1. Questions to Consider…
Why is your skin important?
Do you have a skin care “routine?”
What changes have you observed in your skin as you grow older?
What can you do to keep your skin healthy for many years?

2. Introduction to the Integumentary System
Organs are body structures composed of two or more different tissues.
The skin and its accessory organs make up the Integumentary system

3. Types of Membranes Serous membranes
Line body cavities that lack openings to the outside
Line thorax and abdomen and cover the organs within these cavities
Contain cells that secrete serous fluid to reduce friction
Pericardium: Serous membrane

4. Mucous membranes line the respiratory tract
Types of Membranes
Mucous membranes
Line cavities that lead to the outside of the body
Oran and nasal cavities, openings of the digestive, reproductive, respiratory and urinary systems
Contain specialized cells that secrete mucus
Mucous membranes line the respiratory tract

5. Joints contain synovial membranes
Types of Membranes
Synovial membranes
Line joint cavities
Contain cells that secrete lubricating synovial fluid
Joints contain synovial membranes

6. Types of Membranes Cutaneous membrane – the Skin
Skin is a very large organ made of 4 different types of tissue
22 ft2, 1-2 mm thick, ~10 lbs.
2 Major layers – Epidermis and Dermis
Subcutaneous tissue (hypodermis) joins the skin to the body

7. Functions of the Skin
The skin is one of the largest and most versatile organs of the body
Functions include:
Thermoregulation
Important in maintaining homeostasis

8. Functions of the Skin Protection
Physical, chemical, biological barrier
Cells tightly packed to resist bacterial invasion
Oils hinder water loss
Skin pigments protect against UV damage
Specialized cells alert immune system

9. Functions of the Skin 3. Sensory functions
Touch, pressure, vibration, temperature, pain

10. Functions of the Skin 4. Synthesis of Vitamin D Activated by sunlight
Necessary to absorb calcium from food in the GI tract

11. Functions of the Skin 5. Excretion and Absorption Minor role
Small amounts of salt, CO2, ammonia and urea excreted daily
Fat-soluble substances can be absorbed through the skin

12. 5 distinct layers (strata)
Epidermis
Lacks blood vessels
Important because it protects against water loss, mechanical injury, chemicals and MO’s
5 distinct layers (strata)

13. Stratum Basale Mitosis Also called stratum germinativum
Deepest single layer of cells
Nourished through blood vessels in the dermis
Cells divide through mitosis and move toward surface
Melanocytes (pigment cells) found here

14. Stratum Spinosum Immunity 8-10 cells thick
Langherhans cells = immunity
Keratinocytes found here
During slide preparation, cells shrink and look spiny

15. Stratum Granulosum Keratinization 3 - 5 layers of flat dying cells
Keratin fills the cells as they move upward

16. Stratum Lucidum
Only found in thick skin on palms & soles of feet
3-5 layers of clear, flat, dead cells
Clear

17. A SECTION OF THE STRATUM CORNEUM WITH AN INTACT BARRIER FUNCTION
Protection
A SECTION OF THE STRATUM CORNEUM WITH AN INTACT BARRIER FUNCTION
                                                                                                                    
                      
With the barrier 'intact' the opportunities for water loss is much less.
25 to 30 layers of flat dead cells filled with keratin and surrounded by lipids
Continuously shed
Barrier to light, heat, water, chemicals & bacteria
Friction stimulates callus formation

18. The Dermis Binds the epidermis to underlying tissues
Contains collagen and elastic fibers, nerve fibers, sensory fibers,hair follicles, sebaceous glands, sweat glands
Dermal blood vessels carry nutrients to upper layers of skin and help to regulate temperature

19. Upper Dermis: Papillary Region
Many elastic fibers
Finger like projections called Dermal Papillae give rise to friction ridges (Fingerprints)

20. Upper Dermis: Papillary Region
Anchors dermis to the epidermis
Contains capillaries that feed the epidermis
Sensory receptors for touch, pain, temperature

21. Lower Dermis: Reticular Region
Dense tissue with interlocking collagen and elastic fibers
Packed with oil glands, sweat glands, hair follicles
Provides strength and elasticity to skin
Stretch marks are dermal tears from extreme stretching
Stretch marks due to pregnancy

