“SKIN” Integument System.

“SKIN” Integument System

Now everything so far has been just an introduction
Now everything so far has been just an introduction. Now Anatomy class begins! We’ll discuss the organ systems of the body one by one. For each system, we’ll discuss its function, the individual organs, its tissues, and clinical significance.

Integument System Integument System Organs Skin Hair Nails Glands

Integument System Functions Protection Thermal Regulation
Abrasion Infection UV light Dehydration Thermal Regulation Insulation (fat keeps you warm) Cooling (sweating cools you down) Sensory Reception Vitamin D Production Communication (raised eyebrows) NOTE Vitamin D is made in the dermis of the skin, after exposure to sunlight. It’s function is to allow calcium to be absorbed from the foods you eat so your blood calcium levels are normal.

Skin – our largest organ
The Skin Skin – our largest organ Accounts for 7% of body weight…it weighs twice as much as your brain! Divided into three distinct layers Epidermis (‘epi” means above something) Dermis Hypodermis (“hypo” means deep to something) A hypodermic needle means a long hollow needle that reaches all the way from the epidermis to the hypodermis. Remember, the term “SKIN” refers to all three layers: epidermis, dermis, and hypodermis.

Skin Structure Figure 5.1

EPIDERMIS Primarily made up of keratinized stratified squamous epithelium The EPIDERMIS is the layer that gives strength to the skin. Varies in thickness from a few cells (eyelids) to dozens of cells thick (palms and soles of feet) It does not have any vascularization (blood supply), so it relies on absorbing oxygen and nutrients from the blood vessels in the dermis deep to it. The nails are made in the epidermis.

Layers of the Epidermis
Stratum corneum (most superficial layer of epidermis) Stratum lucidum (only in thick skin) Stratum granulosum Stratum spinosum Stratum basale (the deepest layer of epidermis)

How to remember the layers of the epidermis
The epidermis has five layers. From deep to superficial, they are the stratum basale, stratum spinosum, stratum granulosum, stratum lucidum, and stratum corneum. To remember which one is the deepest layer, visualize your basement. That is the stratum basale. To get from your basement (deepest layer) to the roof (superficial layer), walk up your basement stairs...be careful! They are covered with cactus spines (stratum spinosum). That leads you to the kitchen, where someone has spilled sugar all over the floor (stratum granulosum). Then you go upstairs and stop to put on suntan lotion before you go to the roof. The stratum lucidum is like a layer of suntan lotion; it protects from UV rays, but is only present on the palms and soles, so that's where you picture yourself applying the lotion. Now you are ready to go to the roof and enjoy a nice corn on the cob (stratum corneum).

Epidermal Cells and Layers of the Epidermis
Figure 5.3

STRATUM BASALE: has 4 types of cells
The cell type that makes the epidermis is a KERATINOCYTE Keratin is a protein made by these cells. Keratin is waterproof and strong Merkel cells: used as sensory receptors for the sense of light touch. MACROPHAGES: ingest debris MELANOCYTES produce MELANIN (dark brown pigment) Everyone has the same number of melanocytes But they don’t all make the same amount of pigment, so people have different skin colors.

Melancholy Greek "melan " ("black, dark") and "cholē" ("bile"). Medical practitioners once adhered to the system of humors—bodily fluids that included black bile, yellow bile, blood, and phlegm. An imbalance of these humors was thought to lead to disorders of the mind and body. One suffering from an excess of black bile (believed to be secreted by the kidneys or spleen) could become sullen and unsociable—liable to anger, irritability, brooding, and depression. Today, doctors no longer ascribe physical and mental disorders to disruptions of the four humors, but the word "melancholia" is still used in psychiatry as a "subtype" of clinical depression. Melanin is a dark brown pigment, found in the epidermis.

STRATUM BASALE: This is the only layer of the epidermis where the cells are dividing. As new cells are made in the S. Basale, the older cells get pushed up and become the next layer (S. Spinosum)

Figure 5.3

STRATUM SPINOSUM They are now attached to each other by desmosomes, which are pointy/spiny (“spinosum”) The cells are still alive, but they no longer divide in this layer Also contains Langerhan’s cells, which are white blood cells that function in the immune response. They are made in the red bone marrow. The stratum spinosum provides the strength to the epidermis

Figure 5.3

STRATUM GRANULOSUM As more new cells are made in the S. basale, the S. spinosum layer is pushed up to become the S. granulosum layer. The cells in the S. granulosum begin to die because they are now too far from nutrient source (in dermis). The cells now have a grainy appearance, so this layer is called the stratum granulosum.

