Skin Notes for Exam 2

Skin I.

Skin: an organ or a system (integumentary system) covers entire outer surface of body A. Components of skin and underlying tissues 1. Epidermis: keratinized stratified squamous epithelium 2. Basement membrane 3. Dermis (corium) or true skin: thick layer of connective tissue containing collagenous and elastic fibers; composed of two layers (papillary and reticular) 4. Subcutaneous tissue (hypodermis or superficial fascia) a. Not part of the skin b. Composed of areolar tissue and large amounts of adipose tissue c. Connects the dermis to muscle, cartilage or bone d. Clinical points 1. Cellulitis and erysipelas: wide spread inflammation of HYPODERMIS caused by bacterial infections (streptococcal or staphylococcal); complication of wound healing; erysipelas associated with face 2. Edema: excessive fluid accumulation in areolar tissue of hypodermis; associated with inflammation B. Epidermis 1. Structure (bottom to top) a. Stratum basale: single layer of cuboidal cells; occurs in waves because of the shape of the underlying papillary layer of the dermis 1. Mitosis: occurs constantly; as new cells are produced, old cells move upward into higher strate (layers) 2. Merkels cells (discs): connect to sensory nerve endings; sensitive to light touch 3. Melanocytes: interspersed in s. basale; some present in s. spinosum a) Produce melanin (black pigment) 1) Protects s. basale against ultraviolet radiation in sunlight 2) Responsible for color of skin (black, brown, tallow, white); albinos do not produce melanin 4. Clinical note: layer that produces most common skin cancer (basal cell carcinoma) b. Stratum spinosum: lies above s. basale 1. Mitosis: occurs here sparingly 2. Change in cell shape: become spiny 3. Langerhans cells (dendritic cells or macrophages): react to antigens that cross broken skin and initiate immune responses c. Stratum granulosum: cells begin to flatten and die here 1. Cells die because there are NO BLOOD vessels in epidermis; cells have migrate too far away from source of nutrition (blood vessels in dermis) 2. Keratohyaline (protein): present in cytoplasmic granules in large quantitites

Skin Notes for Exam 2

d. Stratum lucidum: multiple layers of dead flattened cells 1. Found only in thick skin or thick epidermis; (palms, soles, calluses, and bunions) 2. Eleidin: converted from keratohyaline in thick regions of skin associated with relatively constant pressure e. Stratum corneum: multiple layers of flattened dead cells 1. Keratin (protein): converted from eleidin or keratohyaline; main component of this later binds dead cells together and forms a waterproof covering for the epidermis 2. Desquamation: occurs here; portions of s. corneum flake off (usually imperceptible); massive desquamation occurs after sunburn 2. Comparison of thick and thin epidermis a. Thick: contains 5 layers with overall greater dimensions b. Thin: contains 4 layers with overall smaller dimensions (no s. lucidum) C. Dermis 1. Structure a. Papillary layer: made of . (papillae) and grooves; gives s. basale its wavy shape 1. Papillae responsible for finger, palm, and sole prints 2. Contains collagenous and elastic fibers b. Reticular layer 1. Makes up 80% of dermis 2. Bundles of elastic and white fibers present in a network 2. Functions a. Supports and nourishes epidermis and its appendages (hair follicles, nails, and glands of the skin) b. Elastic fibers allow for resiliency (stretch skin and it rebounds to its normal position) 1. Overstretching and damage: tears elastic fibers then are replaced with collagenous fibers forming a linear scar (striae albicantes or stretch marks i. Causes: pregnancy, obesity, and ascites 3. Components of the dermis a. Nerves and sensory organs b. Blood vessels: very abundant c. Lymphatic vessels: very abundant d. Smooth muscle (arrector pili or piloerector) e. Epidermal appendages: structures derived from epidermis but are located in dermis 1) Nails 2) Hair and hair follicles 3) Cutaneous glands a) Sebaceous (oil) b) Ceruminous (wax) c) Sudoriferous (sweat) 4. Epidermal appendages a. Fingernails and toenails 1) Structure

Skin Notes for Exam 2

a) Nail body: hard visible part b) Nail root: portion of nail body under cuticle c) Nail bed: below nail body; region of non-growing epidermis d) Nail matrix: growth region of epidermis under nail root; includes lunule or lunula at base of nail body region e) Clinical note: clubbing of fingernails can indicate constant lack of oxygen in blood b. Hair and hair follicle 1) Hair follicle: hollow tube of s. basale; invaginates into dermis 2) Hair bulb: expanded base of hair follicle; contains hair cells or hair matrix 3) Hair papilla or dermal papilla: invagination at base of hair bulb a) Contains capillaries: supply growing hair cells with nutrients 4) Hair: hair cells divide and die as they move up the hair follicle away from hair bulb; keratin added to lengthening hair a) Root: in follicle; shaft: part we see c. Arrector pili or piloerector muscles (smooth, involuntary muscle) 1) Attached from basement membrane to side of hair follicle 2) Stimuli for contraction: cold temperature (usually), emotional distress; muscle pulls hair follicle vertically producing goose bumps d. Sebaceous glands (holocrine glands) 1) Locations: found over most of body surface; associated with hair follicles; most numerous over face and scalp 2) Secretion: sebum (oil) secreted into hair follicle; keeps hair pliable; spreads over epidermis; lubricates skin and prevents bacterial growth 3) Meibomian glands: special sebaceous glands NOT associated with hair follicles; open on upper and lower eyelids where eye lashes originate e. Sweat (sudoriferous) glands: some apocrine; most merocrine 1) Locations: most numerous over forehead, palms, and sole (merocrine); those in axillary and anogenital regions (apocrine) 2) Secretory portion located in dermis (dead end, coiled tube) 3) Myoepithelial cells: surround secretory portion; force movement of sweat up the duct to skin surface 4) Ducts: open at skin surfaces as pores for merocrine sweat glands; open into hair follicles for apocrine sweat glands 5) Sweat: watery secretion that contains: water, NaCl, other salts, and urea; it is hypotonic to blood plasma f. Ceruminous glands (apocrine) 1) Location: external auditory meatus or external ear canal ONLY 2) Secretion: cerumen that combines with sebum and deal epidermal cells which produce a wax-like material D. Functions of skin

