SURFACE CHANGES OF THE SKIN

Introduction
The skin is one of the largest organs in the body, having a surface area of 1,8
m
2
and making up about 16% of body weight. t has many functions, the most
important of which is as a barrier to protect the body from no!ious e!ternal factors
and to keep the internal systems intact. "kin composed of threee layers# the
epidermis, the dermis and the subcutis.
1

Epidermis
The epidermis is an avascular, keratini$ed sheet of stratified s%uamous
epithelium. &ost epidermal cells are keratinocytes. "cattered among the keratinocytes
in the deepest epidermal layers are melanocytes, &erkel 'ells, and (angerhans cells.
)rom deep to superficial, the strata, or layers of the epidermis, are the basale,
spinosum, granulosum, lucidum, and corneum. The stratum lucidum is absent in thin
skin. The actively mitotic stratum basale is the source of new cells for epidermal
growth. The most superficial layers are increasingly keratini$ed and less viable.
2

Dermis
The dermis, composed mainly of dense, irregular connective tissue, is well
supplied with blood vessels, lymphatic vessels, and nerves. 'utaneous receptors,
glands, and hair follicles resides within the dermis. The more superficial papillary
layer e!hibits dermal papillae that protrude into the epidermis above, as well as
dermal ridges, and the epidermal ridges that produce fingerprints. n the deeper,
thicker reticular layer, the connective tissue fibers are much more densely
interwoven. (ess dense regions between the collagen bundles produce cleavage, or
tension, lines in the skin. *oints of tight dermal attachment to the hypodermis
produce dermal folds, or fle!ure lines.
2

Appendages Of Te S!in
"kin appendages, which derive from the epidermis, include hairs and hair
follicles, nails, and glands +sweat and sebaceous,.
2

1. "weat +"udoriferous, -lands
.ccrine +merocrine, sweat glands, with a few e!ceptions, are distributed over the
entire body surface. Their primary function is thermoregulation. They are simple
coiled tubular glands that secrete a salt solution containing small amounts of other
solutes. Their ducts usually empty to the skin surface via pores.
1
)igure 1. Cutaneous g"ands. +a, photomicrograph of a sebaceous gland +16/!,.
+b, photomicrograph of eccrine sweat glands +20/!,.
2
1pocrine sweat glands, which may function as scent glands, are found primarily
in the a!illary and anogenital areas. Their secretion is similar to eccrine secretion,
but it also contains proteins and fatty substances on which bacteria thrive.
2. "ebaceous +2il, -lands
"ebaceous glands occur all over the body surface e!cept for the palms and soles.
They are simple alveolar glands3 their oily holocrine secretion is called sebum.
"ebaceous gland ducts usually empty into hair follicles.
"ebum lubricates the skin and hair, prevents water loss from the skin, and acts as
a bactericidal agent. "ebaceous glands are activated +at puberty, and controlled by
androgens.
3. 4airs and 4air )ollicles
1 hair, produced by a hair follicle, consists of heavily keratini$ed cells. 1 typical
hair has a central medulla, a corte!, and an outer cuticle and root and shaft
portions. 4air color reflects the amount and kind of melanin present.
1 hair follicle consists of an inner epithelial root sheath, enclosing the matri!
+region of the hair bulb that produces the hair,, and an outer connective tissue root
sheath derived from the dermis. 1 hair follicle is richly vasculari$ed and well
supplied with nerve fibers. 1rrector pili muscles pull the follicles into an upright
position and produce goose bumps.
2
.!cept for hairs of the scalp and around the eyes, hairs formed initially are fine
vellus hairs3 at puberty, under the influence of androgens, coarser, darker terminal
hairs appear in the a!illae and genital region.
)igure 2. Structure of a air and air fo""ic"e# +a, 'ross section of a hair within
its follicle, diagrammatic view. +b, *hotomicrograph of a cross section of a hair
and hair follicle +20/5,. +c, 6iagram of a longitudinal view of the e!panded hair
bulb of the follicle, which encloses the matri!, the actively dividing epithelial
cells that produce the hair. +d, *hotomicrograph of a longitudinal view of the hair
bulb in the follicle +16/5,.
2

The rate of hair growth varies in different body regions and with se! and age.
6ifferences in life span of hairs account for differences in length on different
3
body regions. 4air thinning reflects factors that lengthen follicular resting
periods, age7related atrophy of hair follicles, and a delayed7action gene.
4. 8ails
1 nail is a scalelike modification of the epidermis that covers the dorsum of a
finger +or toe, tip. The actively growing region is the nail.
)igure 9. Structure of a nai"# +a, "urface view of the distal part of a finger. +b,
"agittal section of the fingertip. The nail matri! that forms the nail lies beneath the
lunula.
2