22. Subcutaneous layer/Hypodermis
Deepest layer
Missing on eyelids, nipples, genitals and shins
Adipose tissue (fat) helps with insulation, provides cushioning and stores energy
Bonds skin to underlying organs
Blood vessels, nerves, lymph vessels and hair follicles also cross through this layer
No sharp boundary between subQ and dermis

23. Skin Layer Cake

24. Skin Color & Pigments
Skin color or skin tone depends on several factors:
Melanin
Carotene
Blood supply
Other factors such as diet, drugs, pollutants, toxins, disease

25. Melanin A brown pigment produced by cells called melanocytes
Melanocytes found deep in the epidermis (stratum basale) and in upper dermis
Melanin protects underlying tissues from UV damage

26. Melanin
Granules of melanin are passed to nearby cells (“tanning”)

27. Melanin Number of melanocytes is nearly identical in all races
Differing amounts of melanin and size of melanin granules cause main color variations seen in different races

28. Carotene Orange-yellow pigment (precursor of Vitamin A)
Found in stratum corneum and dermis
The child’s nose and the palm on the left have turned orange due to a diet high in carotene

29. Hemoglobin Red oxygen-carrying pigment in RBC’s
Lack of other pigments allows “pink” color to show through the translucent epidermis

30. Other Factors: Skin color can also be influenced by: Diet/drugs
Ex: colloidal silver
Pollutants or toxins
Disease
Blue skin(argyria) due to colloidal silver used as an antibiotic – color change is permanent
Viktor Yushchenko’s skin was permanently disfigured through dioxin poisoning by his political opponents

31. Clinical Observations
Freckles, moles or liver spots: clusters of melanocytes
Albinism: inherited lack of melanin production
Vitiligo: autoimmune loss of melanocytes that produces white patches

32. Skin Color as Diagnostic Clue
Jaundice: yellow color of skin and eyes
Build-up of bilirubin from normal RBC breakdown or from liver disease

33. Skin Color as Diagnostic Clue
Cyanosis: Bluish tint to nail beds, lips and skin
Due to loss of oxygen

34. Skin Color as Diagnostic Clue
Erythema: Redness due to enlarged capillaries in dermis
Indicates inflammation, allergy, infection or burns

35. Henna Tattoos

36. Accessory Organs of the Skin
Accessory organs form as epidermal cells sink inward during development to form:
Hair
Sebaceous glands
Sweat glands
Nails

37. Hair Xie Qiuping Hair Length = 18’ 5.54” Tran Van Hay

38. Hair Hair shaft Visible portion of hair
3 layers – medulla, cortex & cuticle

40. Hair
Root – below the surface

41. Hair Cross section determines texture Round = straight Oval = wavy
Flat = curly

42. Hair Follicle Forms a sheath that surrounds root
Base of follicle called the bulb – blood vessels & germ cell layer

43. Hair Arrector pili Smooth muscle in dermis contracts with cold or fear
Forms goosebumps as hair is pulled vertically
Tiny nerve detects hair movement

44. Hair Growth Hair grows in cycles. Growth stage(anagen) 2-6 years
Matrix cells at base of hair root produce length
Resting stage (telogen)
~3 months
Matrix cells inactive & follicle atrophies
Old hair falls out as growth stage begins

45. Hair Growth Growth cycles vary in the body:
Eyelashes: 30 days growth/105 days rest
Scalp: 3 years growth/1-2 years rest
Normal hair loss ~ hairs/day

46. Strips of scalp hair can be transplanted in the eyelash area for long lashes – BUT the hair must be trimmed

47. Hair Color: Result of melanin produced in melanocytes in hair bulb
Dark hair = true melanin
Blonde/red=melanin w/iron and sulfur
Graying=decline in melanin production
White hair=air bubbles in medullary shaft

48. Sebaceous (Oil) Glands
Secretory portion in the dermis
Most open into hair shafts
Sebum – combo of cholesterol, protein, fat & salt
Keeps hair soft and pliable
Inhibits growth of bacteria and fungi

49. Sebaceous (Oil) Glands
Acne
Bacterial inflammation of glands
Secretions stimulated by hormones at puberty

51. Sudoriferous (Sweat) glands
Eccrine (sweat) glands
Most areas of skin
Regulate body temperature through perspiration
Hyperhydrosis is a disorder that causes excessive sweating – it can be treated with botox injections or surgery

