1. The Integumentary System
Chapter 24
The Integumentary System
PowerPoint® presentation to accompany:
Medical Assisting
Third Edition
Booth, Whicker, Wyman, Pugh, Thompson

2. Learning Outcomes 24.1 List the functions of skin.
24.2 Explain the role of skin in regulating body temperature.
24.3 Describe the layers of skin and the characteristics of each layer.
24.4 Explain the factors that affect skin color.
24.5 Identify and describe common skin lesions.

3. Learning Outcomes (cont.)
24.6 List the accessory organs of skin and describe their structures and functions.
24.7 Explain the process of skin healing, including scar production.
24.8 Describe the effects of aging on skin.
24.9 List the different types of burns and describe their appearances and treatments.

4. Learning Outcomes (cont.)
24.10 Describe the causes, signs and symptoms, and treatments of various types of skin cancer.
24.11 Describe the causes, signs and symptoms, and treatments of common skin disorders.
24.12 Explain the ABCD rule and its use in evaluating melanoma.
24.13 Using the acronym CAUTION, list the seven warning signs of cancer.

5. Introduction Skin is the body’s outer covering and its largest organ.
Integumentary system consists of skin and its accessory organs
Accessory organs:
Hair follicles
Nails
Skin glands
Skin is the body’s outer covering and its largest organ.

6. Functions of the Integumentary System
Protection
First line of defense against
Bacteria
Viruses
Protects underlying structures from
Ultraviolet (UV) radiation
Dehydration

7. Functions of the Integumentary System (cont.)
Body temperature regulation
If too hot
Dermal blood vessels dilate
Vessels carry more blood to surface so heat can escape
If too cold
Dermal blood vessels constrict
Prevents heat from escaping

8. Functions of the Integumentary System (cont.)
Vitamin D production
Needed for calcium absorption
Sensation
Sensory receptors
Excretion
Small amounts of waste products are lost through perspiration

9. Apply Your Knowledge Super!
What are the functions of the integumentary system?
ANSWER: The functions of the integumentary system are protection, regulation of body temperature, vitamin D production, sensation, and excretion.
Super!

10. Structure of Skin Epidermis Dermis Hypodermis or subcutaneous layer
Back

11. Skin Structure: Epidermis
Most superficial layer
Two parts
Stratum corneum
Outermost layer
Mostly dead cells form an impermeable layer
Stratum basale (stratum germinativum)
Deepest layer
Cells constantly dividing and pushing older cells outward
To Figure of Skin

12. Skin Structure: Epidermis (cont.)
Keratinocyte – most common
Makes and accumulates keratin
Durable protein that makes the epidermis waterproof and resistant to pathogens
Melanocyte
Makes the pigment melanin
Traps UV radiation and prevents damage to underlying layers of the skin

13. Skin Structure: Dermis
Deeper of the two skin layers
Contains all major tissue types, plus
Sudoriferous (sweat) glands
Sebaceous (oil) glands
Hair follicles and arrector pili muscles
Collagen, elastic, and nerve fibers
Blood vessels
Binds the epidermis to the subcutaneous tissue
To Figure of Skin

14. Skin Structure: Subcutaneous Layer
Hypodermis
Composed of
Adipose (fat) and loose connective tissue
Blood vessels and nerves
Functions
Storage in adipose tissue
Cushions and insulates underlying structures
To Figure of Skin

15. Excellent! Apply Your Knowledge
Where are melanocytes and keratinocytes, and what is their function?
ANSWER: Both are located in the epidermis of the skin. Keratinocytes make and accumulate keratin, which is a durable protein that makes the epidermis waterproof and resistant to pathogens.
Melanocytes make the pigment melanin, which traps UV radiation and prevents damage to underlying layers of the skin.
Excellent!

16. Skin Color Determined by amount of melanin in the epidermis of skin
The more melanin, the darker the skin color
Range is from yellowish to brownish

17. Skin Color (cont.) Oxygenated blood
Amount of oxygen dissolved in the hemoglobin of the red blood cells
Hemoglobin – a pigment in the RBCs
If blood is well-oxygenated, skin will be pink
If oxygen level in blood is low, skin will be pale or have a bluish color (cyanosis)

18. Nice Job! Apply Your Knowledge What affects skin color?
ANSWER: The amount of melanin produced by the melanocytes and the oxygenation of the blood.
Nice Job!

