Human skin

Skin

Epidermis, dermis, and subcutis, showing a hair

follicle, sweat gland, and sebaceous gland
Details
Identifiers
Latin Cutis
Code TH H3.12.00.1.00001
TA 16.0.00.002
Anatomical terminology
[edit on Wikidata]

The human skin is the outer covering of the body. In humans, it is the largest organ of the
integumentary system. The skin has multiple layers of ectodermal tissue and guards the
underlying muscles, bones, ligaments and internal organs.[1] Human skin is similar to that of
most other mammals. Though nearly all human skin is covered with hair follicles, it can
appear hairless. There are two general types of skin, hairy and glabrous skin.[2] The adjective
cutaneous literally means "of the skin" (from Latin cutis, skin).

Because it interfaces with the environment, skin plays an important immunity role in
protecting the body against pathogens[3] and excessive water loss.[4] Its other functions are
insulation, temperature regulation, sensation, synthesis of vitamin D, and the protection of
vitamin B folates. Severely damaged skin will try to heal by forming scar tissue. This is often
discolored and depigmented.

In humans, skin pigmentation varies among populations, and skin type can range from dry to
oily. Such skin variety provides a rich and diverse habitat for bacteria that number roughly
1000 species from 19 phyla, present on the human skin.[5][6]

Contents
 1 Structure

o 1.1 Epidermis

o 1.2 Dermis

o 1.3 Hypodermis

o 1.4 Cross-section

2 Development

o 2.1 Skin color

o 2.2 Aging

3 Functions

o 3.1 Skin flora

4 Clinical significance

5 Society and culture

o 5.1 Hygiene and skin care

6 Permeability

o 6.1 Nanoparticles

o 6.2 Increasing permeability

o 6.3 Applications

o 6.4 Sunblock and sunscreen

o 6.5 Diet

7 See also

8 References

9 External links

Structure
Skin has mesodermal cells, pigmentation, such as melanin provided by melanocytes, which
absorb some of the potentially dangerous ultraviolet radiation (UV) in sunlight. It also
contains DNA repair enzymes that help reverse UV damage, such that people lacking the
genes for these enzymes suffer high rates of skin cancer. One form predominantly produced
by UV light, malignant melanoma, is particularly invasive, causing it to spread quickly, and
can often be deadly. Human skin pigmentation varies among populations in a striking
manner. This has led to the classification of people(s) on the basis of skin color.[7]

The skin is the largest organ in the human body. For the average adult human, the skin has a
surface area of between 1.5-2.0 square metres (16.1-21.5 sq ft.). The thickness of the skin
varies considerably over all parts of the body, and between men and women and the young
and the old. An example is the skin on the forearm which is on average 1.3 mm in the male
and 1.26 mm in the female.[8] The average square inch (6.5 cm) of skin holds 650 sweat
glands, 20 blood vessels, 60,000 melanocytes, and more than 1,000 nerve endings.[9]
[better source needed]
The average human skin cell is about 30 micrometers in diameter, but there are
variants. A skin cell usually ranges from 25-40 micrometers (squared), depending on a variety
of factors.

Skin is composed of three primary layers: the epidermis, the dermis and the hypodermis.[8]

Epidermis

Main article: Epidermis

Epidermis, "epi" coming from the Greek meaning "over" or "upon", is the outermost layer of
the skin. It forms the waterproof, protective wrap over the body's surface which also serves as
a barrier to infection and is made up of stratified squamous epithelium with an underlying
basal lamina.

