FISIOLOGI KULIT

Retty Ratnawati
Lab. Fisiologi, FKUB
 PERCEPTION
MODULATION

TRANSMISSION

TRANSDUCTION
FUNGSI SISTIM
INTEGUMEN
1. Lapis pertahanan pertama pada sistim imun
2. Regulasi suhu tubuh
3. Mencegah dan melindungi dari dehidrasi dan
infeksi
4. Memberikan respon terhadap rangsangan: suhu,
raba, tekanan dan rasa nyeri.
5. Ekskresi air, garam, urea (sampah metabolisme
nitrogen)
6. Synthesis Vitamin D3 (esensial untuk absorpsi
Calsium & Phosphor)
ANATOMY INTEGUMEN
 Skin = Cutis = Integument (Integere ~ to cover)
 Surface area: 1.5 ~ 2.0 m2  The largest organ
 Its appearance & thickness are vary:
 The skin of the soles of the feet: 8 mm (thickest)
 The skin of the eyelids : 1 mm (thinnest)

 Its divided into 2 layers:

 The epidermis or cuticle
 The dermis or corium

 The subcutaneous tissue is deep to dermis; sometimes

included as part of anatomy of the skin
R
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• Pacinian corpuscle – vibration

• Meissner’s corpuscle – touch
• Hair-follicle receptor – touch
• Merkel’s disk – pressure
• Tactile disk – pressure
• Ruffini’s corpuscle – pressure
ANATOMY INTEGUMEN
(CONT’D)
 The epidermis is completely cellular
 Organized into 5 layers:
1. Stratum cornium
2. Stratum lucidum
3. Stratum granulosum
4. Stratum spinosum
5. Stratum basale } Stratum germinativum
STRUCTURE OF EPIDERMIS (EPITHELIAL TISSUE)
A. Different Cells of Epidermis
1. Keratinocyte - produce protein "keratin" (structure)
2. Melanocyte - produce "melanin" (pigment)
3. Nonpigmented granular dendrocytes
a. Langerhan's cells
b. Granstein cells both assist in immunity
B. Stratum Corneum
1. Stratified squamous epithilium
2. 25-30 rows of dead keratinized cells
3. Keratinization occurs as cells rise from below
4. Protects against light, heat, bacteria, chemicals
5. Most superficial layer of epidermis
C. Statum Lucidum
1. Present only in thick areas (palms, feet)
2. Contain clear substance called eleidin
3. Eleidin eventually changes into keratin at surface
STRUCTURE OF EPIDERMIS (EPITHELIAL TISSUE)

D. Stratum Granulosum
1. Cells from lower layers begin to die here
2. Contain granules with keratohyalin
3. Keratohyalin is precursor to eleidin and keratin
E. Stratum Spinosum
1. 8-10 rows of polyhedral shaped cells
2. Contain spine-like projections ("spinosum")
F. Stratum Basale (Stratum Germinativum) (germination)
1. Deepest layer of the epidermis
2. Single layer of cuboidal-columnar shaped cells
3. Origin of all cells of epidermis through mitosis
4. Origin of cells for sweat-oil glands and hair
S
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ANATOMY OF SKIN (CONT’D)
 The dermis is subdivided into 2 layers:
1. The Papillary dermis
2. The Reticular dermis
– The papillary dermis contains:
 Blood vessels
 Nerve endings
 Thermo-receptors
 Cryo-receptors
ANATOMY OF SKIN (CONT’D)
 The reticular dermis:
 Connective tissue (fibroblast surrounded by a
matrix): collagen, elastin, & proteoglycans
 Provide the structural support for the skin.

 Dermal appendages: hair follicles & sweat glands

 The crypts of the hair follicle:

 Incontinuity with the epidermis
 Be a source of epidermal regeneration.
ANATOMY OF SKIN (CONT’D)

 The subcutaneous tissue:

 Isdeep to the dermis
 Contains a variety of cells:
 Adipocytes, Fibroblasts, Histiocytes, Plasma
cells, Lymphocytes, and Mast cells.
 Many of them are involved in the processing
of foreign antigen that traumatically
introduced into skin.
THERMAL REGULATION BY THE SKIN
 Heat is transferred from deeper organ and
tissues to the skin.
 Insulator system of the body:
 The skin; subcutaneous tissues & fat.
 Effective in maintaining normal internal core
temperature.
 Radiator system of the body:
 Blood vessels:
Artery  capillaries Veins Venous plexusVein
Artery  Arterio-venous anastomosis
 The rate of blood flow into the venous plexus can
vary tremendously (Almost zero  30 % Cardiac
output).
CONTROL OF HEAT CONDUCTION TO THE SKIN