19. Skin Lesions Any variation in the skin As simple as a freckle
As serious as a tumor

20. Skin Lesions (cont.) Lesion Name Description Bulla
A large blister or cluster of blisters
Cicatrix
A scar, usually inside a wound or tissue
Crust
Dried blood or pus on the skin
Ecchymosis
A black-and-blue mark or bruise
Erosion
A shallow area of skin worn away by friction or pressure
Excoriation
A scratch; may be covered with dried blood

21. Skin Lesions (cont.) Lesion Name Description Fissure
A crack in the skin’s surface
Keloid
An overgrowth of scar tissue
Macule
A flat skin discoloration, such as a freckle or a flat mole
Nodule
A large pimple or small node
Papule
An elevated mass similar to but smaller than a nodule
Petechiae
Pinpoint skin hemorrhages that result from bleeding disorders

22. Skin Lesions (cont.) Lesion Name Description Plaque
A small, flat, scaly area of skin
Purpura
Purple-red bruises usually due to clotting abnormalities
Scale
Thin plaques of epithelial tissue on skin’s surface
Pustule
An elevated (infected) lesion containing pus
Tumor
A swelling of abnormal tissue growth

23. Skin Lesions (cont.) Lesion Name Description Ulcer
A wound that results from tissue loss
Vesicle
A blister
Wheal
Another term for hive

24. Apply Your Knowledge BRAVO! ANSWER: Match the following:
___ Keloid A. A blister
___ Vesicle B. A crack in the skin’s surface
___ Crust C. An overgrowth of scar tissue
___ Fissure D. A small, flat scaly area of skin
___ Ulcer E. Dried blood or pus on the skin
___ Plaque F. A wound that results from tissue loss A
BRAVO! E B F D

25. Accessory Organs (cont.)
Hair follicles
Tube-like depressions in the dermis of skin
Generate hairs
Alopecia (baldness) occurs when follicles die
Arrector pili muscles attached to follicles cause goose bumps
Sebaceous glands
Produce sebum to keep hair soft
Prevent bacteria from growing on skin
Nails
Protect the ends of fingers and toes
Hard keratin
Diagram

26. Accessory Organs (cont.)
Sudoriferous (sweat) glands
Located in the dermis of skin
Types
Eccrine
Produce watery type of sweat
Activated by heat
Apocrine
Produce thicker type of sweat with more proteins
Concentrated in armpit and groin areas
Activated by nervousness or stress
Diagram

27. Accessory Organs Sebaceous gland Hair follicle Sudoriferous gland
Return

28. Skin Healing Injury  inflammation
Redness due to dilation of nearby blood vessels
Swelling because vessels leak fluid into spaces between cells
Pain because excess fluid activates pain receptors

29. Skin Healing (cont.) Inflammation promotes healing Extra blood to area
Extra nutrients for skin repair
Defensive cells
Injury occurs
Blood clot forms
Scab replaces blood clot
Clotted blood and other dried tissue
Collagen fibers replace scab
Bind the edges of wound; major component of scars

30. Correct Apply Your Knowledge
How does inflammation promote healing of the skin?
ANSWER: Inflammation promotes healing by bringing extra blood, nutrients for skin repair, and defensive cells to the area of injury.
Correct

31. Skin and Aging Skin loses firmness due to Skin color changes
Loss of elastic and collagen fibers in dermis
Loss and shifting of underlying adipose tissues
Skin color changes
Dermis becomes thinner and more transparent
Paler due to decrease in circulation

32. Skin and Aging (cont.) Melanocytes decrease
Those remaining gather  “age” spots
Hair grays and becomes thinner
Decreased tolerance to temperature changes
Sudoriferous glands decrease in number
Decreased perspiration, hard to adjust to high temperatures
Loss in adipose tissue and decreased circulation
Increased sensitivity to cold

33. Apply Your Knowledge Very Good!
What happens to the skin in the elderly?
ANSWER: As a person ages, the skin loses firmness, skin color changes, melanocytes decrease, and tolerance to temperature changes decreases due to a loss of adipose tissue and sweat glands.
Very Good!

34. Burns Second leading cause of accidental death in the U.S.
Rule of nines is used to determine severity (degree) of burn
Burn severity:
First-degree
Second-degree
Third-degree
Rule of Nines

35. Back

36. Burns: Treatment Do not remove anything sticking to the burn
Do not apply butter, lotions, or ointments
Cool with large amounts of water
Cover with sterile sheet or plastic bag

37. Click for Figure 24-5 Rule of Nines
Apply Your Knowledge
Using Figure 24-5, determine burn severity for a patient who has burnt his anterior face and both arms.
Click for Figure 24-5 Rule of Nines
ANSWER: Head = 9%
Both arms, hands, and shoulders = 18% + 18%
9% + 18% + 18% = 45%
It all adds up to a right answer!

