● Stratum Basale: composed of a single layer of

columnar epithelial cells placed on the surface of

Subject: INTEGUMENTARY PT the dermis, and its basal surface has a role to fix
INTEGUMENTARY SYSTEM the epidermis to the dermis

● DERMIS (CORIUM)
The dermis is the layer under the epidermis. It contains
nerve endings, blood vessels, oil glands, and sweat glands.

The Dermis is composed of Two Layers.

● The upper layer is the Papillary Layer also
known as stratum papillarosum, lies below the
epidermis and consists of loose connective tissue.
It accounts for 1/5 of the dermis.
● The deep thicker layer of the dermis is called
● THE SKIN stratum reticularosum (reticular layer). It is
As the largest organ of the human body, the skin surrounds located beneath the stratum papillarosum and
the body and comprises 16 % of a person’s total body consists of dense irregular connective tissues
weight. containing cross-linked collagen and elastin
fibers
FUNCTIONS
P - Protection ● HYPODERMIS
I - Insulation The hypodermis is the deepest layer of the skin. It
R – Receptors in dermis (sensation) connects the dermis layer to the muscles and bones. It
A – Aids in homeostasis contains a layer of adipose tissue.
T – Temperature regulation
E – Elimination of waste product APPENDAGES OF THE SKIN
S – Synthesizes vitamin D ● HAIR
O – Oil production ➢ thin and flexible filament produced by hair
F – Fluid retention follicle.
C – Cosmesis ➢ Consists of keratinized dead cells
➢ contributes to maintaining body temperature and
● EPIDERMIS perceiving touch sensation
Protects internal organs from dangerous chemicals and
harmful microorganisms, regulates body fluid volume and
body temperature, and eliminates body wastes. it consists
of tough stratified squamous epithelium and does not
contain blood vessels.

LAYERS OF THE EPIDERMIS

● Stratum Corneum- composed of thick
keratinized layers of dead squamous epithelial
cells and accounts for up to 75 % of the
epidermal thickness. ● FINGERNAILS AND TOENAILS
● Stratum Lucidum- thin, translucent layer that ➢ firm plates formed in the stratum corneum of the
presents only in thick skin such as the lips, the epidermis and consist of highly compressed and
palm of the hand, and the sole of the feet. keratinized dead cells.
● Stratum Granulosum- is composed of three to ○ almost transparent and colorless, but it
four layers of flattened cells and contains appears slightly pink due to the
irregular granules of keratohyalin. capillaries running underneath
● Stratum Spinosum: (+) prickle cell layer called
SPINE
 4. Ruffini Corpuscle: for heat sensation; respond to
continuous pressure and stretching of the skin and detect
the intensity and speed of the stimulus.
5. Krause End Bulb: for cold sensation
6. Merkel Disk: light touch and continuous pressure
7. Muscle Spindle: pocket-shaped neural structures that
detect the length of skeletal muscles and the speed of
muscle contraction.
8. Golgi Tendon: tension detectors by providing
information about tension applied to tendons.
● SWEAT GLAND
- Secretes sweat to the surface of the skin LAB
- Drains unto hair CUTANEOUS NERVES
- Stimulated during emotional stress ● Cutaneous Nerve of the Scalp
- terminal branches of trigeminal nerves are
distributed mainly on the front and sides of the
head, while cutaneous cervical nerves are located
in the neck.
● Cutaneous Nerve of the Face
- Trigeminal nerves control facial sensation and are
distributed on the scalp, teeth, and mucous
membrane of the mouth and nose
● Cutaneous Nerves of the back: posterior rami of
the spinal nerves
● Cutaneous Nerves of the Chest: supraclavicular
❖ Eccrine nerves
⚬ Located on entire surface ● Cutaneous Nerve of the Upper Limb: C4 to T2
⚬ Drains unto sweat pores nerve
⚬ Regulates body temp ● Cutaneous Nerve of the Lower Limb : mainly
⚬ Aids in removal of waste segments L1 to L5 and S1 to S3 of the spinal
❖ Apocrine cord.
⚬ Located in axillary area and genitals
Sensory Conduction Pathway.
● SEBACEOUS GLAND Posterior White Column: Medial Lemniscal Pathway
- AKA: oil glands conveys :
- Secrete oil and sebum - discriminative touch information
- Sebum: lubricates and moisturizes hair and skin - conscious proprioceptive information
- stereognosis information
● Mammary Glands
- in female breasts are modified sweat glands lying Spinothalamic Tract
in the subcutaneous tissue Lateral: pain and temperature
Anterior: Light touch
● Ceruminous Glands
- modified sweat glands that are found only in the
external auditory canal
- secrete cerumen, whose role is to lubricate the ear
canal and to protect the eardrum from bacteria,
insects, and water.