Functions Of Te S!in
The skin and its derivatives perform a variety of functions that affect body
metabolism and prevent e!ternal factors from upsetting body homeostasis. -iven its
superficial location it is our most vulnerable organ system, e!posed to bacteria,
abrasion, temperature e!tremes, and harmful chemicals.
2

1. *rotection. The skin protects by chemical barriers +the antibacterial nature of
sebum, human defensin, cathelicidins, the acid mantle, and the :; shield of
melanin,, physical barriers +the hardened keratini$ed and lipid7rich surface,, and
biological barriers +(angerhans< cells, macrophages, and 681,.
2. =ody temperature regulation. The skin vasculature and sweat glands, regulated by
the nervous system, play an important role in maintaining body temperature
homeostasis.
3. 'utaneous sensation. 'utaneous sensory receptors respond to temperature, touch,
pressure, and pain stimuli.
4. &etabolic functions. ;itamin 6 is synthesi$ed from cholesterol by epidermal
cells. "kin cells also play a role in some chemical conversions.
5. =lood reservoir. The e!tensive vascular supply of the dermis allows the skin to
act as a blood reservoir.
4
6. .!cretion. "weat contains small amounts of nitrogenous wastes and plays a minor
role in e!cretion.
Homeostatic Im$a"ances of Te S!in
>hen skin rebels, it is %uite a visible revolution. (oss of homeostasis in body
cells and organs reveals itself on the skin, sometimes in startling ways. The skin can
develop more than 1/// different conditions and ailments. The most common skin
disorders are bacterial, viral, or yeast infections. (ess common, but far more
damaging to body well7being, are skin cancer and burns.
2

The study e!amined the skin of ?apanese children over 1/ years of age, i.e. at
the beginning of puberty, when physiological changes including active sebum
secretion begin to occur. Tokudome @ Tagami reported e!tremely low skin surface
hydration on the face and trunk in ?apanese children aged AB11 years, even compared
with the skin of elderly individuals, who are well7known to develop senile !erosis.
2ur present biophysical data, obtained in children older than this, showed similar
results, i.e. the children<s skin showed a significantly low surface hydration state and
low levels of skin surface lipids. .ven in normal adults, the dry and cold winter
season has a great influence on the skin condition, and affects the face more than the
forearm. 'linical observation revealed that appro!imately one7third of the children in
our study e!hibited visible dry skin changes in winter, in contrast to their mothers, the
maCority of whom did not show any dry skin in winter. >e found that the stratum
corneum +"', barrier function of the children, as assessed by trans7epidermal water
loss +T.>(, measurements, e!hibited distinct age7 and location7dependent
functional characteristics. 2n the fle!or forearm, the "' barrier function tended to
improve with increasing age, whereas it became poorer on the cheek of the older
children. "ebum e!cretion, which starts to occur on the cheek at around the age of 1A
years, worsens the poor facial "' barrier function by inducing the proliferation of
skin surface microflora, which may e!ert an irritating effect on the skin. 'ornified
envelopes +'., is a thin insoluble structure enveloping corneocytes, and is formed via
transglutaminase7catalysed cross7linking of various precursor proteins, including
involucrin and loricrin. Thus, it provides a foundation for the organi$ation of the
intercellular lipids that are essential for the barrier function of the "'. The presence
of immature '.s has been detected in the outermost layer of the "' of barrier7
impaired skin, including even normal facial skin. The ratio of immature '.s on the
face does not depend on the age of the subCects +within the range 1/B0/ years,, but it
increases during the winter season3 the ratio of immature '.s in the children was
reported to be similar to that of adults. 2ur present results agree well with these
5
findings. 1lthough it is not known why the ratio of immature '.s in the 1A7year7old
age group tended to be higher than in other age groups, both children and adults, we
speculate that the start of high sebum e!cretion in the children in this age group may
lead to mild inflammation, possibly due to the proliferation of surface microflora as
mentioned above. The skin surface hydration state of the children was remarkably
lower than that of the adults, as is clear from the development of dry skin in winter,
even on the face. t is well known that dry skin is observed in elderly persons in
winter. "uch senile !erosis is due to levels of skin surface lipids, intercellular lipids
and natural moisturi$ing factors +8&),, together with the retention of effete
corneocytes on the skin surface due to slower turnover of the "', reflecting the less
active epidermal proliferation in elderly individuals that is noted histologically as
atrophic epidermis +1A,. n the present study, we also found similarly low skin
surface lipids in the children<s skin, reflecting lower production of all the components
of skin surface lipids.
9
The ultraviolet component of solar light consists of :;= and :;1 parts,
which differentially penetrate the skin barrier and thus affect prevalently epidermal
+:;=, or dermal +:;1, skin cells and corresponding e!tracellular structuresD
molecules. "kin surface lipids +""(, play an important role for essential human skin
functions such as mechanical and chemical barrier, thermoregulation, and photo7
protection. (aying on the surface of the skin, ""( are also e!posed to the highest
doses of :;1E:;= and they form the first7line defence against its potential danger.
&aCor photo7protective components of ""( are a7tocopherol and s%ualene
+2,6,1/,10,1F,29,7he!amethyl72,6,1/,1A,18,227tetracosahe!aene, "%,, both working as
sacrificing antio!idants, since they block photo7induced lipid pero!idation in cellular
and acellular skin components, either by chain7breaking mechanism +a7tocopherol, or
by %uenching singlet o!ygen +"%,. =oth are continuously produced by skin surface7
open sebaceous glands to maintain their physiologically essential levels and substitute
photo7destructed molecules. "% is the most abundant o!idisable component of ""(,
its concentrations in adult human skin reaching up to 2/%, while its levels are
negligible in other organs. :pon action of environmental o!idants and microbial
residents of the skin, fast o!idative degradation of "% occurs giving rise to a wide
spectrum of by7products, such as monohydropero!ides, epo!ides, and aldehydes.
*hysiological doses of :;1 o!idise "% at much higher rates than :;=. The role of
"% and its o!idation products +"%*!, in skin photo7protection and in the induction of
inflammatory responses of keratinocytes in the conte!t of acne pathogenesis has been
evaluated and recently reviewed in.
A

