Você está na página 1de 52

Anatomy & Physiology

of

The Skin

7/2/2012

Basic Science of the Epidermis


The skin is composed of the 3 primary layers: Epidermis, Dermis & Subcutaneous Each layer specific characteristics & functions The Epidermis ->most superficial layer plays important role from a cosmetic standpoint gives the skins texture, moisturize and color
7/2/2012 2

Basic Science of the Epidermis


Knowledge of the basic structure of the Epidermis best enables a practitioner to improve the appearance of patients skin In the future, study of these components is likely to lead to an enhanced understanding of skin aging and the effects of topical products on the biological function of the skin
7/2/2012 3

The Keratinocyte
Also known as corneocytes Born at the base of the epidermis at the dermal-epidermal junction / DEJ Produced by stem-cells, and slowly move to the top These process of cells maturing and moving to the top is called keratinization
7/2/2012 4

The Keratinocyte
As the cells move through the epidermis and mature, they develop different characteristics The layers of the epidermis are named for these characteristic traits : Basal layer, Spinous layer, Granular layer and Stratum Corneum

7/2/2012

The Keratinocyte
As keratinocytes migrate through the layers of the epidermis, their contents and functions change according to or depending on the specific epidermal layer in which they are moving

7/2/2012

The Basal Layer


Located at the base of the epidermis Basal Cells are cuboidal in shape Produced by stem cells When the stem cells divide, they create daughter cells, which is slowly move to the top of epidermis Basal cells join with other basal called Hemidesmosome and overlying spinous cells via Desmosomes to form the basement membrane
7/2/2012 7

The Basal Layer


These basal keratinocytes contain keratines 5 and 14, mutations that result in an inherited disease called epidermolysis bullosa. Responsible for maintaining the epidermis by continually renewing the cell population.

7/2/2012

The Basal Layer


10 percent of cells are stem cells, 50 percent are amplifyng cells, and 40 percent are postmitotic cells that move superficially superbasal cells. It is worth noting that basal cells produce bullous pemphigoid antigens, which are proteins that lead to the development of bullous pemphigoid disease, if the body produces corresponding antibodies. Contains melanocytes that produce melanin
7/2/2012 9

The Spinous Layer


Have prominent spiny attachments called desmosomes. Keratins 1 and 10 are first seen in this layer of suprabasal keratinocytes. This keratins form a more rigid cytoskleleton that provides a greater mechanical strength to the cell.

7/2/2012

10

The Spinous Layer


Lamellar granules- which are considered the first sign of keratinization- first appear in this layer. These granules contain lipids such as ceramides, cholesterol, and fatty acids, as well as enzymes such as proteases, acid phosphatase, lipases, and glycosidases.
7/2/2012 11

The Spinous Layer


Lamellar granules migrate to the surface and expel their contents by exocytosis. The lipids that are released coat the surface to provide barrier-like properties. Desmosomes are very prominent in this layer, thus accounting for the name spinous layer.

7/2/2012

12

The Granular Layer


Contain visible keratohyaline granules. The uppermost viable layer of the epidermis. The granules represent keratohyaline granules, which contain profilaggrin, the precursor to fillagrin. Filaggrin cross-links keratin filaments, providing strength and structure.
7/2/2012 13

The Horny Layer / SC


Stratum corneum, a condensed mass of cells that have lost their nuclei and granules. Covered by cell envelope, which aids in providing a barrier to water loss and absorption of unwanted materials. The Corneocytes that reside in this layer are the most mature and have completed the keratinization process.

7/2/2012

14

The Horny Layer


These Corneocytes have no organelles, and their arrangement resembles a brick wall. Composed of protein-rich corneocytes embedded in a bilayer lipid matrix arranged in a brick and mortar fashion. The bricks are composed of corneocytes, and the mortar is composed of the contents extruded from the lamellar granules, including lipids and proteins.
7/2/2012 15

The Horny Layer


The stratum corneum is described as the dead layer of cells do not demonstrate protein synthesis and unresponsive to cellular signaling. The function : protective barrier to prevent transepidermal water loss (TEWL). Amino acids and their metabolites, which by products formed from the breakdown of filaggrin, make up a substance known as the natural moisturizing factor (NMF).
7/2/2012 16

The Horny Layer


NMF and lipids released by the lamellar granules play an important role in skin hydration, suppleness, and flexibility.

7/2/2012

17

The Cell Cycle


The above keratinization process is also referred to as the cell cycle. Normal cell cycle of the epidermis : 26- 42 days. = desquamation, normally occurs invisibly with shedding of individual cells or small clumps of cells. Disturbances of this process accumulation of partially detached keratinocytes clinical findings of dry skin

7/2/2012

18

The Cell Cycle


Disease states may also after the cell cycle. For example, psoriasis dramatic shortening of the cell cycle formation of crusty cutaneous eruptions. In aging : cell cycle lengthens in time cells at the superficial layer of the stratum corneum (SC) are older and their function may be empaired. Many cosmetic products such as retinol and hydroxy acids are believed to quicken the pace of the cell cycle, leading to younger keratinocytes at the superficial layers of SC.
7/2/2012 19

Moisturization of the Stratum Corneum


A main function of the SC is to prevent TEWL by regulating the water balance in the skin. Two major components : lipids and the NMF.

