CUTANEOUS SENSATION

Group members
Singh Aatmika
Sogaang Christian M
Solagan Emigel C
Tandoc Mark Harold
Tharakaew Nattawut
Tasupalli Vijay Kumar
Thapa Deepika
Thennakoon Aiyshwini
• The sensory quality of skin.
DEFINITION
• The skin consists of two main layers, the
epidermis and the dermis.
• Sensory receptors in or beneath the skin
are peripheral nerve-fiber endings that are
differentially sensitive to one or more forms
of energy.
• The sensory endings can be loosely
categorized into three morphological
groups: endings with expanded tips, such as •
Merkel's disks found at the base of the
epidermis; encapsulated endings, such as
Meissner's corpuscles (particularly plentiful
in the dermal papillae), and other organs
located in the dermis or subcutaneous
tissue, such as Ruffini endings, Pacinian
corpuscles, Golgi-Mazzoni corpuscles, and
Krause's end bulb; and bare nerve endings
that are found in all layers of the skin (some •
of these nerve endings are found near or
around the base of hair follicles).
• There is a remarkable relationship between
the response specificities of cutaneous
receptors and five primary qualities of
cutaneous sensation, the latter commonly
described as touch-pressure
(mechanoreceptors), cold and warmth
(thermoreceptors), pain, and itch.
• Each quality is served by a specific set of
cutaneous peripheral nerve fibers.
More complex sensations must result from
an integration within the central nervous
system of information from these sets of
nerve fibers.
• Exploration of the skin surface with a
rounded metal point reveals that there exist
local sensory spots on the skin, stimulation
of which evokes only one of the five
qualities of sensation.
Thus, there may be plotted maps of
pressure, warm, cold, pain, or itch spots
Receptor types and functions

Cutaneous Receptors (Fine Touch)

Meissner’s Corpuscles Light Touch, Vibration Mechanoreceptor

Merkel’s Discs Pressure, point localization and 2-point discrimination. Mechanoreceptor

Hair Follicle Endings Hair movement and direction Mechanoreceptor

Pacinian Corpuscles Deep touch and vibration Mechanoreceptor

Ruffini Endings Deep pressure and stretch of skin Mechanoreceptor

Cutaneous Receptors (Course touch)

Free Nerve Endings Crude touch, tickle, itch and pressure Mechanoreceptor

Cutaneous Receptors (Temperature)

Free Nerve Endings Warm (hot) and cold Thermoreceptor

Cutaneous Receptors (Pain)

Free nerve endings Pain and extremes of sensation Nociceptor (thermal, chemical or mechanical)

Musculoskeletal Receptors (Proprioception)

Muscle Spindles Change in length of muscle and velocity Mechanoreceptor

of change in length of muscle

Golgi Tendon Organs Muscle tension Mechanoreceptor

Joint Receptors (Ruffini endings, Paciniform corpuscles and ligament Joint position at end ranges, joint Mechanoreceptor
receptors) movement and ligament tension

Musculoskeletal Receptors (Pain)

Free nerve endings (multiple) Pain and extremes of sensation Nociceptor (thermal, chemical or mechanical)
Spatial Properties
Deep receptors: RA2 fibers (Pacinian corpuscle)and Ruffini (SA2) have large
receptive fields and respond to high vibration rates.
Surface receptors: Merkel receptors (SA1) and Meissner receptors (RA1)
have small receptive fields and respond to slow vibration rates.
Adapting Rate

Slow Rapid
Merkel receptors (SA1) Meissner receptors (RA1)

Ruffini (SA2) Pacinian corpuscle (RA2)

Surface receptors have smaller receptive fields than deep receptors:
The Medial Lemniscal and Spinothalamic Pathways
Nerve fibers from receptors in the skin travel to the spinal cord in bundles
called peripheral nerves.
They enter the spinal cord through the dorsal root, and then move up the spinal cord in two
major pathways:
1. The medial lemniscal pathway and the spinothalamic pathway. The two pathways serve
different functions.
2. The lemniscal pathway has large fibers that carry signals related to proprioception (sensing
the position of limbs) and touch.
The spinothalamic pathway has smaller fibers and carries signals related to temperature and
pain. As shown below,
the nerve fibers in both pathways cross to the other side of the body as they travel up the
spinal cord to the thalamus.
Like vision, the somatosensory system is organized in contralateral fashion:
the signals sent from the right side of the body end up in the left hemisphere and signals
from the left side enter the right hemisphere.
Most of the nerve fibers synapse in the ventral posterior nucleus in the thalamus; some,
however, synapse in other thalamic nuclei.
 From the thalamus, signals move on to the somatosensory receiving area (S1) and possibly
the secondary somatosensory cortex (S2)
Signals also travel from S1 to S2 as well as from S1 and S2 to other somatosensory areas.

The Somatosensory Cortex

• Signals travel from the thalamus to the somatosensory receiving area (S1) and the
secondary receiving area (S2) in the parietal lobe.
• Body map (homunculus) on the cortex in S1 and S2 shows more cortical space
allocated to parts of the body that are responsible for detail.
• Plasticity in neural functioning leads to multiple homunculi and changes in how
cortical cells are allocated to body parts.
 DISORDERS-
Cutaneous sensory disorder (CSD) represents a heterogeneous clinical situation where the
patient presents with either disagreeable skin sensations
(ie, itching, burning, stinging) or pain (ie, allodynia) and/or negative sensory symptoms (ie,
numbness, hypoaesthesia).
These patients have no apparent diagnosable dermatologic or medical condition that explains
the cutaneous symptom, and typically have negative findings upon medical workup.
Skin regions that normally have a greater density of epidermal innervation tend to be more
susceptible to the development of CSD.
CSDs can affect any body region but generally tend to be confined to the face, scalp and
perineum, and have been referred to in the literature with region-specific terms such as burning
mouth syndrome, glossodynia and vulvodynia. Symptoms such as pruritus with unexplained
hyperhidrosis may occur during sleep, as a result of heightened sympathetic tone. Sleep
deprivation and insomnia can play a moderating role in CSD.
Somatization and dissociation can play a central role in the pathogenesis of CSDs.
A review of the literature suggests that CSDs represent a complex,
and often poorly understood interplay between neurobiological factors associated with
neuropathic pain, neuropathic itch and neurologic/neuropsychiatric states (eg, radiculopathies,
stroke, depression and posttraumatic stress disorder).
These neurologic/neuropsychiatric states can modulate pain and itch perception by potentially
affecting the pain and itch pathways at a structural and/or functional level.
Skin Anatomy
The skin is composed of several layers
. The very top layer is the epidermis and is the layer of skin you
can see. In Latin, the prefix “epi-” means “upon” or “over.”
So the epidermis is the layer upon the dermis (the dermis is the
second layer of skin). Made of dead skin cells,
the epidermis is waterproof and serves as a protective wrap for
the underlying skin layers and the rest of the body
. It contains melanin, which protects against the sun's harmful
rays and also gives skin its color.
When you are in the sun, the melanin builds up to increase its
protective properties, which also causes the skin to darken.
The epidermis also contains very sensitive cells called touch
receptors that give the brain a variety of information
about the environment the body is in.
The second layer of skin is the dermis. The dermis contains hair follicles, sweat
glands, sebaceous (oil) glands, blood vessels, nerve endings, and a variety of
touch receptors. Its primary function is to sustain and support the epidermis by
diffusing nutrients to it and replacing the skin cells that are shed off the upper
layer of the epidermis. New cells are formed at the junction between the dermis
and epidermis, and they slowly push their way towards the surface of the skin so
that they can replace the dead skin cells that are shed. Oil and sweat glands
eliminate waste