The epidermis contains no blood vessels, and cells in the deepest layers are nourished almost
exclusively by diffused oxygen from the surrounding air[10] and to a far lesser degree by blood
capillaries extending to the outer layers of the dermis. The main type of cells which make up
the epidermis are Merkel cells, keratinocytes, with melanocytes and Langerhans cells also
present. The epidermis can be further subdivided into the following strata (beginning with
the outermost layer): corneum, lucidum (only in palms of hands and bottoms of feet),
granulosum, spinosum, basale. Cells are formed through mitosis at the basale layer. The
daughter cells (see cell division) move up the strata changing shape and composition as they
die due to isolation from their blood source. The cytoplasm is released and the protein keratin
is inserted. They eventually reach the corneum and slough off (desquamation). This process is
called "keratinization". This keratinized layer of skin is responsible for keeping water in the
body and keeping other harmful chemicals and pathogens out, making skin a natural barrier
to infection.
2D projection of a 3D OCT-tomogram of the skin at the fingertip, depicting the stratum
corneum (~500 m thick) with the stratum disjunctum on top and the stratum lucidum in the
middle. At the bottom are the superficial parts of the dermis. The sweatducts are clearly
visible. (See also: Rotating 3D Version)

Components

The epidermis contains no blood vessels, and is nourished by diffusion from the dermis. The
main type of cells which make up the epidermis are keratinocytes, melanocytes, Langerhans
cells and Merkels cells. The epidermis helps the skin to regulate body temperature.[citation needed]

Layers

Epidermis is divided into several layers where cells are formed through mitosis at the
innermost layers. They move up the strata changing shape and composition as they
differentiate and become filled with keratin. They eventually reach the top layer called
stratum corneum and are sloughed off, or desquamated. This process is called keratinization
and takes place within weeks. The outermost layer of the epidermis consists of 25 to 30 layers
of dead cells.

Sublayers

Epidermis is divided into the following 5 sublayers or strata:

Stratum corneum

Stratum lucidum

Stratum granulosum

Stratum spinosum

Stratum germinativum (also called "stratum basale").

Blood capillaries are found beneath the epidermis, and are linked to an arteriole and a venule.
Arterial shunt vessels may bypass the network in ears, the nose and fingertips.
Dermis

Main article: Dermis

The dermis is the layer of skin beneath the epidermis that consists of epithelial tissue and
cushions the body from stress and strain. The dermis is tightly connected to the epidermis by
a basement membrane. It also harbors many nerve endings that provide the sense of touch
and heat. It contains the hair follicles, sweat glands, sebaceous glands, apocrine glands,
lymphatic vessels and blood vessels. The blood vessels in the dermis provide nourishment
and waste removal from its own cells as well as from the Stratum basale of the epidermis.

The dermis is structurally divided into two areas: a superficial area adjacent to the epidermis,
called the papillary region, and a deep thicker area known as the reticular region.

Papillary region

The papillary region is composed of loose areolar connective tissue. It is named for its
fingerlike projections called papillae, that extend toward the epidermis. The papillae provide
the dermis with a "bumpy" surface that interdigitates with the epidermis, strengthening the
connection between the two layers of skin.

In the palms, fingers, soles, and toes, the influence of the papillae projecting into the
epidermis forms contours in the skin's surface. These epidermal ridges occur in patterns (see:
fingerprint) that are genetically and epigenetically determined and are therefore unique to the
individual, making it possible to use fingerprints or footprints as a means of identification.

Reticular region

The reticular region lies deep in the papillary region and is usually much thicker. It is
composed of dense irregular connective tissue, and receives its name from the dense
concentration of collagenous, elastic, and reticular fibers that weave throughout it. These
protein fibers give the dermis its properties of strength, extensibility, and elasticity.

Also located within the reticular region are the roots of the hair, sebaceous glands, sweat
glands, receptors, nails, and blood vessels.

Tattoo ink is held in the dermis. Stretch marks from pregnancy are also located in the dermis.

Hypodermis

The hypodermis is not part of the skin, and lies below the dermis. Its purpose is to attach the
skin to underlying bone and muscle as well as supplying it with blood vessels and nerves. It
consists of loose connective tissue, adipose tissue and elastin. The main cell types are
fibroblasts, macrophages and adipocytes (the hypodermis contains 50% of body fat). Fat
serves as padding and insulation for the body.