KERATIN Keratin is a waxy protein substance only found in the epidermis. It makes up the nails, hair, and is also in each superficial skin cell. It can absorb water, so keratin swells when soaking wet. It makes the skin look wrinkled when you are in the tub too long. The water evaporates when you dry off, and pulls more water out of your body, so soaking in the tub will dry your skin out…unless you put lotion on right away to keep the water in the epidermal layers. Lotions will not penetrate to the dermis, just water.

MOISTURIZER CREAMS The secret ingredient of all moisturizers is WATER. They work superficially on the epidermis. Although keratin is waterproof, it swells when wet. So, if you put a moisturizer on skin, stratum corneum expands, and hides wrinkles. You get the same effect by soaking in the tub and putting on any lotion, and that’s cheaper than expensive creams.

Figure 5.3

STRATUM CORNEUM As more new cells are made in the S. basale, the cells are all pushed up again, and the S. granulosum layer becomes the S. Corneum. In this layer, the dead cells fill up with KERATIN. The cells lose their nucleus and fuse to squamous (flat) sheets, which are shed from the surface in about 2 weeks. This process is called desquamation. The main difference between thick skin and thin skin relates to the thickness of the Stratum corneum. It takes about days for a cell to move from the stratum basale to the stratum corneum and another 2 weeks for it to shed We lose half a million cells per hour; 1.5 grams a day That can be a major source of dust in the house Dust allergies are actually from the feces and saliva of dust mites which eat the dead skin. One house has 3 million poops per day from dust mites!

Figure 5.3

STRATUM LUCIDUM This layer is only on the palms and soles It is just deep to the S. corneum and superficial to the S. granulosum This THIN layer provides protection from UV radiation.

Why do black-skinned people have lighter colored palms and soles?
Only the Stratum Basale has pigment-containing cells, but the stratum lucidum contributes the color of protein, which is an orange- tan color. In the palms and soles, the stratum lucidum is present. The tan colored protein blocks the underlying melanocytes from view.

Conditions of the Epidermis
If you frequently rub one area of the skin, it stimulates cell division = callous If you rub the skin too hard, the stratum basale tears away from the basement membrane, and causes a gap, which fills with fluid: BLISTER. The epidermis then dies because it’s too far away from nutrients. That’s why the top of a blister dries up. If the blisters are small (less than 5 mm in diameter), they are known as vesicles; if they are larger (greater than 5 mm in diameter), they are termed bullae.

Vesicles

Bullae

Skin Healing Individual skin cells do not have a high metabolic rate, and construction of scar tissue is more difficult than making normal skin. You get a scar only if the dermis is excessively damaged. Remember that the epidermis does not have blood supply and the fibroblasts are only present in the dermis, and they make the collagen and repair wounds. The skin is capable of repair, even after serious damage, because stem cells persist in both the epidermis and the dermis.

Skin Cancer: This is the most common cancer in the USA, and the major risk factor of all skin cancers is exposure to ultraviolet light. Three major types: BASAL CELL CARCINOMA 2) SQUAMOUS CELL CARCINOMA 3) MELANOMA The second most common type of cancer is lung cancer. The least common (of the common cancers) is leukemia.

BASAL CELL CARCINOMA: Cancer of the blood vessels in the dermis. The most common type of skin cancer, accounts for about 75% of the skin cancers. Almost never metastasizes or crosses the basement membrane, so is almost never fatal. It is the most easily cured: surgical removal, no chemotherapy or radiation usually needed. Symptoms are minor: shiny nodules, usually on nose, face, or other sun exposed areas. NOTE: signs are what a doctor sees, symptoms are what a patient experiences.

