• INTEGUMENTARY SYSTEM

Because the skin (L. integumentum, a covering)*

is readily accessible and is one of the best
indicators of general health, careful observation
of it is important in physical examinations. It is
considered in the differential diagnosis of almost
.every disease

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*Skin is the largest organ in the body. In a 70 kg
individual, the skin weighs over 5 kg and covers
a surface area approaching 2 m 2.

The epidermis is mainly composed of*

keratinocytes and, for the living cell layers, is
.typically 0.05–0.1 mm in thickness

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Skin is composed of three layers: the epidermis, dermis,
and subcutaneous fat (panniculus) . The outermost layer,
the epidermis, is composed of viable keratinocytes covered
by a layer of keratin, the stratum corneum. The principal
component of the dermis is the fibrillar structural protein
collagen. The dermis lies on the panniculus, which is
composed of lobules of lipocytes separated by collagenous
. septa that contain the neurovascular bundles

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 The skin provides
Protection of the body from environmental effects, such as abrasions, fluid-1
.loss, harmful substances, ultraviolet radiation, and invading microorganisms
Containment for the body’s structures (e.g., tissues and organs) and vital
substances (especially extracellular fluids), preventing dehydration, which
.may be severe when extensive skin injuries (e.g., burns) are experienced
Thermal regulation through the evaporation of sweat and/or the dilation or-2
.constriction of superficial blood vessels
.Sensation by way of superficial nerves and their sensory endings-3
by receptors for temperature, touch, pain
.Synthesis and storage of vitamin D-4
Nonverbal communicationFacial expression;Importance in social-5
.acceptance and self image

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 The skin, the body’s largest organ, consists of the epidermis,
a superficial
cellular layer, and the dermis, a deep connective tissue layer
The epidermis is a keratinized epithelium—that is, it has a tough, horny
superficial layer that provides a protective outer surface overlying its
regenerative and pigmented deep or basal layer. The epidermis has no blood
vessels or lymphatics.. In humans, the epidermis contains
three major resident populations of cells: keratinocytes, melanocytes and
Langerhans cells.

The dermis is supplied by arteries that enter its deep surface

to form a cutaneous plexus of anastomosing arteries. The skin is also supplied
with afferent nerve endings that are sensitive to touch, irritation (pain), and
temperature. Most nerve terminals are in the dermis, but a few penetrate the
.epidermis

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The epidermis can be divided into the innermost
1-Basal layer (stratum germinativum),
2-The malpighian or prickle layer (stratum
spinosum),
3-The granular layer (stratum granulosum), and
4-The horny layer (stratum corneum). On the palms
and soles, a pale clear to pink layer, the stratum
lucidum, is noted just above the granular layer .

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Cells of the Epidermis
•four epidermal cell types
–Stem cells Undifferentiated cells that give rise to
keratinocytes
In deepest layer of epidermis (stratum basale)
–Keratinocytes Great majority of epidermal cells
Synthesize keratin
–Melanocytes Synthesize pigment melanin that shields DNA
from ultraviolet radiation
•Occur only in stratum basale but have branched processes
that spread among keratinocytes and distribute melanin

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Langerhans cells (LCs): major antigen_
.presenting cells (APC) of the skin

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•Dermis—connective tissue layer beneath epidermis
–Ranges from 0.2 mm (eyelids) to 4 mm (palms, soles)
–Composed mainly of collagen
–Well supplied with blood vessels, sweat glands, sebaceous glands,
and nerve endings
–Houses hair follicles and nail roots
–Is the tissue of the facial skin to which skeletal muscles attach and
cause facial expressions of emotion
–Has a wavy, conspicuous boundary with the superficial epidermis
•Dermal papillae are upward, finger-like extensions of dermis
•Epidermal ridges are downward waves of epidermis
Prominent waves on fingers produce friction ridges of fingerprints

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The Dermis
•Papillary Layer—superficial zone of dermis
Thin zone of areolar tissue in and near the
dermal papilla allows for mobility of leukocytes
and other defense cells,rich in small blood
vessels.
•Reticular Layer—deeper and thicker layer of
dermis consists of dense, irregular connective
tissue

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The Hypodermis
•Hypodermis
–Subcutaneous tissue
–Has more areolar and adipose than dermis has
–Pads body and binds skin to underlying tissues
–Common site of drug injection since it has many blood
vessels
•Subcutaneous fat
–Energy reservoir
–Thermal insulation
–Thicker in women
–Thinner in infants, elderly

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 NAILS
The nails are keratinized plates on the dorsum of digital tip . The nail unit
consists of several components

-nail plate: the hard protective tool, the product of the nail apparatus.
Rest
on & is firmly attached to the nail bed, which is attached to underlying bone.

-proximal nail fold: covers proximal one-quarter of the nail plate

-cuticle: junction of two epithelial surfaces of proximal nail fold, projects

distally
on to nail surface, sealing proximal nail fold & nail

-lateral folds: usually cover lateral edges of the plate

-lunula: underlies proximal fold. Normally is white represent most distal

17 region of the matrix
 -free margin: distal nail.