 By the degree of vasoconstriction of

arterioles and the arteriovenous
anastomoses that supply blood to venous
plexus of the skin
 Vasoconstriction is controlled almost entirely
by the sympathetic nervous system in
response to changes in body core &
environmental temperature.
 Basic Physics of How Heat is Lost from the
Skin: RADIATION, CONDUCTION &
EVAPORATION.
 Epidermis

Dermis
Artery

Veins

Venous
plexus
Subcutane
Artery
ous tissue
Arteriovenous
anastomosis
 Radiation:
 Los of heat in the form of infrared heat rays
 60 %
 Conduction:
 Loss of heat by direct conduction from surface of the
body to solid objects
 3%
 Convection:
 Loss of heat by convection air currents
 15 %
 Evaporation:
 Loss of heat by water evaporation (22 %)
 Evaporation of sweat
 Insensible from the skin & lung
Effect of changes in the environmental temperature on heat conductance
from the body core to the skin surface

Vasodilatation
8

7
(times the vasoconstricted rate)
Heat conductance through skin

Vasoconstriction
1

0
50 60 70 80 90 100 110 120

Environmental temperature oF
EVAPORATION BY THE SKIN
 0.58 Calorie / gram of water that
evaporated (sweat & insensible
evaporation)
 Sweating:
 Sweat gland innervated by cholinergic
sympathetic nerve fibers
 Can also be stimulated by Epinephrine or
Nor-epinephrine
Sensory Receptor in The Skin
TACTILE SENSATION
 There are three principal differences among
TACTILE sensations:
 Touch sensation: Generally results from
stimulation of tactile receptors in the skin or in
the tissues immediately beneath the skin.
 Pressure sensation: Generally results from
deformation of deeper tissues.
 Vibration sensation: Results from rapidly
repetitive sensory signals.
SIX TYPE OF TACTILE RECEPTORS

1. Free Nerve Endings:

• Are found everywhere in the skin & in many
other tissues
• Can detect touch and pressure
2. Meissner’s Corpuscle:
 Are present in the nonhairy parts of the skin
(Glabrous Skin)~ fingertips, lips.
 To discern spatial characteristics of touch
sensation.
 Adapt in a fraction of second
3. Merkel’s discs
 Expanded tip tactile receptors
 Transmit an initially strong but partially
adapting signal  a continuing weaker signal
that adapted slowly
 Play important role in localizing touch
sensation & in determining the texture of what
is felt
4. Hair end-organ:
 Touch receptor
 Adapt readily ~ detects mainly movement of
objects on the skin or initial contact with the
body
5. Ruffini’s end-organs:
 Are multibranched, encapsulated endings
 Adapt very slowly ~ Are important for signaling
continuing state of deformation of the skin & deeper
tissues.
 Also found in joint capsules ~ detects the degree of
joint rotation
6. Pacinian corpuscles:
• Lie both immediately beneath the skin
• Are stimulated only by rapid movement of the tissues
(adapt in a few hundredths of the second
• Are important for detecting tissue vibration or other
rapid changes in mechanical state of the tissues
PAIN & THERMAL RECEPTOR IN THE SKIN

 Pain receptors are Free Nerve Endings

 Three types of stimuli excite pain receptors:
 Mechanical
 Thermal
 Chemical: bradykinin; serotonin; histamin; potassium
ion; acid; acetylcholine & protelytic enzymes
 Adapt very little and sometimes not at all
 Rate of tissue damage as a stimulus for pain
 Tissue ischemia as a cause of pain
 Muscle spasm as a cause of pain
Referred pain
= nyeri
yang dipindahkan
 At least three types of thermal receptor:
 Cold receptor
 Suggested free nerve ending of type C nerve
 Warmth receptors
 Suggested free nerve ending of type Aδ nerve
 Pain Receptors
 Very cold ~ freeze:
 Cold pain fibers become stimulated
 100 – 15 0C:
 Cold-pain impulse ceases  cold receptor begin to
stimulated (reaching peak at 24 0C & fading out at 40
0C)

 30 0C – 49 0C:
 warmth receptors become stimulated
 Arround 45 0C:
 The heat-pain begin to be stimulated + paradoxically
some of the cold fiber begin to stimulated
 Discharge frequencies at different skin temperatures

Warmth receptor Heat-pain

10
Impulse per second

8
Cold receptor
Cold-
pain
6

10 15 20 25 30 35 40 45 50 55 60

Freezing Cold - Cool Indiffer- Warm --- Hot --- Burning

cold - - rent -- - hot

Temperature (0C)
SYNTHESIS OF VITAMIN D3
 Cholecalciferol (vitamin D3) is formed in the skin.
Ultraviolet rays from the sun