7/2/2012

20

Natural Moisturizing Factor


Released by thelamellar granules, NMF is composed of amino acids and their metabolits products formed from the breakdown of filaggrin. NMF found exclusively inside the cells of SC gives SC its humectant (water-binding) qualities. NMF is made of very water-soluble chemicals can absorb amounts of water, even when humidity levels are low enable SC to retain a high water content even in a dry environment. The NMF also provides an important aqueous environment for enzymes that need such an environment to function.
7/2/2012 21

Natural Moisturizing Factor


The importance of NMF is clear when one notes that ichthyosis vulgaris patients, who lack NMF, demonstrate severe dryness and scaling of the skin. Normal skin that is exposed to normal soap washing has significantly lower levels of NMF when compared to normal skin not washed with surfactants. Levels of NMF also decline with age increased incidence of dry skin in the elderly population.
7/2/2012 22

Lipids
In order of abundance, the composition of skin surface lipids includes triglycerides, fatty acids, squalene, wax esters, diglycerides, cholesterol esters, and cholesterol. Important part of the epidermis and are involved in preventing TEWL and the entry of harmful bacteria. Prevent the skin from absorbing water-soluble agents.
7/2/2012 23

Lipids
For decades it has been known that the absence of lipids in the diet leads to unhealthy skin. Inherited defects in lipid metabolism, such as the deficiency of steroid sulfatase seen in X-linked ichthyosis abnormal skin keratinization and hydration. Stratum corneum lipids are affected by age, genetics, seasonal variation, and diet.
7/2/2012 24

Lipids
Deficiency of these lipids predisposes the individual to dry skin. This was demonstrated in mice with essential fatty acids deficiency (EFAD) that, when fed a diet deficient in linoleic acid, developed increased TEWL. Interestingly, administration of hypocholesterolemic drug is also associated with dry skin changes.
7/2/2012 25

Lipids
Skin lipids are produced in and extruded from lamellar granules as described above, or are produced in sebaceous glands and then excreted to the skins surface through the hair follicle. The excretion of sebum by sebaceous glands is hormonally controlled. Lipids help keep the NMF inside the cells keep cells hydranated and aqueous enzymes. Lipids can influence enzyme function.
7/2/2012 26

Role of Lipids in TEWL


The major lipids found in the SC that contribute to the water permeability barrier are ceramides, cholesterol, and fatty acids. Since 1940s, when the stratum corneum was first identified as the important barrier to water loss, many hypotheses have been entertained as to exactly which lipids are important in the SC. The research with the EFAD mice described above led many to focus on phosphelipids because they contain linoleic acids.
7/2/2012 27

Role of Lipids in TEWL


However, it was later found that phospholipids are almost completely absent from the SC. In 1982, ceramide 1 discovered. This lipid compound is rich in linoleic acid play a major role in structuring SC lipids essential for barrier function. Later five more distinct types of ceramides were discovered and named according to the polarity of the molecule. Ceramide 1 is the most nonpolar and ceramide 6 is the most polar.
7/2/2012 28

Role of Lipids in TEWL


Although the ceramides were once thought to be the key to skin moisturization, studies now suggest that no lipid is more important than any other lipid. The most important parameter : ratio of fatty acid, ceramides, and cholesterol. This is demonstrated in a study that showed that after altering the water barrier with acetone, the application of ceramides, fatty acids, and cholesterol resulted in normal barrier recovery.
7/2/2012 29

Role of Lipids in TEWL


Application of each of the separate entities alone resulted in delayed barrier recovery. Many products on the market contain ceramides or a mixture of ceramides, cholesterol, and fatty acids. However, the use of these mixtures to treat atopic dermatitis and other ichthyotic disorders has been disappointing.
7/2/2012 30

Summary
The epidermis is implicated in many of the skin complaints of cosmetic patients. It is the state of the epidermis that causes skin to feel rough and appear dull. A flexible, well-hydrated epidermis more supple and radiant than a dehydrated epidermis. The popularity of buff puffs, exfoliating scrubs, masks, moisturizers, chemical peels, microdermabrasion attests to the obsession that cosmetic patients have with condition of their epidermis
7/2/2012 31

Summary
It is important to understand the properties of the epidermis in order to understand which cosmetic products and procedures can truly benefit patients as opposed to those that are based on myth or hype.