6
The composition of the skin microbiome is determined by some combination
of two simultaneous ecological processes# the selection of certain microbial species
by the skin environment and the dispersal of microbes from a pool of available
species. "kin moisture, temperature, p4 and e!posure to ultraviolet light are all well
documented environmental factors that affect skin microbial communities. The
microbial species available for dispersal onto the skin of any given individual likely
stem from many sources including inanimate surfaces, people, pets, cosmetics, air
and water. 4uman to surface and human to human contact have long been
acknowledged as strong vectors for microbial dispersal in the medical literature,
which has been largely focused on culture7based detection of single7species pathogen
transmissions. n these culture7based studies, handshaking, as well as hand7contact
with other parts of the body and room surfaces, have been identified as strong vectors
of health care service infections, such as with methicillin7resistant Staphylococcus
aureus +&G"1, and Klebsiella spp. -iven that human contact with surfaces, and
especially the skin surfaces of others, has been shown to transfer individual microbial
ta!a, activities which involve human to human contact could be hypothesi$ed to
result in the sharing of skin microbial communities. >e know very little about how
our social, family, and professional interactions shape our microbial identities.
'ontact sports are an ideal setting in which to study how human to human
interactions influence our microbial ecosystems. 1s the rise of mega7cities and
population growth continues, humans may e!perience an increased rate of person to
person contact mediated by urban living and global travel. To predict the implications
of these changes will re%uire, in part, understanding the ecological and evolutionary
forces that act on the skin microbiome. 1 thorough comprehension of the drivers of
the skin microbiome is still emerging3 novel approaches to studying our skin
ecosystems will likely have lasting implications for health care, disease transmission,
and our understanding of urban environment microbiology.
0

&o!ibustion is an important component of traditional 'hinese medicine
+T'&,. t is a thermal treatment procedure that involves ignited material +usually
mo!a, near specific points for treating disease. &o!ibustion is used to regulate
meridiansD channels and visceral organs of the human body. The duration of treatment
and the distance between the mo!a burner and acupuncture point for mo!ibustion are
crucial factors influencing mo!ibustion effectiveness. t has been suggested that the
duration of mo!ibustion at each point should be 9B0 min, but not more than 1/B10
min. n 2/1/, the 8ational "tandards of the *eople<s Gepublic of 'hina
recommended covering the mo!a burner with 8B1/ layers of gau$e while
implementing mo!ibustion, and that the appropriate distance between the mo!a
7
burner and skin surface was 2B9 cm. 4yperthermia is variously defined as a body
core temperature higher than 9H.0B98.9I'. >hen the environmental temperature is
higher than the body, heat transmits into the body via conduction, convection, or
radiation. The therapeutic effects of heat include +1, increased e!tensibility of
collagen tissues and +2, vasodilatation and increased blood flow to the affected area.
The increased rate of circulation acts to provide nutrients and o!ygen to promote
tissue healing. &o!ibustion is also used to regulate blood flow and %i. "uperficial
hyperthermic temperature is skin temperature maintained at A/BA0I'. 1 study by
1driaensen et al showed that thermal stimulation of human skin at AA.0BA6.0I'
activated 17fibre mechano7heat7sensitive nociceptors. &ori et al showed that the
ma!imum temperature for indirect mo!ibustion was appro!imately 0/I'. 1nimal
studies of the thermal properties of indirect mo!ibustion show that the ma!imum
temperature induced by indirect mo!ibustion was about 60I' on the skin surface and
A0I' in the subcutaneous layer.2H .!cessive heating can cause protein denaturation
and cell damage.
6