BASAL CELL CARCINOMA: Cancer of the blood vessels. Almost never metastasizes or crosses the basement membrane Looks like shiny nodules Figure 5.11

Basal Cell carcinoma

Reconstructive Surgery for Basal Cell Carcinoma

Basal cell carcinoma, when left untreated.
This 74-year-old man developed an enlarging tumor on his left medial canthus 3 years ago. He had been unable to wear his glasses for two years and sought medical attention when this tumor offended other members of his church. Ulceration, crusting, and drainage developed recently. The tumor was 12 centimeters in diameter, malodorous, and draining a foul serous fluid. Surgical excision was easier than expected, because the tumor was attached by a pedicle which spared the orbit.

2) SQUAMOUS CELL CARCINOMA 25% of all skin cancers Will metastasize if not treated.

Actinic Keratosis A premalignant condition of thick, scaly, or crusty patches of skin. It is more common in fair-skinned people, in sun-exposed areas of skin. 20% of these lesions progress to squamous cell carcinoma. They begin as flat, dry, scaly areas, and later grow into tough, wart-like lesions.

3) MELANOMA: cancer of the melanocytes of the epidermis; least common (about 1% of skin cancer) Highly metastatic, causes 75% of skin cancer deaths. Asymmetrical, sharp but irregular borders and edges Not uniform in color.

The warning signs in moles: ABC's: A is for Asymmetry, where one side of the mole looks different than the other side. B is for Border, where the border is jagged or irregular instead of smooth and regular. C is for Color, where the mole contains more than one color.

Excoriations is the term for scratch marks on the skin.
The medical term for a mole = nevus (plural = nevi). Moles stick upward from the skin. The medical term for a freckle or any other pigmented area that is flat and does not stick upwards from the skin = macula Excoriations is the term for scratch marks on the skin. How cancer cells grow:

The medical term for dry skin is xerosis.
Terminology The medical term for dry skin is xerosis. There are many things that can cause xerosis. The medical term for inflamed skin is dermatitis. There are many things that can cause it.

Seborrheic dermatitis Psoriasis Vitelligo
Conditions of the Skin Eczema Atopic dermatitis (autoimmune allergy to own skin) Contact dermatitis (allergy to something touched) Seborrheic dermatitis Psoriasis Vitelligo

Itchy red skin that comes and goes.
Eczema Itchy red skin that comes and goes. The most frequently occuring form of eczema is ATOPIC DERMATITIS. Caused by an autoimmune reaction.

Atopic dermatitis Triggered by allergens like soaps, cosmetics, clothing, detergents, jewelry, or sweat. Can be triggered by changes in weather or stress. Tends to run in families. Treatment is lubricant creams daily and steroid creams during outbreaks.

Contact dermatitis Localized reaction from an allergy to something you touch. Common allergens are plastic shoes, latex gloves, detergents, perfume, makeup, jewelry, etc. People with a history of allergies are more likely to get contact dermatitis from these objects.

Contact Dermatitis

Seborrheic dermatitis
In Children, it is called “Cradle Cap” In Adults, it is called severe dandruff Caused by an allergy to the fungus that we all have around our hair roots. The skin cells proliferate in an attempt to shed the fungus. The results is severe dandruff that does not respond to regular dandruff shampoo. Treatment is shampoo with ketoconazole (steroid) or coal tar. Usually works for one year, then you have to switch to another product for a year, then switch back.

Seborrheic dermatitis

Psoriasis An autoimmune disease of the skin (the body’s immune system thinks the skin is foreign so it attacks it). Causes silvery flaking of skin, especially knees, elbows, scalp. It is not itchy There are treatments, but no cure. Treatments include shampoo with coal tar or steroids.

Psoriasis

Laser treatment for psoriasis lesions

Vitelligo An autoimmune disease of the skin Destroys melanocytes, especially in areas of friction (eyelids, mouth, hands) Causes depigmentation.

Mongolian Spots Mongolian spots are benign, flat, congenital birthmarks that looks like bruises, usually on the buttocks and legs. They are extremely prevalent among Asians and Native Americans. They normally disappear three to five years after birth. Child care workers need to be informed by the parents that their child has these spots. Otherwise, the worker might report the parents for child abuse.

