1. True or False: Every month you have a whole new layer of skin.
Your nails grow .5mm per week.
You will shed 40lbs of skin in a lifetime.
The average amount of head hair is 120,000.
Your eyelids have the thinnest skin.
Hair grows 1cm per month.
An adult has sq.ft of skin.

2. Functions of skin Protection Synthesizes vitamin D from UV rays
Cushions and insulates and is waterproof
Protects from chemicals, heat, cold, bacteria
Screens UV
Synthesizes vitamin D from UV rays
Regulates body heat
Prevents unnecessary water loss
Sensory reception (nerve endings)
About 18 square feet

3. Key Terms Epi- “above” Derm- “skin” Hypo- “below” Kerat- “horn”
Melano- “black/dark”
Cyte- “cell”
Strata- “cover”

4. The Integumentary System
Integument is skin
Two distinct regions
Epidermis (keratinized stratified squamous)
Dermis (Dense Irregular CT w/ smooth muscle, nervous and blood tissue)
A fatty layer (hypodermis) lies deep to it- not a true layer of skin(areolar & adipose tissue)

5. Did you know? Transdermal patches Necrosis Blushing Paleness
nicotine patches, motion sickness, and those associated with alleviating chest pain
Necrosis
Cut off of blood supply (bed sores)
Blushing
Blood vessels dilate
Paleness
Blood vessel constriction (low temp. or fright)

6. Epidermis Keratinized stratified squamous epithelium
Avascular- top layer has poorer nutrient supply
Four types of cells:
Keratinocytes – deepest, produce keratin (tough fibrous protein)
Melanocytes - make dark skin pigment called melanin; absorbs UV rays preventing mutations in skin cells’ DNA
Have long, pigment-containing extensions that travel upward
Merkel cells – associated with sensory nerve endings (temperature change/ factors that can damage the epidermis)
Langerhans cells – macrophage-like cells
We have same number of melanocytes; difference is amount of melanin that is produced, the distribution and the size of the pigment granules
When blood is well oxygenated, the blood pigment makes the skin in light complected people look pink; cyanosis- blue tint, diet high in orange and yellow food makes the skin appear yellow-orange (beta-carotene); bilirubin in jaundice babies

7. Cutaneous carcinomas- cancer of basal cells (most common); light skin ppl over 40
Cutaneous melanomas- cancer of melanocytes, colored irregular shape; quick exposure to sun
Dense Irregular Tissue (connects to epidermis which is squamous epithelium)/ Areolar Tissue (to underlying organs)

8. Epidermis Keratinization Layers (from deep to superficial)
Stratum basale (germinativum) – single row of cells attached to dermis; youngest cells that divide continuously (old cells are pushed towards the skin surface).
Stratum spinosum - bundles of protein resist tension (develop desmosomes)
Stratum granulosum – layers of flattened keratinocytes producing keratin
Stratum lucidum increased keratinocytes only on palms and soles (hairless areas)
Stratum corneum – dead cells, many layers thick (eventually shed)
Keratinization
Germ- i-na tivum
Basale cells receive nutrients from the blood vessels in the dermis.
Basement, Spinsters, Grace, Lurky, Corridors
Germs spin grandparents lucidly to the coroner
Rate of cell division increases where skin is rubbed, causing growth of thickened areas call calluses or corns

9. Create an acronym to remember them!
Create a Mnemonic
Create an acronym to remember them!

11. What are the five layers of the epidermis from deep to superficial?
Bell Work
What are the five layers of the epidermis from deep to superficial?

12. Stratum Basale Lowest epidermal layer, near dermis
Good nutrient supply (cells pushed away from this layer die)
Reproduces by mitosis (cells divide continuously)
Single row of cuboidal cells, columnar in shape
Where merkel cells are located (sensory cells)
Moves to upper epidermis in 27 days.

13. Stratum Basale

14. Stratum Spinosum
Living cells (keratinocytes, langerhans cells, melanocytes)
Cells are still dividing
8-10 cells thick
Polygonal in appearance
Contain bundles of protein to resist tension (support the skin)

15. Stratum Spinosum

16. Stratus Granulosum Lucidum Poor nutrient supply
Flatten layer of keratinocytes producing keratin
3-5 cells thick
No cell division
Found only in very thick skin (palms & soles)
Translucent
Highly keratinized
Much thicker
Dead cells

17. Stratum Corneum 25-30 cells thick made of dead keratinocytes.
Cells are filled with keratin and hardened.
Sloughed off.
Outer most layer of epidermis.

