1. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Human Anatomy & Physiology, Sixth Edition Elaine N. Marieb PowerPoint ® Lecture Slides prepared by Vince Austin, University of Kentucky 5 The Integumentary System

2. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings The Integumentary System  The skin and its derivates (sweat, and oil glands, hairs and nails) make up a complex set of organs that serves several functions mostly protectives.

3. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Skin (Integument)  It covers the entire body, has a surface area of 1.2 to 2.2 m 2, weight 4 to 5 kg (aprox. 7% total body weight). Varies in thickness from 1.5 to 4.0 mm.  Consists of three major regions  Epidermis – outermost superficial region  Dermis – middle region  Hypodermis (also called superficial fascia) – deepest region

4. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Skin (Integument) Figure 5.1

5. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Epidermis  Composed of keratinized stratified squamous epithelium, consisting of four distinct cell types and four or five layers  Cell types include keratinocytes, melanocytes, Merkel cells, and Langerhans’ cells  Outer portion of the skin is exposed to the external environment and functions in protection

6. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Cells of the Epidermis  Keratinocytes – produce the fibrous protein keratin.  Melanocytes. Are found in the deepest part of epidermis. – produce the brown pigment melanin. The melanin granules accumulate on the superficial or “sunny” side of the keratinocyte nucleus forming a pigment that protects the nucleus from UV radiation.  Langerhans’ cells – epidermal macrophages that help activate the immune system.  Merkel cells. Are present at the epidermal-dermal junction – function as touch receptors in association with sensory nerve endings.

7. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Layers of the epidermis  The skin could be: 1.- Thick (covers the palms, fingertips and soles of feet ) 2.- Thin (covers the rest of body, the stratum lucidum appears to be absent)  The epidermis consist in five layers: Stratum basale, s. spinosum, s. granulosum, s. lucidum and s. corneum (from deeper to superficial)

8. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings  Deepest epidermal layer firmly attached to the dermis  Consists of a single row of the youngest keratinocytes  Cells undergo rapid division, hence its alternate name, stratum germinativum  10-25% of the cells are melanocytes. Ocassionally Merkel cells are also seen in this stratum. Layers of the Epidermis: Stratum Basale (Basal Layer)

9. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Layers of the Epidermis: Stratum Basale (Basal Layer) Figure 5.2b

10. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings  It is several cell layer thick.  Cells contain a weblike system of intermediate filaments attached to desmosomes  Melanin granules and Langerhans’ cells are abundant in this layer.  The keratinocytes in this layer appear irregular (spiny) in shape, causing them to be called prickle cells. However the spines do not exist in living cells. Layers of the Epidermis: Stratum Spinosum (Prickly Layer)

11. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings  Thin; consists in three to five cell layers in which drastic changes in keratinocyte appearance occurs  Keratohyaline and lamellated granules accumulate in the cells of this layer. These make them more resistant to destruction. Layers of the Epidermis: Stratum Granulosum (Granular Layer)

12. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings  Appears as a thin, transparent band superficial to the stratum granulosum  Consists of a few rows of flat, dead keratinocytes  Present only in thick skin Layers of the Epidermis: Stratum Lucidum (Clear Layer)

13. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings  Outermost layer of keratinized cells  Accounts for three quarters of the epidermal thickness  The shingle-like cell remnants of the s. corneum are referred to as cornified, or “horny” cells.  Functions include:  Waterproofing  Protection from abrasion and penetration  Rendering the body relatively insensitive to biological, chemical, and physical assaults Layers of the Epidermis: Stratum Corneum (Horny Layer)

14. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Dermis  Second major skin region containing strong, flexible connective tissue  Cell types include fibroblasts, macrophages, and occasionally mast cells and white blood cells  Composed of two layers – papillary and reticular

15. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Layers of the Dermis: Papillary Layer  Papillary layer  Areolar connective tissue with collagen and elastic fibers  Its superior surface contains peglike projections called dermal papillae  Dermal papillae contain capillary loops, Meissner’s corpuscles, and free nerve endings  On the palms of the hands and soles of the feet these papillae lie atop larger mounds called dermal ridges which form epidermal ridges (unique to each of us)

16. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Layers of the Dermis: Reticular Layer  Reticular layer  Accounts for approximately 80% of the thickness of the skin  Collagen fibers in this layer add strength and resiliency to the skin  Elastin fibers provide stretch-recoil properties

17. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Hypodermis  Subcutaneous layer deep to the skin  Composed of adipose and areolar connective tissue

18. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Skin Color  Three pigments contribute to skin color  Melanin – yellow to reddish-brown to black pigment, responsible for dark skin colors  Freckles and pigmented moles – result from local accumulations of melanin  Carotene – yellow to orange pigment, most obvious in the palms and soles of the feet  Hemoglobin – reddish pigment responsible for the pinkish hue of the skin

19. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Skin Color  The skin color of some people is also influenced by emotional stimuli, and many alterations in skin color signal certain disease states: - Redness or erythema - Pallor or blanching - Jaundice or yellow - Bronzing - Black and blue marks or bruises

20. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Sweat Glands (sudoriferous glands)  Different types prevent overheating of the body; secrete cerumen and milk. Two types: eccrine and apocrine  Eccrine sweat glands – found in palms, soles of the feet, and forehead. Composed by 99% water with some salts, Vit. C, antibodies, dermicidin, and trace of metabolic waste.  Apocrine sweat glands – found in axillary and anogenital areas.  Ceruminous glands – modified apocrine glands in external ear canal that secrete cerumen. Block foreign material  Mammary glands – specialized sweat glands that secrete milk.

21. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Sebaceous Glands  Simple alveolar glands found all over the body, except on the palms and soles.  Soften skin when stimulated by hormones.  Secrete an oily secretion called sebum (hair follicle or pore on skin surface).  They are small on the body trunk and limbs but quite large on the face, neck, and upper chest.

22. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Structure of a Nail  Scalelike modification of the epidermis on the distal, dorsal surface of fingers and toes Figure 5.4

23. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Homeostatic imbalance  Acne is an active inflammation of sebaceous glands accompanied by “pimples” (pustule or cysts) on the skin. It is usually caused by bacterial infection, particularly by staphylococcus.  Seborrhea known as “cradle cap” in infants, is caused by overactive sebaceous glands.

24. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Hair  Filamentous strands of dead keratinized cells produced by hair follicles  Contains hard keratin which is tougher and more durable than soft keratin of the skin  Made up of the shaft projecting from the skin, and the root embedded in the skin  Consists of a core called the medulla, a cortex, and an outermost cuticle  Pigmented by melanocytes at the base of the hair

25. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Hair Function and Distribution  Functions of hair include:  Helping to maintain warmth  Alerting the body to presence of insects on the skin  Guarding the scalp against physical trauma, heat loss, and sunlight  Hair is distributed over the entire skin surface except  Palms, soles, and lips  Nipples and portions of the external genitalia

26. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Hair Follicle  Root sheath extending from the epidermal surface into the dermis  Deep end is expanded forming a hair bulb  A knot of sensory nerve endings (a root hair plexus) wraps around each hair bulb  Bending a hair stimulates these endings, hence our hairs act as sensitive touch receptors

27. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Hair Follicle Figure 5.6a

28. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Hair Follicle Figure 5.6c

29. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Types of Hair  Hairs come in various sizes and shapes, but as a rule they can be classified as:  1.- Vellus – pale, fine body hair found in children and the adult female  2.- Terminal – coarse, long hair of eyebrows, scalp, axillary, and pubic regions

30. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Homeostatic imbalance  Hirsutism: Excessive hairiness, as well as other signs of masculinization, may result from an adrenal gland or ovarian tumor that secretes abnormally large amounts of androgens. Since few women want a beard or hairy chest, such tumors are surgically removed as soon as possible.

31. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Hair Thinning and Baldness A follicle has only a limited number of cycles in it. Hair grows fastest from the teen years to the 40s, then its growth slowly.  Alopecia – hair thinning in both sexes  True, or frank, baldness  Genetically determined and sex-influenced condition  Male pattern baldness – caused by follicular response to DHT

32. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Functions of the Integumentary System  Protection: 1.- Chemical (skin secretion, ex: natural antibiotic “defensin”, peptides called “cathelicidins” prevent group A streptococcus bacteria infections, and melanin) 2.- Physical (hardness of its keratinized cells) 3.- Mechanical barrier 4.- Biological barrier (include the Langerhans cells of the epidermis, macrophages and DNA itself

33. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Functions of the Integumentary System  Body temperature regulation is accomplished by:  Dilation (cooling) and constriction (warming) of dermal vessels  Increasing sweat gland secretions to cool the body  Cutaneous sensation – exoreceptors sense touch and pain

34. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Functions of the Integumentary System Sunlight modified cholesterol molecules in the skin  Metabolic functions – synthesis of vitamin D in dermal blood vessels  Blood reservoir – skin blood vessels store up to 5% of the body’s blood volume  Excretion – limited amounts of nitrogenous wastes are eliminated from the body in sweat

35. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Skin Cancer  Most skin tumors are benign and do not metastasize  A crucial risk factor for nonmelanoma skin cancers is the disabling of the p53 gene  Newly developed skin lotions (tiny oily vesicles “lyposomes” filled with enzymes) that can fix damaged DNA

36. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Skin Cancer  The three major types of skin cancer are:  Basal cell carcinoma  Squamous cell carcinoma  Melanoma

37. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Basal Cell Carcinoma  Least malignant and most common skin cancer  Stratum basale cells proliferate and invade the dermis and hypodermis  Slow growing and do not often metastasize  Can be cured by surgical excision in 99% of the cases

38. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Squamous Cell Carcinoma  Arises from keratinocytes of stratum spinosum  Arise most often on scalp, ears, and lower lip  Grows rapidly and metastasizes if not removed  Prognosis is good if treated by radiation therapy or removed surgically

39. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Melanoma  Cancer of melanocytes is the most dangerous type of skin cancer because it is:  Highly metastatic  Resistant to chemotherapy

40. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Melanoma The American Cancer Society suggest the evaluation of skin tumors by ABCD rule.  Melanomas have the following characteristics (ABCD rule)  A: Asymmetry; the two sides of the pigmented area do not match  B: Border is irregular and exhibits indentations  C: Color (pigmented area) is black, brown, tan, and sometimes red or blue  D: Diameter (spot) is larger than 6 mm (size of a pencil eraser)  E: Elevation above the skin surface, improve diagnosis

41. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Melanoma  Treated by wide surgical excision accompanied by immunotherapy  Chance of survival is poor if the lesion is over 4 mm thick

42. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Burns: Tissue damage inflicted by intense heat, electricity, radiation or certain chemicals. CLASSIFICATION ACCORDING SEVERITY  First-degree – only the epidermis is damaged  Symptoms include localized redness, swelling, and pain  Second-degree – epidermis and upper regions of dermis are damaged  Symptoms mimic first degree burns, but blisters also appear  Third-degree – entire thickness of the skin is damaged  Burned area appears gray-white, cherry red, or black; there is no initial edema or pain (since nerve endings are destroyed)

43. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Rule of Nines  Estimates the severity of burns  Burns considered critical if:  Over 25% of the body has second-degree burns  Over 10% of the body has third-degree burns  There are third-degree burns on face, hands, or feet

44. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Rule of Nines: Body is divided into 11 areas (9%) + 1%(genital) Figure 5.8a

45. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Developmental Aspects of the Integument: Fetal  Epidermis develops from ectoderm  Dermis and hypodermis develop from mesoderm  Lanugo – downy coat of delicate hairs covering the fetus (5-6 months)  Vernix caseosa – substance produced by sebaceous glands that protects the skin of the fetus in the amnion (when baby is born)

46. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings  Skin and hair become oilier and acne may appear  Skin shows the effects of cumulative environmental assaults around age 30  Scaling and dermatitis become more common Developmental Aspects of the Integument: Adolescent to Adult

47. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings  Epidermal replacement of cells slows and skin becomes thinner  Skin becomes dry and itchy  Subcutaneous fat layer diminishes, leading to intolerance of cold  Decreased elasticity and loss of subcutaneous tissue leads to wrinkles  Decreased numbers of melanocytes and Langerhans’ cells increase the risk of skin cancer Developmental Aspects of the Integument: Old Age