Mongolian Spots

DERMIS: 1) PAPILLARY LAYER (Papillary = “Pimple”. Has bumps). This is the more superficial layer. 2) RETICULAR LAYER

Dermis Figure 5.1

Dermis 1) PAPILLARY LAYER (Papillary = “Pimple”. Has bumps)
The papillary layer of the dermis; LOOSE connective tissue. Has ridges to increase surface area for contact with the epidermis because the blood vessels and nutrients from them are only in the dermis. The papillary layer in the DERMIS is what forms our fingerprints. Surgeons make incisions on the body based on the lines of cleavage of the skin formed by the papillary layer of the DERMIS

Skin lines of cleavage

Lines of cleavage

Dermis Figure 5.1

Dermis 2) RETICULAR LAYER DENSE IRREGULAR Connective Tissue Gives the dermis its strength. Remember, the epidermis is the strongest layer of the SKIN, but the reticular layer of the dermis is the strongest layer of the DERMIS. The stratum spinosum is the strongest layer of the epidermis. This layer has lots of COLLAGEN and ELASTIN (elastic fibers) The DERMIS is where most of the body’s collagen is found. Stretch marks are caused from tiny tears in the collagen of the DERMIS. Leather is made of the dermis.

The dermis is also the area where all the glands of the body are located.
A transdermal patch (nicotine patch, etc) must diffuse all the way from the epidermis into the dermis to reach the blood vessels there. The blood vessels in the dermis are what gives a pink color to Caucasian people.

Dermis Meissner's Corpuscle: nerve receptors in the dermis for light touch Pacinian Corpuscle: nerve receptors in the dermis for vibration and pressure

NOSE PIERCING Let me warn you about nose piercing: There is a region of the face called the “Danger Triangle” which goes from between your eyes to your upper teeth. All of the blood in this region drains into the brain, so infection there can cause meningitis and death in hours. A cut on the forehead isn’t so bad, but a cut on the cheek near the nose is considered very dangerous and needs immediate antibiotics. A nose piercing can become a serious infection because some of the worst bacteria in the body is in the nose…that’s why your mother always told you not to pick your nose. Can you imagine if you put a hole in your nose and it got infected? A nose piercing that gets infected can cause meningitis.

Danger Triangle

Dermis Conditions What happens when you get cut? Bleed, then clot Macrophages eat foreign bodies and dead cells Fibroblasts lay down collagen to repair the wound. If they produce more than normal, you get a SCAR. If skin is cut with the grain (line of cleavage), scar is not bad. Against the grain, the scar is worse. Some people are more prone to scar tissue than others.

Keloid Scars Keloid Scars Thick, red, sometimes painful scars More common in African American, Native American, and Asian races Treatment with cortisone injections Keloid scar formers can get internal adhesions also

Keloid Scars

Another type of scar tissue is called an adhesion.
This is scar tissue in the deeper layers of the body, such as right outside of the intestines, outside of the ovaries, etc. Some people form adhesions spontaneously from the organs rubbing against each other. If the adhesions cause symptoms, they might need a surgery to clean them away. Here are some photos of deep tissue adhesions.

Cutting the adhesions away

Dermis Conditions Stretch Marks Caused by sudden weight gain (pregnancy) Expansion of skin, collagen fibers in the dermis separate = stretch marks.

Do Lasers Remove Stretch marks?
Claim Lasers are used to stimulate new collagen growth and fill the stretch mark from the bottom up. The laser energy is absorbed in the dermal layer of the skin stimulating the production of new collagen. As the new collagen thickens and plumps the skin, it fills in the stretch mark from below. Rebuttal Although some physicians claim that lasers are effective in removing stretch marks, the American Medical Association states that there is no evidence to support this. Most plastic surgeons think that lasers are ineffective in treating this problem. Lasers are effective in removing, vaporizing, and breaking down tissues. They do not generally repair tissues. Stretch marks represent torn tissue. Hence, improvement should not be expected from laser treatment. Moreover, clinical studies have shown no improvement in stretch marks after laser treatment.

WRINKLES Over time, collagen fibers align themselves more and more as they are always being pulled in the same direction: smile, frown. As you age, the skin begins to sag because the body makes less collagen, and some is lost from sun exposure. Pinch your grandma’s skin. Does it bounce back, or ooze back? What can be done about wrinkles? Not much. A face lift clips off extra skin. Creams don’t work. Trying to fix a collagen problem with a cream is like trying to shampoo your carpet by putting the cleaner on the roof!