7/2/2012

32

BASIC SCIENCE OF THE DERMIS


The dermis lies between the epidermis and the subcutaneous fat responsible for the thickness of the skin cosmetic appearance. The thickness of the dermis varies over different parts of the body and doubles between the ages of three and seven years old and again at puberty.
7/2/2012 33

BASIC SCIENCE OF THE DERMIS


With aging decreases in thickness and moisture. The dermis, which is laden with nerves, blood vessels, and sweat glands, consists mostly of collagen. The uppermost portion of this layer lies beneath the epidermis papillary dermis The lower portion the reticular dermis.
7/2/2012 34

BASIC SCIENCE OF THE DERMIS


Smaller collagen bundles, greater cellularity, and a higher density in its vascular elements characterize the papillary dermis as compared to the reticular dermis. Fibroblasts the primary cell type in the dermis produce collagen, elastin, other matrix proteins, and enzymes such as collagenase and stromelysin.
7/2/2012 35

BASIC SCIENCE OF THE DERMIS


Immune cells such as mast cells, Langerhans cell , polymorphonuclear leukocytes (PMNs), lymphocytes, and macrophages are also present in the dermis. Junction epidermis - dermis --> dermal-epidermal junction (DEJ). Attachment proteins found in the basement membrane of the DEJ.
7/2/2012 36

Collagen
One of the strongest natural proteins durability & resilience characteristics of skin. The focus of much anti aging research and the target of many skin products and procedures. The importance of collagen is emphasized in the literature regarding many of the topical agents that claim to increase collagen syntheses, such as glycolic acid and ascorbic acid.
7/2/2012 37

Collagen
Resurfacing techniques (CO2 laser and dermabrasion) change collagen structure improving skin texture. Various forms of collagen are injected into the dermis to replace damaged collagen and to reverse the signs of aging. Topical retinoids reduce the collagen damage that occurs due to sun exposure.
7/2/2012 38

Collagen
A complex family of 18 proteins, 11 dermis. Always seen in the final, mature, state of assembly as opposed to elastin, whose immature fibers are seen in the superficial dermis and whose more mature fibers are found in the deeper layer of dermis. Each type of collagen is composed of three chains.
7/2/2012 39

Collagen is synthesized in the fibroblasts in a precursor form called procollagen. TYPES of Collagen in Dermis : - Type 1 : 80 -85% of dermal matrix responsible for the tensile strength of dermis in photoaged skin after dermabrasion
7/2/2012 40

Collagen

Collagen
Types of Collagen : - Type III : 10-15% of dermal matrix smaller than type I skin pliability fetal collagen predominates in embryonic life around blood vessels & beneath epidermis
7/2/2012 41

Collagen
Types of Collagen : - Type IV : forms a structure lattice in the basement zone - Type V : 4-5% dermal matrix - Type VII : makes up the anchoring fibrils in the DEJ - Type XVII : in the hemidesmosome
7/2/2012 42

Collagen
Types of Collagen : Important in genetic diseases Ex : Scarcity of type VII abnormalities in anchoring fibrils Dominant Dystrophic Epidermolysis Antibody to Type VII Epidermolysis Bullosa Acquisita (EBA) Loss of anchoring fibrils (Type VII) weakened bond dermis-epidermis wrinkle
7/2/2012 43

ELASTIN
Found at the periphery of collagen bundles & endow the skin with recoil properties Assembled on bundles of microfibrils composed of fibrillin Fibrillin forms a template deposited of elastin Sun exposure elastin degrades amorphous substance in dermis ELASTOSIS (hallmark of photoaged skin)
7/2/2012 44

Elastin
Damage to elastin fibers decreased skin elasticity Defect / damage to elastin wrinkles WRINKLED SKIN SYNDROME child with deficiency of elastin fibers Elastin fibers present in various levels of maturity.
7/2/2012 45

Glycoproteins (GP)
influence cell migration, adhesion & orientation Fibronectin & Tenascin most relevant GPs in dermis Fibronectin : filamentous GP mediates platelet binding to collagen, development of granulation tissue & reepithelialization

7/2/2012

46

Glycoprotein
Tenascin : found only in the papillary dermis in adult skin significant role in tissue remodelling & important in wound healing following cosmetic procedures

7/2/2012

47

Glycosaminoglycans (GAGs)
polysaccharide chains composed of repeating disaccharide units -> linked to a core protein Bind water avidly maintenance of salt & water balance Found in areas with a fibrous matrix cells are closely associated but have little space for free movement
7/2/2012 48

Glycosaminoglycans (GAGs)
The most abundant GAGs in dermis : Hyaluronic acid (HA) and dermatan sulfate HA : - important in cell growth, membrane receptor function & in adhesion - appears freely in dermis : Young skin : periphery of collagen & elastin fibers & at interface of these fibers Aged skin : no connection -Popular in cosmetic products humectant
7/2/2012 49

Hypodermis
Hypodermis = Subcutis Located beneath dermis Composed : Fat (mostly) important energy source for the body Contains : collagens type I, III,V Aged skin : subcutaneous fat is lost or redistributed into undesired area
7/2/2012 50

SUMMARY
Epidermis is the target of most topical cosmetic products Dermis is the target for injectable treatment for aging Dermis is an extremely important component in skin appearance responsible for giving skin thickness & suppleness
7/2/2012 51

SUMMARY
Thinner dermis & altered junction between epidermis dermis hallmarks of aged skin Loss of collagen, elastin & GAGs located primarily in the dermis cutaneous aging

7/2/2012

52