Skin Notes for Exam 2

1. Protection a. Physical barrier: protects deep tissues against physical, chemical, and thermal damage b. Against bacterial infection c. Against water and electrolyte uptake from environment d. Against dehydration e. Against ultraviolet radiation 2. Sensory detector: can detect stimuli from outside the body because of sensory receptors located mostly in the dermis and one in the epidermis a. Light touch b. Deep pressure c. Heat d. Cold e. Pain 3. Thermoregulation: maintenance of core body temperature (98.6 F or 37 C) with range of 97-99 F or 37-38 C a. Superficial body temperature: is near ambient (temp outside body at surface of skin) b. Sources of body heat 1) All metabolic reactions in cells 2) All reactions related to muscle contraction c. Body heat loss mechanisms (physical processes) 1) Radiation: transfer of heat from one object of a higher temp to another of a lower temp without actual contact btw the 2 objects 2) Evaporation a) Heat energy of body warms water of ECF b) Water of ECF is vaporized from the respiratory tract or from sweat at the skin surface c) Water vapor loss from either source carries thermal energy (heat) away from the body 3) Conduction: heat loss from the body by direct contact with and object of lower temp d. Control of body temp: physiological mechanisms 1) Hypothalamus: contains a region called the human thermostat; it contains heat loss and heat gain centers a) Centers are most sensitive to temp of blood flowing through them and they also receive stimuli from temp receptors in the dermis 2) Heat loss mechanism: if temp of blood rises above normal, heat loss center activated; causes arterioles (blood vessels) in dermis to dilate and those in internal organs to constrict; result is an increased heat loss through skin by radiation; if external ambient temp is above 85 F heat loss center, in addition, stimulates sweat glands to secrete sweat; this represents a heat loss by evaporation; loss of heat by radiation and evaporation reduces blood temp toward normal; then the heat loss center shuts off the heat loss mechanism

Skin Notes for Exam 2

3) Heat gain mechanism: is activated if blood temp drops below normal a) Heat gain center caused arterioles in dermis to constrict and those in internal organs to dilate; less blood flows through the skin so this is a decreased heat loss by radiation or alternatively a heat gain if external ambient temp drops below 66 F b) Non-shivering thermiogenesis occurs: epinephrine and thyroxine are secreted causing increased aerobic respiration; increased metabolism and increased body heat production c) Shivering thermiogenesis: occurs at much lower temps; heat gain center stimulates involuntary skeletal muscle contractions resulting in increased body heat production E. Miscellaneous functions 1. Vitamin D production: UV radiation from sunlight cause conversion of cholesterol into an active form of Vitamin D in epidermal cells (vitamin D production is limited; need more from diet) 2. Excretion: urea from blood plasma is lost in small amounts from sweat 3. Identification of individuals: finger, palm, and sole prints produced by papillae of the dermis; finger prints are specific for all individuals including identical twins F. Clinical aspects and diseases 1. Fungal infections- athletes foot 2. Decubitus ulcers: caused by non-movement and constant pressure on bone-skin surface areas; blood flow thru skin reduced; results in skin and subcutaneous ulcerations a. Reason that immobile patients must be turned in bed from prevention of ulcers 3. Psoriasis: uncontrolled cell division in s. basale of specific body regions (cause unknown, non-malignant) 4. Burns a. First degree 1) Damages epidermis 2) Vasodilation of dermal arterioles (reddening of skin) b. Second degree 1) Damages epidermis, dermis and dermal arterioles 2) Produces blisters c. Third degree 1) Destroys epidermis, dermis down to subcutaneous tissue 2) If extensive (>10% body surface area) person susceptible to: a) Loss body fluids (loss of water, electrolytes, plasma proteins); results in dehydration and possibly hypovolemic shock b) Bacterial infection: of deep body tissues 5. Skin color in various diseases a. Pallor (paleness or blanching): could indicate anemia (lack of red blood cells or hemoglobin) or hypotension (low blood pressure) b. Erythema (redness): due to dilation or arterioles in dermis

Skin Notes for Exam 2

1) Burns 2) Inflammation a) Bacterial infections (cellulitis, erysipelas) b) Fungal infections (athletes foot) c) Allergic reactions: poison ivy d) Irritation: exposure to caustic chemicals (strong acids and bases) e) Autoimmune disease: lupus erythematosus c. Cyanosis: light blue-purple color particularly around lips and under fingernails; indicates lack of oxygen in blood 1) Causes a) Heart disease (cardiac failure) b) Pneumonia c) Cold temp (vasoconstriction of blood vessels in extremities) d. Jaundice: yellow-brown coloration (skin and sclera); too much bile in blood usually indicates liver problems 1) Liver disease a) Cirrhosis, hepatitis, hepatic failure, gall stones 2) Hemolytic disease of the newborn (HDN) a) Result of Rh reaction causing destruction of fetal red blood cells e. Bronzing 1) Occurrence in distal extremities (sun-exposed areas of the skin); mucus membrane around mouth and gums 2) Addisons disease: caused by lack of production of adrenocorticosteroid hormones that in turn cause excessive production and secretion of adrenocorticotrophic hormone (ACTH) from the anterior pituitary gland; ACTH causes excessive production of melanin in epidermis