"tem cells +"', are immature cells capable of self7renewal and development
to form speciali$ed cells of the body. The ability to provide a wide variety of cell
types makes "' an important reserve for the body in filling defects. *luri7and
multipotency properties of stem cells make them ideal for use in transplantation. t
should be borne in mind that in addition to the fact that stem cells, which migrate to
the $one of inCury or damaged tissues of the body +homing,, also divide, and
differentiate, forming new cell types in the tissue +local "', fibroblasts, etc.,, as if
they were Jcentral warehouse partsJ B stromal cells of organs# adipose tissue +1T,,
red bone marrow etc. n recent years, one line of stem cell B mesenchymal stem cells
+&"'s, have found promising use in various aspects of cell therapy, including filling
of wound defects. &"'s are versatile cells3 they apparently are able to enter the
bloodstream into the affected organ or tissue and locally influenced by several
factors, give rise to speciali$ed cells, which replace the dead cells. 1t present, sources
of &"'s are adult red bone marrow, adipose tissue, blood, skin, etc. &"'s from
adipose tissue have been described not so long ago. n 2//2, 1merican scientists first
proposed the use of human adipose tissue as a source of multipotent stem cells.
"omewhat later, in 2//9, there were reports from ?apan about the prospects of clinical
application of &"'s from adipose tissue. -iven the fact that fat tissue in humans is
present in large %uantity, a patient can be his own donor. This avoids immunological
incompatibility reaction. =one marrow tissue of humans and mammals is considered
as one of the preferred sources of &"'s. 4owever, the clinical use of bone marrow as
a source of &"'s is problematic, because the procedure is difficult, and as a result
8
one can obtain only a small number of cells. 6ata of several authors indicate that
adipose tissue may serve as a source of cells that resemble bone marrow
mesenchymal stem cells, which posses the morphology of fibroblasts, reproduce in
vitro in standard medium, and are capable of multilineage differentiation. -iven that
the method of obtaining &"'s from adipose tissue compared with &"'s from bone
marrow or other tissues is easier and the number of cells obtained in the process is
more, we can hope for good prospects, for their use in medicine in the recovery of
damaged tissues.
H

The use of &"'s of 1T in the treatment of infected wounds allows to %uickly
restore the integrity of the skin, compared to traditional methods of treatment. The
regeneration of wound is greatly accelerated due to the ability of stem cells to
strengthen anti7inflammatory and regenerative processes. &"'s stimulate the
development epidermis, accelerate wound healing, and hence may improve cosmetic
outcome of treatment. The use of &"'s of adipose tissue for transplantation may
improve the treatment outcome of non7healing wounds in surgical practice.
H

9
DAFTAR %USTAKA
1. -awkrodger 6?. &icroanatomy 2f The "kin. n# -awkrodger 6?, 4orne T,
editors. 6ermatology 1n llustrated 'olour Te!t. 9
rd
ed. :K# 'hurchill
(ivingstone3 2//9. p. 2
2. &arieb .8, 4oehn K. The ntegumentary "ystem. n# &arieb .8, 4oehn K,
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th
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9. 1kutsu 8, 2oguri &, 2nodera T, Kobayashi L, Katsuyama &, Kuni$awa 8, et al.
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1ge and "easonal nfluences. 1cta 6erm ;enereol. 2//F3 8F# 2172H
A. Kostyuk ;, *otapovich 1, "tancato 1, 6e (uca ',(ulli 6, *astore ", Korkina (.
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nflammatory Gesponses to "olar :; in 4uman Keratinocytes. *los 2ne ?ournal.
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0. &eadow ?), =ateman 1', 4erkert K&, 2<'onnor TK, -reen ?(. "ignificant
'hanges n The "kin &icrobiome &ediated =y The "port 2f Goller 6erby. *eer?
?ournal. 2/19
6. (in (&, >ang "), (ee G*, 4su =-, Tsai 8&, *eng T'. 'hanges n "kin "urface
Temperature 1t 1n 1cupuncture *oint >ith &o!ibustion. =ritish &edical
?ournal. 2/19
H. "ahab 14, Tretyak ", 8ed$ved &K, =aranov .;, 8adyrov ., (obanok 44, et al.
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2/193 2+2,# 6/171H
8.
10