COLLAGEN INJECTION Collagen is injected into hypodermis. Lasts up to six months if injected into areas that do not move much. Smile lines need a new injection every 3 months.

The source of collagen for injections is either from bovine (cow), porcine (pig) or human skin.
Some people are allergic to the preservatives or to the animal collagen. They can have their own collagen removed from one part of their body, have it sent to a lab for purification, and injected into where they want it (expensive!).

Complications of collagen injections

BOTOX This is a deadly poison which paralyses the muscles, making them sag. That releases the tension, and relaxes the skin line. In 3 months, new muscle cells are made, so wrinkles come back, and need new injection.

Botox Before and After: scam photos; the patient was told to crinkle the eyes in the “before” shot.

Botox Before and After: realistic photos

What is it like to be disfigured?
Physical Appearance What is it like to be disfigured? I'm 18 and was born with a cleft lip and palate. Your self-esteem can suffer a lot. I know mine did, as a young teenager. You can feel alone, and trapped, and that no one can solve these problems. It's self-consuming, unhealthy, and depressing. However, as you grow older and realize that the world is a much, much bigger place than yourself, your confidence multiplies. You'll still have your 'down' days, but then so does everyone.

What is it like to be disfigured?
Physical Appearance What is it like to be disfigured? It's a blessing in many ways... You can see beyond the appearances, understand the kinds of pain others experience. You see beauty everywhere; you appreciate it in all its forms. You appreciate what you can do, even more. You learn to live and love without pretense. You know how to talk to people nicely. You seize opportunities to learn and develop yourself in other ways, defining yourself beyond your "deformity". You just accept the facts of life, the funny ways in which its cards are dealt. You find the humor. You take pretty much everything less seriously. You don't get bogged down following the crowd. You do your own thing - what genuinely makes you happy . And the people who like you... really, really, really do! It's a massive bonus.

Scurvy Scurvy is a disease resulting from a deficiency of vitamin C, which is required for the synthesis of collagen in humans. The chemical name for vitamin C, ascorbic acid, is derived from the Latin name of “scurvy”. Scurvy often presents itself initially as symptoms of malaise (feeling ill) and lethargy (very tired), followed by formation of spots on the skin and pale, bleeding gums.

Scurvy Spots are most abundant on the thighs and legs, and a person with the ailment looks pale. As scurvy advances, there can be open, suppurating (“weeping”) wounds, loss of teeth, and can go on to be fatal.

Scurvy Scurvy was at one time common among soldiers and sailors who were unable to obtain perishable fruits and vegetables. Most animals can make their own vitamin C, so they don’t get scurvy. Vitamin C is destroyed by the process of pasteurization, so babies fed with ordinary bottled milk sometimes suffer from scurvy if they are not provided with adequate vitamin supplements. Virtually all commercially available baby formulas contain added vitamin C for this reason.

Foods high in vitamin C Citrus fruits such as oranges or lemons, blackcurrants, guava, kiwifruit, papaya, tomatoes, bell peppers, and strawberries. It can also be found in some vegetables, such as carrots, broccoli, potatoes, cabbage, spinach and paprika.

HYPODERMIS: This is the fat layer. It varies tremendously in thickness: Shins = thin; Buttocks = thick. It also contains fibrous tissue, blood vessels and nerves and sits on top of the muscles. Functions 1) Stores fat 2) Cushions 3) Insulation from cold because of heat produced by the larger blood vessels in this layer.

Dermis Figure 5.1

Hypodermis Conditions
Hypodermis is not connected to the muscle under it. Therefore, exercising muscle will not burn off fat only in that area. Fat is burned off equally over entire body. Losing 10 lbs is like loosing ¼” off whole body. More noticeable in face than in hips. By the way, there’s no such thing as cellulite. The term was invented by marketers. It is NOT a special type of fat. It’s just fat, the same as every other fat. It looks like wrinkled, “orange peel” skin because the collagen fibers on top of it bind it down like a net. There is no such thing as a cream to get rid of adipose. (Don’t confuse cellulite with cellulose, a plant fiber)

Cellulite is just fat, protruding around fascia fibers

LIPOSUCTION This is a surgical procedure where the patient has fat sucked out of the hypodermis layer. Liposuction is dangerous because hypodermis is very vascular, can bleed too much. LIPOSUCTION SURGERY VIDEO

BURNS: Three types: FIRST DEGREE: Minor burn to the epidermis; sunburn SECOND DEGREE: Dermis separates from epidermis; blister THIRD DEGREE: Hypodermis is burned. (most severe type of burn) 2˚ and 3˚ burns over a large part of the body gives a survival chance proportional to the amount of skin left. 60% burn = 60% chance of dying.