-nail matrix: proximal matrix underlies nail plate to distal

border of [Link] matrix is distal to distal border of
lunula produces major part of nail plate. nail bed: consist of
epidermal part (ventral matrix) no more than two-three cells
thick, & dermis closely apposed to periosteum of distal
phalanx.

Hyponychium: space under free margin of nail plate from

point of separation of nail plate from nail bed to the distal
end of the nail plate
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 Functions of nails

1-Nails act to assist in grasping small objects

2-protecting the fingertip from trauma
3-serve a sensory function.
Pacinian corpuscle-like structures are present in the nail
bed of human fetuses, but are difficult to identify in adults.
Fingernails grow an average of 0.1 mm/day, requiring about
4–6 months to replace a complete nail plate. The growth
rate is much slower for toenails, with 12–18 months
required to replace the great toenail.
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 Hair
Hair grow out of follicles, which are invaginations of the
epidermis into the dermis .
The follicles lie obliquely to the skin surface, and their
expanded extremities, called hair bulbs, penetrate to the
deeper part of the dermis. Each hair bulb is concave at its
end, and the concavity is occupied by vascular connective
tissue called the hair papilla. A band of smooth muscle, the
errector pili, connects the undersurface of the follicle to the
superficial part of the dermis. The muscle is innervated by
sympathetic nerve fibers, and its contraction causes the hair
to move into a more vertical position; it also compresses
the sebaceous gland and causes it to extrude some of its
secretion.

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•Three types of hair
Lanugo: Soft fine pigmented hair that covers much of–
fetus; usually shed before birth
–Vellus: fine, pale hair that replaces lanugo by time of
birth.
–Terminal : longer, coarser, and more heavily pigmented
growth is influenced by hormones.
•Forms eyebrows, eyelashes, and the hair of the scalp
•After puberty, forms the axillary and pubic hair
•Male facial hair and some of the hair on the trunk and
limbs.

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 Vellus hair •

Terminal hair •

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 Hair Follicle Cycle
The hair follicle undergoes life-long cyclic transformations into three primary
phases:
1-ANAGEN Growth phase; determines the ultimate length of hair at a site.
Anagen hair
matrix has rapidly proliferating epithelial cells and is very sensitive to drugs,
growth
factors, hormones, stress. and immunologic and physical injury. Destruction
of epithelial stem cells results in permanent hair loss.
Anagen hairs have pigmented malleable proximal ends About 85 to 99%of
hairs will be in this phase, with some individual variation.
2-TELOGEN Period of relative quiescence, prior to shedding. Telogen hairs are
club hairs with depigmented rounded proximal ends About 1 to 15% of hairs
an: in this phase at any given time.

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3-CATAGEN Apoptosls-driven phase between telogen
and anagen phase. Only about 1% of hairs are seen in
this phase.
4-EXOGEN Active process of hair shaft shedding
The length of anagen determines the final length of the
hair and thus varies according to body site; catagen and
telogen duration vary to a lesser extent depending on
site. Scalphair has the longest anagen of 2 years to more
than8 years. Anagen duration in young males at other
sites is shorter: legs, 5 to 7 months; arms, 1.5 to 3.0
months; eyelashes, 1 to 6 months; and fingers, 1 to 3
months

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Skin Color
•Melanin—most significant factor in skin color Produced by melanocytes, accumulates
in keratinocytes
–Two forms of the pigment:
•Eumelanin—brownish black
•Pheomelanin—reddish yellow (sulfur-containing)
•People of different skin colors have the same number of melanocytes
–Darker skinned people
•Produce greater quantities of melanin
•Melanin breaks down more slowly
•Melanin granules more spread out in keratinocytes
•Melanized cells seen throughout the epidermis
–Lighter skinned people
•Melanin clumped near keratinocyte nucleus
•Little melanin seen beyond stratum basale

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Hair Texture and Color
•Texture—related to cross-sectional shape of hair
–Straight hair is round
–Wavy hair is oval
–Curly hair is relatively flat
•Color—due to pigment granules in the cells of the
cortex
–Brownand black hair is rich in eumelanin
–Red hair has high concentration of pheomelanin
–Blond hair has an intermediate amount of pheomelanin
and very little eumelanin
–Gray and white hair have little or no melanin
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 Muscles

Smooth muscle occurs in the skin as arrectores

pilorum (erectors of the hairs). The arrectores
pilorum are attached to the hair follicles below
the sebaceous glands and, in contracting, pull
the hair follicle upward, producing gooseflesh.
The presence of scattered smooth muscle
throughout the dermis is typical of anogenital
skin .
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 Nerves

In the dermis, nerve bundles are found together

with arterioles and venules as part of the
neurovascular bundle. In the deep dermis,
nerves travel parallel to the surface, and the
presence of long, sausage-like granulomas
following this path is an important clue to the
diagnosis of Hansen disease.

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