Cross-section
Skin layers, of both hairy and hairless skin

Development
Skin color

Main article: Human skin color

Human skin shows high skin color variety from the darkest brown to the lightest pinkish-
white hues. Human skin shows higher variation in color than any other single mammalian
species and is the result of natural selection. Skin pigmentation in humans evolved to
primarily regulate the amount of ultraviolet radiation (UVR) penetrating the skin, controlling
its biochemical effects.[11]

The actual skin color of different humans is affected by many substances, although the single
most important substance determining human skin color is the pigment melanin. Melanin is
produced within the skin in cells called melanocytes and it is the main determinant of the skin
color of darker-skinned humans. The skin color of people with light skin is determined
mainly by the bluish-white connective tissue under the dermis and by the hemoglobin
circulating in the veins of the dermis. The red color underlying the skin becomes more
visible, especially in the face, when, as consequence of physical exercise or the stimulation of
the nervous system (anger, fear), arterioles dilate.[12]

There are at least five different pigments that determine the color of the skin.[13][14] These
pigments are present at different levels and places.

Melanin: It is brown in color and present in the basal layer of the epidermis.

Melanoid: It resembles melanin but is present diffusely throughout the epidermis.

Carotene: This pigment is yellow to orange in color. It is present in the stratum

corneum and fat cells of dermis and superficial fascia.

Hemoglobin (also spelled haemoglobin): It is found in blood and is not a pigment of

the skin but develops a purple color.

Oxyhemoglobin: It is also found in blood and is not a pigment of the skin. It develops
a red color.

There is a correlation between the geographic distribution of UV radiation (UVR) and the
distribution of indigenous skin pigmentation around the world. Areas that highlight higher
amounts of UVR reflect darker-skinned populations, generally located nearer towards the
equator. Areas that are far from the tropics and closer to the poles have lower concentration of
UVR, which is reflected in lighter-skinned populations.[15]

In the same population it has been observed that adult human females are considerably lighter
in skin pigmentation than males. Females need more calcium during pregnancy and lactation
and vitamin D which is synthesized from sunlight helps in absorbing calcium. For this reason
it is thought that females may have evolved to have lighter skin in order to help their bodies
absorb more calcium.[16]

The Fitzpatrick scale[17][18] is a numerical classification schema for human skin color
developed in 1975 as a way to classify the typical response of different types of skin to
ultraviolet (UV) light:

I Always burns, never tans Pale, Fair, Freckles

II Usually burns, sometimes tans Fair
III May burn, usually tans Light Brown
IV Rarely burns, always tans Olive brown
V Moderate constitutional pigmentation Brown
VI Marked constitutional pigmentation Black

Aging

For more details on this topic, see senescence.

For more details on this topic, see Intrinsic and extrinsic aging.
A typical rash

Skin infected with scabies

As skin ages, it becomes thinner and more easily damaged. Intensifying this effect is the
decreasing ability of skin to heal itself as a person ages.

Among other things, skin aging is noted by a decrease in volume and elasticity. There are
many internal and external causes to skin aging. For example, aging skin receives less blood
flow and lower glandular activity.

A validated comprehensive grading scale has categorized the clinical findings of skin aging
as laxity (sagging), rhytids (wrinkles), and the various facets of photoaging, including
erythema (redness), and telangiectasia, dyspigmentation (brown discoloration), solar elastosis
(yellowing), keratoses (abnormal growths) and poor texture.[19]

Cortisol causes degradation of collagen,[20] accelerating skin aging.[21]

Anti-aging supplements are used to treat skin aging.

Photoaging

Main article: Photoaging

Photoaging has two main concerns: an increased risk for skin cancer and the appearance of
damaged skin. In younger skin, sun damage will heal faster since the cells in the epidermis
have a faster turnover rate, while in the older population the skin becomes thinner and the
epidermis turnover rate for cell repair is lower which may result in the dermis layer being
damaged.[22]

Functions
Skin performs the following functions:

1. Protection: an anatomical barrier from pathogens and damage between the internal
and external environment in bodily defense; Langerhans cells in the skin are part of
the adaptive immune system.[3][4]

2. Sensation: contains a variety of nerve endings that react to heat and cold, touch,
pressure, vibration, and tissue injury; see somatosensory system and haptics.