Estimating Burns Using the Rule of Nines
Figure 5.10a

Third Degree Burn

Why are deep burns so dangerous? 1) Infection
2) Dehydration: nothing to keep fluid in body. Therefore, they need a skin graft. Skin grafts can be from a cadaver, animal, artificial, or from another part of the same person’s body. Skin grafts cause lots of scarring.

Skin graft mesher

DECUBITUS ULCERS (bed sore)
Epidermis and dermis are destroyed from pressure, underlying tissue is exposed. How decubitus ulcers form: If you’re sitting down, weight of the body presses against blood vessels, no blood flow to skin of buttocks. In you, it’s ok, because you’ll be walking around again soon. But if it goes on longer than a couple of hours because one can’t move, tissues can’t get oxygen. Ulcer forms, can get gangrene (tissue death). It can also become systemic (bacteria enter the wound, travel in the blood), which can cause death. Whose fault is it? The nurse’s, for not moving the patient every couple of hours.

Decubitus Ulcers

Cellulitis Cellulitis is inflammation in subcutaneous layers of the skin, due to infection. Cellulitis can be caused by normal skin flora (bacteria) or by exogenous bacteria, and often occurs where the skin has previously been broken: cracks in the skin, cuts, blisters, burns, insect bites, surgical wounds, intravenous drug injection or sites of intravenous catheter insertion. Treatment with appropriate antibiotics is needed, and recovery periods last from 48 hours to six months.

SKIN COLOR; Caused by four things:
1) MELANIN: (dark brown pigment). More melanin, darker the skin. 2) CAROTENE: (a yellowish/orange pigment found only in plants). Accumulates more in the skins of Asians and Native Americans. 3) SKIN THICKNESS: thinner skin see blood vessels, looks pinker 4) HEMOGLOBIN: The DERMIS contains the blood vessels that give Caucasians the pink color to the skin. Even veins are red because blood is red. But when you look at veins through the adipose layer (the hypodermis), they look blue.

Carotene Dietary sources of carotene (These are also high in Vitamin A) sweet potatoes carrots cantaloupe melon mango apricots spinach broccoli

CONTUSION: “Bruise” Why does a bruise look black and blue? The vessels in the hypodermis are ruptured, and the blood leaks out; looks blue. As it ages, the hemoglobin breaks down to a green color, then a yellow color. The color of the bruise depends on the age of the bruise.

CYANOSIS: Bluish color to skin.
Caused by superficial blood vessel constriction in the dermis or lack of blood flow to skin Occurs for two reasons: 1) Cold 2) Not enough oxygen in body to go around. The oxygen is conserved for the vital organs, so oxygen to skin and nails is shut down.

Cyanosis

TATTOOS Pigment is injected into the dermis. If the needle is sterile, there’s no health risk. However, the pigment diffuses with time. What looks good in your 20’s will look like a blob when you’re 50.

TATTOO REMOVAL The tattoo you got years ago seemed like a great idea at the time. But if you now wish it could disappear, you're not alone: 1 in 8 tattooed Americans now regret getting "inked." Tattoo removal is a long and laborious process. So now some people are going the do-it-yourself route. "We had a patient once who had used salt to try to scrub the tattoo off," said dermatologist Dr. Amy Derick. Some have even tried safety pins to try to poke the pigment out. For some, do-it-yourself treatments can cause serious side effects like infection, scarring and skin discoloration. Doctors say successful treatment depends on the size, color, location, and age of your tattoo. It can take 18 months with laser treatment to remove the tattoo successfully.

Laser Tattoo Removal Laser treatment is just burning the ink out of the dermis; may leave a scar. Depending on the color of the tattoo ink, it may only cause it to fade.