Sensory Nerve Endings

[Link] Nerve Endings: for pain and itch
2. Meissner Corpuscle: for light touch; typical speed
sensors and sense low- frequency vibrations.
3. Pacinian Corpuscle: for deep touch and vibration
 SKIN AGING
Characteristics of the skin.
Skin Types
A. Normal: soft, elastic, and well moisturized
B. Dry: has a rough surface; accompanied by the
formation of the erythema, fissure, and scale.
C. Oily: greasy skin type with excessive sebum
secretion due to overactive oil glands
D. Combination: both characteristics of dry skin and
oily skin

Causation Theory of Skin Aging.

1.) Programmatic Theory
- argues that aging process is genetically decided,
that is, an individual’s aging and lifespan are
results of a process that is set and controlled by a
genetic program.
Pathology and recovery of skin damage
2.) Stochastic Theory
- claims that the continuous environmental stimuli
destroy genes and proteins, and as cell damages
accumulate, the cells become dysfunctional or
deformed, which eventually leads to aging
Causes of skin aging.
1. Changes in the integumentary structure and
function caused by intrinsic aging.
2. Environmental factors such as the accumulation
of ultraviolet radiation damage (photoaging).
3. Cutaneous changes or diseases related to the
aging of other organs or age-related systemic
diseases (diabetes, vascular insufficiency, and
neurological syndromes).
4. Skin problems due to environmental changes:
with more spare time, people make physical
contact with more diverse range of materials.
5. Living conditions such as living alone, nutrition
deficiency, poor hygiene, lack of energy, and
financial difficulty make it difficult to receive
medical cares.
6. Problems on physiological functions or cognitive
functions: those with these problems tend to be
stubborn and reluctant to listen to other people’s
advices (amnesia and dementia).
7. Declined motor ability: proper disease prevention
and therapeutic activities (e.g., applying ointment
to a wound) are difficult.
Assessment of the skin
● Cutaneous signs
Primary Lesions
A. Macule
B. Papule
C. Nodule
D. Bulla
E. Vesicle
F. Pustule
G. Cyst
H. Wheal
I. Plaque

Secondary Lesions
A. Scale
B. Excoriation
C. Erosion
D. Ulcer
E. Fissure
F. Crust
G. Scar
H. Atrophy
I. Lichenification

Primary Lesions
a. Macule: display circular or oval shapes without
elevation or depression; Their borders can be
well defined or fade out into the surrounding.
b. Papule: small, solid elevation of the skin with
diameters less than 5 mm.
c. Nodule: their diameters are normally larger than
5 mm, and they can invade any layer of the skin.
d. Bulla: fluid filled sac or lesion that has diameters
more than 1 cm
e. Vesicle: small blisters less than 1 cm in diameter.
f. Pustule: pus-filled blisters.
g. Cyst: refer to epidermal nodules containing fluid
or semisolid materials.
h. Wheal: are temporarily developed papules or
plaques caused by urticaria or allergic reaction.
i. Plaque: elevated skin with 2 cm in diameter
Secondary Lesions
A. Scales: are aggregates of keratin debris in the
stratum corneum; in psoriasis, scales look white
or silver, and they may appear similar to fish
scales.
B. Excoriation: caused by mechanical traumas or
repetitive scratching to ease pruritus.
C. Erosion: occur by bursting of vesicles in
varicella, variola, impetigo, or herpes simplex.
D. Ulcer: imply skin loss extending through the
epidermis and part of the dermis, which leads to a
breach in epithelial continuity
E. Fissure: linear cleavages of the skin which
sometimes extend into the dermis
F. Crust: dried layers of serum, blood, or purulent
exudate and are composed of bacteria and
epidermal debris.
G. Scar: as a part of the healing processes, replace
the damaged skin tissues.
H. Atrophy: symptom with a decrease in cell size
due to the loss of organelles and substances.
I. Lichenification: a condition in which a part of
the dermis thickens.
 H. Vesicle and Bulla
I. Hypertrichosis and Hirsutism
J. Acanthosis Nigricans
K. Acquired Ichthyosis