3. Heat regulation: the skin contains a blood supply far greater than its requirements
which allows precise control of energy loss by radiation, convection and conduction.
Dilated blood vessels increase perfusion and heatloss, while constricted vessels
greatly reduce cutaneous blood flow and conserve heat.

4. Control of evaporation: the skin provides a relatively dry and semi-impermeable

barrier to fluid loss.[4] Loss of this function contributes to the massive fluid loss in
burns.

5. Aesthetics and communication: others see our skin and can assess our mood,
physical state and attractiveness.

6. Storage and synthesis: acts as a storage center for lipids and water, as well as a
means of synthesis of vitamin D by action of UV on certain parts of the skin.

7. Excretion: sweat contains urea, however its concentration is 1/130th that of urine,
hence excretion by sweating is at most a secondary function to temperature
regulation.

8. Absorption: the cells comprising the outermost 0.250.40 mm of the skin are "almost
exclusively supplied by external oxygen", although the "contribution to total
respiration is negligible".[10] In addition, medicine can be administered through the
skin, by ointments or by means of adhesive patch, such as the nicotine patch or
iontophoresis. The skin is an important site of transport in many other organisms.

9. Water resistance: The skin acts as a water resistant barrier so essential nutrients are
not washed out of the body.

Skin flora

Main article: Skin flora

The human skin is a rich environment for microbes.[5][6] Around 1000 species of bacteria from
19 bacterial phyla have been found. Most come from only four phyla: Actinobacteria
(51.8%), Firmicutes (24.4%), Proteobacteria (16.5%), and Bacteroidetes (6.3%).
Propionibacteria and Staphylococci species were the main species in sebaceous areas. There
are three main ecological areas: moist, dry and sebaceous. In moist places on the body
Corynebacteria together with Staphylococci dominate. In dry areas, there is a mixture of
species but dominated by b-Proteobacteria and Flavobacteriales. Ecologically, sebaceous
areas had greater species richness than moist and dry ones. The areas with least similarity
between people in species were the spaces between fingers, the spaces between toes, axillae,
and umbilical cord stump. Most similarly were beside the nostril, nares (inside the nostril),
and on the back.

Reflecting upon the diversity of the human skin researchers on the human skin microbiome
have observed: "hairy, moist underarms lie a short distance from smooth dry forearms, but
these two niches are likely as ecologically dissimilar as rainforests are to deserts."[5]

The NIH has launched the Human Microbiome Project to characterize the human microbiota
which includes that on the skin and the role of this microbiome in health and disease.[23]

Microorganisms like Staphylococcus epidermidis colonize the skin surface. The density of
skin flora depends on region of the skin. The disinfected skin surface gets recolonized from
bacteria residing in the deeper areas of the hair follicle, gut and urogenital openings.

Clinical significance
For more details on this topic, see skin disease.

Diseases of the skin include skin infections and skin neoplasms (including skin cancer).

Dermatology is the branch of medicine that deals with conditions of the skin.[2]

Society and culture

Hygiene and skin care

See also: Exfoliation (cosmetology)

The skin supports its own ecosystems of microorganisms, including yeasts and bacteria,
which cannot be removed by any amount of cleaning. Estimates place the number of
individual bacteria on the surface of one square inch (6.5 square cm) of human skin at 50
million, though this figure varies greatly over the average 20 square feet (1.9 m2) of human
skin. Oily surfaces, such as the face, may contain over 500 million bacteria per square inch
(6.5 cm). Despite these vast quantities, all of the bacteria found on the skin's surface would
fit into a volume the size of a pea.[24] In general, the microorganisms keep one another in
check and are part of a healthy skin. When the balance is disturbed, there may be an
overgrowth and infection, such as when antibiotics kill microbes, resulting in an overgrowth
of yeast. The skin is continuous with the inner epithelial lining of the body at the orifices,
each of which supports its own complement of microbes.