7-dehydrocholesterol Cholecaciferol (vit D3)

Liver

25-Hydroxycholecalciferol

Kidney

1,25-Hydroxycholecalciferol
SPECIALIZED CELLS IN THE EPIDERMIS
 Melanocytes
 Produce pigment Melanin
 Responsible for skin color
 Keratinocytes
 Produce keratin
 Generating hair and nails
 Secrete IL-1 influence T cells maturation.
 Langerhans & Granstein cells
 Langerhans: APC to T helper cells
 Granstein: APC to T suppressor cells
 Langerhans cells are more susceptible to damage by
ultraviolet than Granstein
SPECIALIZED CELLS IN THE SUBCUTAN

 They are involved in the processing of

foreign antigen / micro organisms that
traumatically introduced into skin:
1. Histiocytes,
2. Plasma cells,
3. Lymphocytes,
4. Mast cells.
 Skin-Associated Lymphoid Tissue (SALT)
Immune Cells in the Skin

Keratinocytes Langerhans cells Granstein cells

Form outer Process & Process &

protective Generate Secrete present present
keratinized hair & nails IL-1 antigen to antigen to
layer of skin helper T suppressor
cells T cells
Nonimmune function

Influence Facilitate Put

maturation responses “brake” on
of T cells to skin- skin-
that associated activated
localize in antigen immune
the skin responses

Immune function
CONTOH KERUSAKAN KULIT
DERMAL WOUND HEALING
The three principal mechanism of wound healing:
1. Contraction
2. Epithelialization
3. Connective tissue deposition
Types of wound (according to therapeutic
intervention):
1. Primary intention
• To be closed shortly after injury
2. Delayed primary intention
• Are left open for 1 to 2 days and then surgically
closed heal
3. Secondary intention
• It edges remain open heal
 Type of Wound
Healing Mechanism Sutured Open Partial-
(Primary (Secondary Thickness
Intention) intention)
Contraction 0 +++ 0
Epithelialization + + +++
Connective tissue deposition +++ ++ 0

 Temporal sequence of normal healing:

1. Hemostasis
2. Inflamation
3. Proliferation
4. Remodelling
THE HEALING PROCESS : HOW SKIN REPAIRS ITSELF
Superficial and Deep Wound Healing:
A. Superficial Wound Healing - Epidermal Repair
1. Epidermal cells of stratum basale migrate
over area
2. Contact inhibition - cells stop when they
meet
3. Dead cells sluff off (scab) as new cells
replace
B. Deep Wound Healing - Dermal Repair
1. Inflammatory phase - blood clot, fibroblasts
2. Migratory phase - scab forms, epidermal migration
a. Fibroblasts make scar tissue (collagen fibers)
b. Damaged vessels grow into place
c. Granulation tissue - new scar tissue in place
d. Fibroplasia - period of scar formation
i. Hypertrophic scar - normal
ii. Keloid scar - abnormal
3. Proliferative phase - new growth
a. Epithilium grows beneath scab
b. Fibroblasts make random collagen deposit (scar)
c. Blood vessels continue to grow
4. Maturation phase - final healing process
a. Epidermis is restored
b. Fibroblasts disappear, collagen more organized
c. Blood vessels repaired to normal
PENUAAN PADA INTEGUMEN

At birth the skin has not developed a sufficient protective layer, or facilitated the
synthesis of immune cells. The skin is often seen to be transparent, and
therefore is sensitive to damage, and must be protected by extra clothing.

 At puberty, glandular, hair development and immune systems begin to function

at an increased rate, giving extra protection against the adult world.
 During puberty, the skin is very active and vulnerable to sensitisation by
allergens. At age 20 however the skin begins to deteriorate

 Age of 50 is in a rapid state of degradation. Collagen fibres begin to fall apart,

elastic fibres stiffen, and thicken into lumps. This wrinkles the skin. Oil glands
ceases production, and melanin production decreases, leading to pallid colour,
and grey hairs. The keratin cells also cease production and so become thin and
stiff. It heals poorly, after wounding, and becomes susceptible to disease,
cancer, shingles and dermatitis.

 Exposure to ultra violet light will accelerate ageing.

EFEK TESTOSTERONE & ESTROGEN
 Testosterone:
 Increases the thickness of the skin
 Increases the rate of secretion sebaceous gland,
exp: in the face  acne.
 Estrogen:
 The skin develop soft & smooth
 To become more vascular
New Hampshire, USA, 1995