52. Sudoriferous (Sweat) glands
Apocrine (sweat) glands
Axillary, pubic & inguinal regions
Secretions more viscous (milky)

53. Ceruminous Glands Modified sweat glands
Cerumin contains secretions of oil & wax glands
Helps form barrier for entrance of foreign bodies
Impacted cerumin may reduce hearing

54. Nails Tightly packed, keratinized cells
Growth ~ 1mm/week – faster in summer & on dominant hand

55. Nails Nail body Visible portion pink due to underlying capillaries
Free edge appears white
Nail body lifted from bed due to trauma

56. Nails
Nail matrix (root)
Buried under skin layers

57. Nails
Lunula is white due to thickened stratum basale mixed with air

58. Nails Cuticle = stratum corneum layer Infected cuticle
Hangnail – torn cuticle

59. Fingerprints

60. Fingerprint Principles
According to criminal investigators, fingerprints follow 3 fundamental principles:
A fingerprint is an individual characteristic; no two people have been found with the exact same fingerprint pattern.
A fingerprint pattern will remain unchanged for the life of an individual; however, the print itself may change due to permanent scars and skin diseases.
Fingerprints have general characteristic ridge patterns that allow them to be systematically identified.

61. Fingerprint Classes
There are 3 specific classes for all fingerprints based
upon their visual pattern: arches, loops, and whorls.
Each group is divided into smaller groups as seen in the lists below.
Arch
Plain arch
Tented arch
Loop
Right Loop
Left loop
Whorl
Plain whorl
Central pocket whorl
Double loop whorl
Accidentical

62. 60% of people have loops, 35% have whorls,
Interesting Info
Fingerprint Factoid:
60% of people have loops, 35% have whorls,
and 5% have arches
Did you know?
Dactyloscopy is the study of fingerprint identification. Police investigators are experts in collecting “dactylograms”, otherwise known as fingerprints.

63. Arches
Arches are the simplest type of fingerprints that are formed by ridges that enter on one side of the print and exit on the other. No deltas are present.
Tented Arches
Similar to the plain arch,
but has a spike in the center.
Spike or “tent”
Plain Arch
Ridges enter on one side and
exit on the other side.

64. Loops
Loops must have one delta and one or more ridges that enter and leave on the same side.
Loop (Opens to Left)
Loop opens toward the left.
Loop (Opens to Right)
Loop opens toward right.
Delta

65. Whorls
Whorls have at least one ridge that makes (or tends to make) a complete circuit. They also have at least two deltas. If a print has more than two deltas, it is most likely an accidental.
Central Pocket Whorl
Plain Whorl
Draw a line between the two deltas in the plain and central pocket whorls. If some of the curved ridges touch the line, it is a plain whorl. If none of the center core touches the line, it is a central pocket whorl.

66. Whorls – Part 2 Double Loop Whorl
Double loop whorls are made up of any two loops combined into one print.
Delta
Accidental Whorl
Accidental whorls contain two or more patterns (not including the plain arch), or does not clearly fall under any of the other categories.

67. Identify each fingerprint pattern.? A B C E D

68. It’s time to make some prints!
Avoid Partial Prints
GOOD PRINT Get as much of the top part of your finger as possible!

69. Directions
1st – Roll the “pad” portion of your thumb over the ink pad from the left side of your thumb to the right. You do not have to push down really hard!
2nd – Roll the “pad” portion of your thumb from the left side of your thumb to the right in the correct box on your paper to make a thumbprint.
3rd – Continue this process to make a fingerprint of all ten fingers on the “My Prints” worksheet.
4th –Use your notes and a magnifying lens to help you figure out what type of pattern is found in each of your fingerprints. Label each one with the pattern’s name.

70. Hair Structure Hair is composed of three principal parts:
Cuticle – outer coating composed of overlapping scales
Cortex – protein-rich structure around the medulla that contains pigment
Medulla – central core (may be absent)
The structure of hair has been compared to that of a pencil with the medulla being the lead, the cortex being the wood and the cuticle being the paint on the outside.