18. Create a Flip Chart
Include the layers, their function and an image of the layer:

19. Remember… Four basic types of tissue
Epithelium – epidermis just discussed
Connective tissue - dermis
Muscle tissue
Nervous tissue

20. Dermis Strong, flexible connective tissue: your “hide”
Cells: fibroblasts, macrophages, mast cells, WBCs
Fiber types: collagen, elastic, reticular
Rich supply of nerves and vessels
Critical role in temperature regulation (the vessels)
Two layers (see next slides)
Papillary – areolar connective tissue; includes dermal papillae (which connect to the epidermis)
Reticular – dense irregular connective tissue “reticulum” (network) of collagen and reticular fibers

21. *Dermal papillae
*Dermis layers * *

22. Epidermis and dermis of (a) thick skin and (b) thin skin
(which one makes the difference?)

23. Fingerprints, palmprints, footprints.
Keep skin from tearing and aid in gripping objects & are “sweat films” because of sweat pores
Genetically determined
Result from dermal papillae
Finger like projects that connect the epidermis to the dermis
Elevate the overlying epidermis into ridges
Flexion creases:
Deep dermis, from continual folding

24. Hypodermis Names/meaning:
“Hypodermis” (Gk) = below the skin
“Subcutaneous” (Latin) = below the skin
“Superficial fascia”= band or sheet of connective tissue
Fatty tissue which stores fat and anchors skin (areolar tissue and adipose cells)
Different patterns of accumulation
(male/female)

25. Bell Work What layers of the epidermis go through mitosis?
What layer of the epidermis is the thickest?
What layer of the epidermis is only on the palms and soles?

26. Bell Work
Identify the three types of fingerprints. What is the function of hair? What is the lunula of the nail?

27. Skin appendages Derived from epidermis but extend into dermis Include
Nails
Hair and hair follicles
Sebaceous (oil) glands
Sweat (sudoiferous) glands

28. Create Class Questions
Play the Role
Summarize the article
Illustrate
Create Class Questions

30. Nails
Protective coverings made of keratin on the ends of the fingers and toes
Components:
Consists of a nail plate that overlies a nail bed
Lunula- white part of nail; most active growing region
Corresponds to hooves and claws
Nail Activity
This is a fun activity that requires nothing more than the individuals own fingernails. Students will do this activity to learn more about the anatomy of the nail before moving on to the anatomy of the skin and the terms that go with it.
Ask students to place their middle finger of the right hand on the skin of their right hand index finger right behind the nail. Now students should use their left hand to press down on the very end of the index fingernail of the right hand. Make sure students press down on the very tip of the nail for maximum effect. As they press down, students should actually be able to feel the nail root move with their middle finger.
Explain to students that this is the nail root and is part of the Integumentary System. Next, define the anatomy of the nail as listed below.

31. Hair and hair follicles: complex
Derived from epidermis and dermis; found everywhere but palms, soles, nipples, parts of genitalia
*“arrector pili” is smooth muscle *
Hair bulb: epithelial cells surrounding papilla
Hair papilla
is connective tissue________________

32. Functions of hair Development
Warmth
Sense light touch of the skin
Protection – scalp
Development
Develops from epidermal cells at the base of a tube-like depression- hair follicle
Components/Parts
Made of hard keratin
Root imbedded in skin
Shaft projecting above skin surface

33. Three concentric layers
Medulla (core)
Cortex (surrounds medulla)
Cuticle (single layers, overlapping
Hair growth: averages 2 mm/week
Growth Phase: growing (90% of the time)
Resting phase then shed
Hair color
Amount of melanin for black or brown; distinct form of melanin for red
White: decreased melanin and air bubbles in the medulla
Healthy person loses hairs a day (normal growth cycle); hair typically grows 2-6 yrs then rests for 2-3 months anchored in its follicle; later a new hair begins to grow from the base of the follicle, pushing the old hair outward until it drops off

34. Sebaceous (oil) glands
Entire body except palms and soles
Produce sebum (oil)
Oils and lubricates

35. Sweat glands
Entire skin surface except nipples and part of external genitalia
Prevent overheating
500 mL to 12 L/day! (is mostly water)
Produced in response to stress as well as heat
Many on the forehead, neck, back, palms and soles

36. Types of sweat glands Eccrine or merocrine Apocrine
Most numerous
True sweat: 99% water, some salts, traces of waste
Open through pores
Apocrine
Axillary, anal and genital areas only
Ducts open into hair follices
The organic molecules in it decompose with time - odor
Modified sweat glands
Ceruminous – secrete earwax
Mammary – secrete milk
Apocrine- become active at puberty

37. Bell Work Identify each type of sweat gland: Eccrine Glands
Apocrine Glands
Ceruminous Glands
Mammary Glands

38. Bell Work
What is the difference between a first degree, second degree and third degree burn (based on what you already know)?