38. Skin Cancer
Basal cell carcinoma – progresses slowly and rarely spreads to other body parts
Squamous cell carcinoma – more likely to spread to surrounding tissues
Malignant melanoma – more aggressive and occurs anywhere
Most arise from melanocytes

39. Skin Cancer: Basal Cell Carcinoma
Signs and symptoms
New growth or sore that will not heal
Waxy, smooth, red, pale, flat, or lumpy
May or may not bleed
Treatment:
Curettage and electrodessication  Cryosurgery
Mohs’ surgery  Laser therapy

40. Skin Cancer: Squamous Cell Carcinoma
Less common than basal cell carcinoma
Found on face, lips, ears, and backs of hands
Signs and symptoms and treatments are the same as for basal cell carcinoma

41. Skin Cancer: Malignant Melanoma
Signs and Symptoms
From melanocytes
Appear on trunk, head, neck of men
Appear on arms and legs of women
Itches or bleeds
Treatment
Surgery and biopsy
Removal of lymph nodes
Chemotherapy and radiation therapy
Immunotherapy

42. Skin Cancer: Stages of Melanoma
Only found in epidermis
Stage I
Spread to epidermis and dermis (1 to 2 mm thick)
Stage II
2 to 4 mm thick plus ulceration
Stage III
Spread to one or more lymph nodes
Stage IV
Spread to other body organs or lymph nodes far from original melanoma

43. A B C D Skin Cancer: ABCD Rule
Asymmetry: The mole should not become asymmetrical B
Border should not become irregular C
Color should not change or become mixture of colors D
Diameter should not grow larger than the diameter of a pencil eraser

44. Cancer Warning Signs C – Change in bowel or bladder habits
A – A sore that will not heal
U – Unusual bleeding or discharge
T – Thickening or lump
I – Indigestion or difficulty swallowing
O – Obvious change in wart or mole
N – Nagging cough or hoarseness

45. Melanomas are more aggressive .
Apply Your Knowledge
True or False:
___ Basal cell carcinoma is the most aggressive form of skin cancer and can form anywhere.
___ Squamous cell carcinoma is more likely to spread to surrounding tissues.
___ Lesions of melanoma appear on trunk, head, neck of men and on arms and legs of women.
___ The borders of skin cancers are usually regular.
___ Basal cell carcinoma progresses slowly and rarely spreads to other body parts.
ANSWER: F
Melanomas are more aggressive . T T
Borders are irregular. F T
Good Job!

46. Common Skin Disorders Alopecia Dermatitis Cellulitis Eczema
Results in hair loss
Cellulitis
Inflammation of connective tissue in skin
Dermatitis
Inflammation of skin or a rash
Eczema
Chronic dermatitis
Folliculitis
Inflammation of hair follicles

47. Common Skin Disorders (cont.)
Herpes simplex
Type 1 – cold sores
Type 2 – genital
Herpes zoster
Shingles
Impetigo
Oozing skin lesions that eventually crust over
Pediculosis
Head lice
Body lice
Pubic lice
Psoriasis
Inherited autoimmune disorder

48. Common Skin Disorders (cont.)
Ringworm
Tinea corporis
Tinea capitis
Tinea pedis
Rosacea
Dilation of small facial blood vessels
Scabies
Contagious skin condition caused by mites
Warts
Harmless growths caused by a virus

49. Right! Apply Your Knowledge C E F B A D Match the following: ANSWER:
___ Alopecia A. Dilation of small facial blood vessels
___ Folliculitis B. Inherited autoimmune disorder
___ Impetigo C. Hair loss
___ Psoriasis D. Growths caused by a virus
___ Rosacea E. Inflammation of hair follicles
___ Warts F. Oozing skin lesions
ANSWER: C E F B A D
Right!

50. In Summary: First line of defense for body Protects the body from
Invading organisms
Chemicals
UV light
Water loss
Regulates body temperature
Understanding this system can help you be more effective in your role

51. End of Chapter
End of Chapter 24
We may have different religions, different languages, different colored skin, but we all belong to one human race.
~ Kofi Annan