71. Hair Structure Cuticle The cuticle varies in: Its scales,
How many there are per centimeter,
How much they overlap,
Their overall shape, and
How much they protrude from the surface
Its thickness, and
Whether or not it contains pigment.
Characteristics of the cuticle may be important in distinguishing between hairs of different species but are often not useful in distinguishing between different people.
Info: Image:

72. Hair Structure Cortex The cortex varies in: Thickness Texture Color
Distribution of the cortex is perhaps the most important component in determining from which individual a human hair may have come.
Microscopic examination can also reveal the condition and shape of the root and tip.
Info: Image:

73. Hair Structure Medulla The medulla may vary in: Thickness
Continuity - one continuous structure or broken into pieces
Opacity - how much light is able to pass through it
It may also be absent

74. Regulation of Body Temperature
Hypothalamus = control center for thermoregulation
Active cells (heart, muscles) produce heat
Heat lost to surroundings via radiation

75. Regulation of Body Temperature
Excessive heat response = dilation of surface blood vessels, sweating
Evaporation of sweat = cooling
Excessive cooling response = constricting blood vessels, inactivating sweat glands, shivering

76. Physiology of a Fever

77. Healing of Wounds Epidermal wound healing Abrasion or minor burn
Stratum basale cells migrate across wound until epidermis is restored

78. Healing of Wounds Deep wound healing (Dermis)
If injury reaches dermis, healing occurs in 4 phases:
1. Inflammation – swelling, increase in blood flow
2. Migratory phase – fibroblasts secrete collagen to bind wound edges

79. Healing of Wounds
3. Proliferative phase – completion of scar tissue formation
4. Maturation phase – scab falls off

80. Healing of Wounds Scar Formation
Hypertrophic scar – remains w/in boundaries of original wound
Keloid scar – extends into previously normal tissue
Collagen fibers are very dense & fewer blood vessels are present so scar tissue is lighter in color

81. Pressure Ulcers Decubitus ulcers
Caused by constant deficiency of blood flow to tissue
Affects skin over bony prominence in bedridden patients
Preventable with proper care

82. Burns Due to chemicals, electricity, heat “Rule of Nines”
Way to determine extent of burns
Body divided into 11 areas for quick estimation
Each area represents ~9% of total body surface area

83. Burns Problems that result
Shock due to water, plasma and plasma protein loss
Circulatory & kidney problems from loss of fluids
Bacterial infection

84. Burns
Types of burns:
First degree: epidermis only; redness and swelling (sunburn)
Second degree: “partial thicknesss burn”; destroys epidermis and part of dermis; redness, pain, blistering; usually heals in ~3-4 weeks; may scar
Third degree: “full thickness burn”; destroys epidermis, dermis & epidermal derivatives; leathery, brown, black red or white appearance; no pain because nerves are destroyed

85. Skin Grafts
New skin cannot regenerate if stratum basale & its stem cells are destroyed
Skin graft is covering of wound with piece of healthy skin or transplantation

86. New Technology for Burn Victims

87. Age-Related Structural Changes
Newborn skin:
Covered with fine hairs called lanugo for warmth
Pimples called milia may occur due to maternal hormones still in baby’s blood

88. Age-Related Structural Changes
Greasy covering of skin caseosa vernix protects from amniotic fluid
Yellow flakes known as “cradle cap” may form on scalp

89. Age Related Structural Changes
Collagen fibers decrease in number & stiffen
Elastic fibers become less elastic
Fibroblasts decrease in number
Oil glands shrink and the skin becomes dry
Subcutaneous fat is lost

90. Photodamage
Ultraviolet light (UVA and UVB) both damage the skin

91. Photodamage Ultraviolet light (UVA and UVB) both damage the skin
Acute overexposure causes sunburn
DNA damage in epidermal cells can lead to skin cancer
UVA produces oxygen free radicals that damage collagen & elastic fibers
Leads to wrinkles

92. Skin Cancer Most common type of cancer
Skin cancer affects 1 in 5 Americans at some time in their lives
Classified as carcinoma or melanoma

93. Carcinoma
Most common in fair-skinned people over 40 who spend a lot of time outdoors; typically slow growing and easy to treat
Basal cell carcinoma: most common form of skin cancer; rarely spreads; appears as a reddish patch or open sore that does not heal

94. Carcinoma
Squamous cell carcinoma: less common, but more likely to spread; may appear as a bleeding wart, or may resemble basal cell carcinoma

95. Melanoma Malignant form of skin cancer
Starts in melanocytes and often spreads or metastasizes to other parts of the body
90% cure rate if caught before metastasis
Warning signs:
A B C D