39. Burns! Catastrophic loss of body fluids
Threat to life
Catastrophic loss of body fluids
Dehydration and fatal circulatory shock
Infection
Types
Based on the depth of burns
Total Surface Area (TBSA) affected by the burn

40. First Degree/Superficial Burn
Definition – a burn that involves only the epidermis
Sign / Symptoms:
Skin is dry and erythematous (redness of the skin caused by dilation and congestion of the capillaries)
Pain to site
The burned area blanches (temporary whitening) with pressure
Edema (if present) will be minimal (accumulation of fluid under the skin)
Like sunburn

41. Second Degree/Partial Thickness
Definition – a burn in which the epidermis is burned through and the dermis is damaged
Sign / Symptoms :
Deep, intense pain and swelling
Skin is moist
Skin will be hyperemic (pink)in color
Blister formation
Edema will be moderate

42. Third Degree/ Full Thickness Burn
Definition – a burn in which all the layers of the skin are damaged
Sign / Symptoms
Skin has a dry, leathery appearance
The skin can range in color from pale yellow to cherry red, brown, or carbon black
Severe pain around periphery of burn, but little to no pain near center of burn
Will see First and Second Degree burns surrounding the Third Degree Burn
Fat, muscle and bone may be affected

43. Burns First-degree Second-degree Third-degree
(epidermis only; redness)
Superficial partial- thickness burn
Second-degree
(epidermis and dermis,
with blistering)
Deep partial- thickness burn
1st- healing 3-6 days; 2nd – some skin functions are lost, heal 3-4 weeks but scarring may occur
3rd- most skin functions are lost, sensory nerve endings are destroyed,
2nd degree- healing depends upon stem cells associated with accessory structures of the skin (hair follicles, sweat glands, sebaceous glands); they survive because they extend into the dermis… these stem cells divide and differentiate into new epidermis
Third-degree
(full thickness, destroying epidermis, dermis, often part of hypodermis)
Full thickness burn

44. Total Body Surface Area (TBSA)
Burns can be categorized by the percentage of body surface damaged by the burn
Two Methods for Estimating the Total Body Surface Area (TBSA) affected by Burns:
Rule of Nines (RON)
Rule of Palm’s (ROP)

45. Rule of Nines (RON)
The Rule of Nines divides the TBSA into areas compromising 9% (multiples of 9%)
The Rule of Nines is an estimate and is most useful for adults and children over the age of 10.
The Rule of Nine’s is helpful for estimating the TBSA of large shaped burns.

46. Rule of Nines
Burn treatment requires estimating the extent of the body’s affected surface
Rule of Nines is used to estimate the replacement of body fluids and electrolytes lost from injured tissues & for covering the burned area with skin.

47. Rule of Palm's
The Rule of Palm’s assumes that the palm size of the patient represents approximately 1% of the TBSA.
TBSA is then estimated by approximating the number of “palms” it would take to completely cover the burn.
The rule of Palm’s is helpful for estimating the TBSA of small or irregularly formed burns.

48. Types of Burns
Inhalation Burns – burns in the upper and lower airways, caused by the inspiration of heat, toxic, smoke, or other gases.
Thermal Burns- tissue injury caused by exposure to extreme radiant heat
Industrial/Chemical Burns- occur when the patient comes in direct contact with chemical agents
Electrical Burns- electrical current, including lightning, can cause severe damage to the body. The skin is burned where the energy enters the body and where it flows into the ground. Along the path of this flow, tissues are damaged due to heat.

49. Types of Burns
Inhalation Burns – burns in the upper and lower airways, caused by the inspiration of heat, toxic, smoke, or other gases.

50. Types of Burns
Thermal Burns- tissue injury caused by exposure to extreme radiant heat

51. Types of Burns
Industrial/Chemical Burns- occur when the patient comes in direct contact with chemical agents

52. Types of Burns
Electrical Burns- electrical current, including lightning, can cause severe damage to the body. The skin is burned where the energy enters the body and where it flows into the ground. Along the path of this flow, tissues are damaged due to heat.