Cosmetics should be used carefully on the skin because these may cause allergic reactions.
Each season requires suitable clothing in order to facilitate the evaporation of the sweat.
Sunlight, water and air play an important role in keeping the skin healthy.

Oily skin

Oily skin is caused by over-active sebaceous glands, that produce a substance called sebum, a
naturally healthy skin lubricant.[1] When the skin produces excessive sebum, it becomes
heavy and thick in texture. Oily skin is typified by shininess, blemishes and pimples.[1] The
oily-skin type is not necessarily bad, since such skin is less prone to wrinkling, or other signs
of aging,[1] because the oil helps to keep needed moisture locked into the epidermis
(outermost layer of skin).

The negative aspect of the oily-skin type is that oily complexions are especially susceptible to
clogged pores, blackheads, and buildup of dead skin cells on the surface of the skin.[1] Oily
skin can be sallow and rough in texture and tends to have large, clearly visible pores
everywhere, except around the eyes and neck.[1]

Permeability
Human skin has a low permeability; that is, most foreign substances are unable to penetrate
and diffuse through the skin. Skin's outermost layer, the stratum corneum, is an effective
barrier to most inorganic nanosized particles.[25][26] This protects the body from external
particles such as toxins by not allowing them to come into contact with internal tissues.
However, in some cases it is desirable to allow particles entry to the body through the skin.
Potential medical applications of such particle transfer has prompted developments in
nanomedicine and biology to increase skin permeability. One application of transcutaneous
particle delivery could be to locate and treat cancer. Nanomedical researchers seek to target
the epidermis and other layers of active cell division where nanoparticles can interact directly
with cells that have lost their growth-control mechanisms (cancer cells). Such direct
interaction could be used to more accurately diagnose properties of specific tumors or to treat
them by delivering drugs with cellular specificity.

Nanoparticles

Nanoparticles 40 nm in diameter and smaller have been successful in penetrating the skin.[27]
[28][29]
Research confirms that nanoparticles larger than 40 nm do not penetrate the skin past
the stratum corneum.[27] Most particles that do penetrate will diffuse through skin cells, but
some will travel down hair follicles and reach the dermis layer.

The permeability of skin relative to different shapes of nanoparticles has also been studied.
Research has shown that spherical particles have a better ability to penetrate the skin
compared to oblong (ellipsoidal) particles because spheres are symmetric in all three spatial
dimensions.[29] One study compared the two shapes and recorded data that showed spherical
particles located deep in the epidermis and dermis whereas ellipsoidal particles were mainly
found in the stratum corneum and epidermal layers.[30] Nanorods are used in experiments
because of their unique fluorescent properties but have shown mediocre penetration.

Nanoparticles of different materials have shown skins permeability limitations. In many

experiments, gold nanoparticles 40 nm in diameter or smaller are used and have shown to
penetrate to the epidermis. Titanium oxide (TiO2), zinc oxide (ZnO), and silver nanoparticles
are ineffective in penetrating the skin past the stratum corneum.[31][32] Cadmium selenide
(CdSe) quantum dots have proven to penetrate very effectively when they have certain
properties. Because CdSe is toxic to living organisms, the particle must be covered in a
surface group. An experiment comparing the permeability of quantum dots coated in
polyethylene glycol (PEG), PEG-amine, and carboxylic acid concluded the PEG and PEG-
amine surface groups allowed for the greatest penetration of particles. The carboxylic acid
coated particles did not penetrate past the stratum corneum.[30]
Increasing permeability

Scientists previously believed that the skin was an effective barrier to inorganic particles.
Damage from mechanical stressors was believed to be the only way to increase its
permeability.[33] Recently, however, simpler and more effective methods for increasing skin
permeability have been developed. For example, ultraviolet radiation (UVR) has been used to
slightly damage the surface of skin, causing a time-dependent defect allowing easier
penetration of nanoparticles.[34] The UVRs high energy causes a restructuring of cells,
weakening the boundary between the stratum corneum and the epidermal layer.[34][35] The
damage of the skin is typically measured by the transepidermal water loss (TEWL), though it
may take 35 days for the TEWL to reach its peak value. When the TEWL reaches its highest
value, the maximum density of nanoparticles is able to permeate the skin. Studies confirm
that UVR damaged skin significantly increases the permeability.[34][35] The effects of increased
permeability after UVR exposure can lead to an increase in the number of particles that
permeate the skin. However, the specific permeability of skin after UVR exposure relative to
particles of different sizes and materials has not been determined.[34]

