

• Most skin tumors are benign and do not

metastasize
• The three major types of skin cancer are:
– Basal cell carcinoma
– Squamous cell carcinoma
– Melanoma
 Basal Cell Carcinoma
• Least malignant and most common skin cancer
• Stratum basale cells proliferate and invade the
dermis and hypodermis
• Slow growing and do not often metastasize
• Can be cured by surgical excision in 99% of the
cases
 Squamous Cell Carcinoma
• Arises from keratinocytes of stratum spinosum
• Arise most often on scalp, ears, and lower lip
• Grows rapidly and metastasizes if not removed
• Prognosis is good if treated by radiation therapy
or removed surgically
 Melanoma
Cancer of melanocytes is the most dangerous type
of skin cancer because it is:
– Highly metastatic
– Resistant to chemotherapy
 Melanoma
Melanomas have these characteristics (ABCD rule)
– A: Asymmetry; the two sides of the pigmented area
do not match
– B: Border is irregular and exhibits indentations
– C: Color (pigmented area) is black, brown, tan, and
sometimes red or blue
– D: Diameter is larger than 6 mm (size of a pencil
eraser)
 Melanoma
• Treated by wide surgical excision
accompanied by immunotherapy
• Chance of survival is poor if the lesion is
over 4 mm thick
THE END