53. Treatment of Burns
Remove the patient from the environment where the burn occurred
Remove any substance which will continue to burn the patient
Fluid Replacement Therapy:
Second- and Third- degree burns require massive amounts of fluids to properly resuscitate a patient.
Dressings- initially, most burns can be irrigated with cool water then cover with a dry, sterile, bulky dressing

54. What are the ABCDE’s of tumors on the skin?
Bell Work
What are the ABCDE’s of tumors on the skin?

55. Tumors of the skin Benign, e.g. warts, some moles
Malignant (cancerous) – associated with UV exposure (also skin aging)
Basal Cell Carcinoma- cells of stratum basale
Squamous Cell Carcinoma - keratinocytes
Melanoma – melanocytes: most dangerous; recognition:
A - Asymmetry
B - Border irregularity
C - Colors
D - Diameter larger than 6 mm

56. Healthy Moles Symmetrical, round or oval
Border is sharp and well-defined
Color is usually uniform tan, brown, or skin color
Usually less than a quarter of an inch in diameter
Develop throughout childhood and early adulthood
Normal, benign moles usually look very similar to each other

57. Skin Cancer
Sqaumous cell carcinoma
Basal cell carcinoma
Melanoma

58. Healing of Wounds The surrounding area of a wound becomes inflamed
Blood vessels in the affected area become dilated & more permeable (provide more nutrient & oxygen which aids healing)
If a wound is shallow, epithelial cells divide rapidly
If a wound is deep…
blood clots form scabs to protect underlying tissues
fibroblasts migrate to the injured area
new collagen fibers form & new blood vessels extend beneath the scab

59. Stitches? Look at the depth of the open wound.
Can you see yellow, fatty tissue?
Is bone exposed? Is there a lot of flesh exposed?
Is the wound more than 1/4 inch (6 mm) deep?
Look at the width of the wound.
If the wound is too wide to be held together with bandaging easily, then it will need stitching as this will pull the skin together so it can heal correctly.
Look at the location of the open wound.
If the wound is in an area where you move a lot, you need stitches
Puncture wounds drain better and quicker when not stitched up

60. The Beauty in Aging The epidermis thins The dermis is reduced
Epidermal cells grow larger/ more irregular in shape but fewer
Presence of “Liver Spots”- sites of oxidation of fats in secretory cells
The dermis is reduced
Production of elastin and collagen slows; loss of fat from the subcutaneous layer result in wrinkling
Fewer fibroblasts delay wound healing
Sebaceous glands secrete less oil which dries the skin
Number of sweat glands decrease
Botox- injection of dilute botulinum toxin; blocks nerve activation of certain muscle cells including the facial muscles that control smiling, frowning, and squinting
- Chemical peels, dermabrastion, collagen injections, transplants of subcutaneous fat from the butt to the face

61. Skin Disorders
Acne (acne vulgaris)- occurs when oil glands attached to hair follicles are congested on the face, chest, and back as congested pores . If the wall ruptures, the pore is exposed to bacteria access.
Pimples- if oil breaks through to the surface, the result is a whitehead. If oil accumulates melanin pigments or become oxidized, the oil changes to black.

62. Skin Disorders
Psoriasis- Red and inflamed and may become white scaly patches; commonly found on the elbows, knees, scalp and the lower back.
Skin cells mature about 5x faster
These cells pile up on the skin's surface
Cause is linked to genes and triggers
White blood cells attack skin cells

63. Skin Disorders
Eczema- inflammation of the skin characterized by patches of red, blistering, dry, itchy skin (unknown cause).
Appearance varies
Causes intense itching can cause blisters, lesions, dry and scaly skin
Pimples- if oil breaks through to the surface, the result is a whitehead. If oil accumulates melanin pigments or become oxidized, the oil changes to black.

64. Skin Disorders
Athlete’s Foot- superficial fungal infection of the skin of the foot
Pimples- if oil breaks through to the surface, the result is a whitehead. If oil accumulates melanin pigments or become oxidized, the oil changes to black.

65. Skin Disorders
Vitiligo- pigmentation disorder in which melanocytes in the skin are destroyed resulting in white patches that appear on the skin in different parts of the body.

66. Skin Disorders
Albinism- a recessive inherited disorder in which melanin is not produced

67. What happens to the layers of skin as you age?
Bell Work
What happens to the layers of skin as you age?

68. Trash Ball Two Groups Question given to each individual of each group
If the student gets the answer correct, the team gets one point… the student gets to throw the ball into the trash can
If you choose to throw from across the room and you make it, the team gets 3 points
If you choose to throw from 6 feet and make it the team gets 1 point.
The next team gets their chance.