Other skin damaging methods used to increase nanoparticle penetration include tape
stripping, skin abrasion, and chemical enhancement. Tape stripping is the process in which
tape is applied to skin then lifted to remove the top layer of skin. Skin abrasion is done by
shaving the top 5-10 micrometers off the surface of the skin. Chemical enhancement is the
process in which chemicals such as polyvinylpyrrolidone (PVP), dimethyl sulfoxide
(DMSO), and oleic acid are applied to the surface of the skin to increase permeability.[36][37]

Electroporation is the application of short pulses of electric fields on skin and has proven to
increase skin permeability. The pulses are high voltage and on the order of milliseconds when
applied. Charged molecules penetrate the skin more frequently than neutral molecules after
the skin has been exposed to electric field pulses. Results have shown molecules on the order
of 100 micrometers to easily permeate electroporated skin.[37]

Applications

A large area of interest in nanomedicine is the transdermal patch because of the possibility of
a painless application of therapeutic agents with very few side effects. Transdermal patches
have been limited to administer a small number of drugs, such as nicotine, because of the
limitations in permeability of the skin. Development of techniques that increase skin
permeability has led to more drugs that can be applied via transdermal patches and more
options for patients.[37]

Increasing the permeability of skin allows nanoparticles to penetrate and target cancer cells.
Nanoparticles along with multi-modal imaging techniques have been used as a way to
diagnose cancer non-invasively. Skin with high permeability allowed quantum dots with an
antibody attached to the surface for active targeting to successfully penetrate and identify
cancerous tumors in mice. Tumor targeting is beneficial because the particles can be excited
using fluorescence microscopy and emit light energy and heat that will destroy cancer cells.
[38]

Sunblock and sunscreen

Sunblock and sunscreen are different important skin-care products though both offer full
protection from the sun.[39][40]

SunblockSunblock is opaque and stronger than sunscreen, since it is able to block most of
the UVA/UVB rays and radiation from the sun, and does not need to be reapplied several
times in a day. Titanium dioxide and zinc oxide are two of the important ingredients in
sunblock.[41]

SunscreenSunscreen is more transparent once applied to the skin and also has the ability to
protect against UVA/UVB rays, although the sunscreen's ingredients have the ability to break
down at a faster rate once exposed to sunlight, and some of the radiation is able to penetrate
to the skin. In order for sunscreen to be more effective it is necessary to consistently reapply
and use one with a higher sun protection factor.

Diet

Vitamin A, also known as retinoids, benefits the skin by normalizing keratinization,

downregulating sebum production which contributes to acne, and reversing and treating
photodamage, striae, and cellulite.

Vitamin D and analogs are used to downregulate the cutaneous immune system and epithelial
proliferation while promoting differentiation.

Vitamin C is an antioxidant that regulates collagen synthesis, forms barrier lipids, regenerates
vitamin E, and provides photoprotection.

Vitamin E is a membrane antioxidant that protects against oxidative damage and also
provides protection against harmful UV rays. [42]

Several scientific studies confirmed that changes in baseline nutritional status affects skin
condition. [43]

The Mayo Clinic lists foods they state help the skin: yellow, green, and orange fruits and
vegetables; fat-free dairy products; whole-grain foods; fatty fish, nuts.[44]

See also
Acid mantle

Anthropodermic bibliopegy

Artificial skin

Callus, thick area of skin

List of cutaneous conditions

Cutaneous structure development

 Fingerprint, skin on fingertips

Hyperpigmentation, about excess skin color

Intertriginous

Meissner's corpuscle

Pacinian corpuscle

Polyphenol antioxidant

Skin lesion

Skin repair

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