General diagnosis
➢ Chief Complaint
➢ Past Medical History
➢ Social and Occupational History
➢ Family History
➢ Drug History

Visual Inspection
Changes in Skin Color
➢ Cherry red: carbon monoxide poisoning
➢ Pallor: anemia, fear/shock, lack of sunlight
exposure, arterial insufficiency
➢ Cyanosis: smoking, advanced lung disease,
congenital heart defect, CHF
➢ Jaundice: yellow skin and sclera; liver disease
*carotenemia: yellowish skin d/t excessive
consumption of carotene-rich foods.
➢ Liver Spots: brownish- yellowish spot; aging,
pregnancy, liver/uterine malignancy
➢ Brownish: venous insufficiency

Palpation
Cutaneous symptoms ● Skin turgor test: pinch the skin with two fingers
● Pruritus (MC) then let go.
- an unpleasant sensation that causes an urge to
scratch or rub.
● Pain
- Herpes zoster causes stitching pains along the
nerves and is a typical pain related to the skin
diseases.
- Dermalgia and arthralgia are found in cellulitis
squamous cell carcinoma, malignant melanoma,
lupus erythematosus, systemic sclerosis, and Skin tests with diagnosis supporting devices
polymyositis ● Dermoscopy
● Anaesthesia: absence of sensitivity to sensory - convex lens with 3.5–5× magnification
stimuli - For detailed evaluation of fine wrinkles,
● Hypoesthesia: decreased sensitivity to sensory pigmentation and acne
stimuli
● Hyperesthesia: increased sensitivity to sensory
stimuli

Cutaneous signs and symptoms in the systemic diseases

A. Pruritus
B. Eczema
C. Erythroderma
D. Urticaria
E. Nodule
F. Vascular Lesions
G. Flush
 ● Wood's lamp examination
- Uses UV light
- helpful in the diagnosis of various skin conditions because
infected skin
shows a unique fluorescence reaction under the light of
Wood’s lamp.

● Tuberculin Test
Used to diagnose tuberculosis and is performed by injecting
● Diascopy a small dose of tuberculin.
- method used for examining brown papule and - > 10 mm= positive
nodule and differentiating the causes of erythema - 5-9 mm = false positive
and purpura. - < 4 mm = negative
- performed by pressuring a transparent, flat, firm
object against the surface of the lesion

Immediate Skin Test

● Prick test

SKIN REACTION TESTS

● Patch test
- used to diagnose the cause of skin reactions that
occur after the substance touches the ski.

● Photo Test And Photopatch Test

- Photo test examines photosensitivity reactions of
patients’ skin by measuring the decrease of
minimal erythema dose (MED) after the
illumination with ultraviolet light or visible light. ● Scratch Test
- Photopatch test is used together with patch test - performed by inspecting the specimen obtained
for skin disease diagnosis. by scratching superficial lesions.
 ● Intradermal Test ● Diagnosis
- is information about the final result of
examination and evaluation.

● Prognosis
- refers to the process of figuring out the possible
results of a patient’s current status based on the
collected data regarding the treatment of the
patient or other patients with similar symptoms.

● Plan of Care
- a list of suggested intervention methods and their
frequency and duration.

● Intervention
- means various approaches and techniques of
PHYSICAL THERAPY DIAGNOSIS AND physical therapy designed to improve the
EVALUATION METHODS patients’ medical condition.
● Examination
- provides data gathered from medical histories, - Reexamination
systematic reviews, tests, and measurements. - is carried out to detect the changes after the
- It includes the process of collecting data from treatment.
physical therapy evaluation forms, while physical
therapy and intervention are ongoing

● Medical History
- initial information that physical therapists obtain
from the patient interview.
- includes general details gained from history
taking, family history, birth records, past health
status, occupational history, marital history,
pregnancy, menstruation, previous(and current)
illnesses, injuries, surgeries, and medications.

● Systematic Review
- includes the process of evaluating emotional
status, learning type, communication,
communicative competence, and cognitive status
by making an observation on the cardiovascular
system, integumentary system, musculoskeletal
system, and nervous system.

● Test and Measurements

- are performed based on the information gained
from the history taking and systematic review.

● Assessment
- includes the disease’s progress, phases of
symptoms and signs, stability of the disease and
correlation between the involved system and the
damaged site