Laser Tattoo Removal

Tattoo Removal SC Student:
I went through a series of 8 treatments about 2 months apart each lasting less than 5 minutes for both spots. The laser is focused on the dark pigment and blasts it to bloody raw skin; then Neosporin is applied until it is completely healed, then it is blasted with the laser again. The laser boils all the water in each cell, turning it to steam immediately. After many treatments of penetrating deeper and deeper to get to the dermis, the cells containing the pigment are eventually all blasted away. The lower back area hurt much more than my shoulder laser work.

After 5 treatments Shoulder Back

After 8 treatments (16 months)

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Hemangioma Hemangioma: enlargement of the lining of blood vessels Laser treatment works well

Strawberry Hemangioma

Laser treatment of blood vessel problems

There are about 2 million hairs on the body; 200,000 on the scalp.
Arrector pillae Hair root Hair matrix Hair papilla

Longitudinal Section of Base of Follicle
Figure 5.5c, d

ARRECTOR PILLI: tiny muscles that make the hairs stand up during “goosebumps”.
HAIR PAPILLAE: what is destroyed by electrolysis, so hair won’t grow back. The HAIR MATRIX is the leading edge of the papillae. It is actually skin cells (keratinocytes) which are rapidly dividing. When they die, the new ones push them out, forming the hair. Hair is just dead skin cells. The HAIR ROOT is just the base of the hair. The hair matrix is the part of the follicle that is the site of hair growth and the location of the melanocytes that determine hair color. Hair that goes grey has lost its melanin pigment. Differences in uncut hair length result from both variations in hair growth rate and duration of the hair growth cycle.

Hair Loss Hair loss in men and women is due to the presence of a male hormone (an androgen) called DHT. Men who have gene for baldness show male pattern baldness. Women who have the baldness gene don’t have as much of the male hormone; they just get thinning of the amount of hair. Women get the baldness gene from their father, and men get the gene from their mothers. A man can tell if he will go bald by looking at his mother’s father.

Hair Loss Hereditary hair loss and premature greying are some of the most common genetic conditions. Hereditary baldness, in men also known as male pattern baldness, is not exclusively a male concern. An estimated 25% of women suffer from female pattern baldness but, since their hair loss is diffuse, it is not as easily recognizable as the male form.

Life Cycle of Hair For most hair loss treatments to be effective, the hair's growth phase has to be interrupted and the hair shed. Only the new budding hair that comes out of a hair follicle after a short resting period can be of noticeably better quality than its predecessor. This replacement can sometimes come in a shock wave called shedding and it is frequently misunderstood by hair loss sufferers as a negative reaction to the new treatment and so the treatment is then discontinued.

Life Cycle of Hair The life cycle of hair is divided into three phases. The actively growing (anagen) phase, the transitional (catagen) phase and the resting (telogen) phase. Growth phase: 3-6 years, growing 10mm a month. About 85% of the hair on any head at any given time is in the growth phase. At the end of this period, blood supply to the hair bulb slows down and eventually stops. As a result, the hair ceases to grow and moves into the transitional phase, which lasts only about two weeks. Resting phase:,hair just sits on the head for about three months. Then, it falls out, to be replaced by the next budding hair in the growth phase which begins to grow from the same hair follicle.

Life Cycle of Hair These replacement hairs get finer and thinner due to an increase in an androgen hormone (DHT) as a person ages. In most settings of baldness, the hair follicle finally shuts down and refuses to produce more hair to replace the ones that have fallen out. Good treatment enables you to maintain the hair you have remaining. The maximum improvement you can expect is to regain the hair you have lost in the last three years. Do not wait for too long. The later you start treating the baldness, the less successful your treatment will be. Do not let your follicles die. You need at least the vellus hair (peach fuzz) to start with.

Current antiandrogen modes of action include
Hair Loss Medicines Current antiandrogen modes of action include (a) preventing the creation of DHT (b) preventing DHT from binding to the receptor site (c) blocking activity in the androgen receptor itself. There are two FDA-approved oral medicines for treating hair loss: Finasteride (Propecia) and Minoxidil (Rogaine).

Hair Loss Medicines Finasteride (Propecia) It is the first and only FDA-approved pill proven to treat male pattern hair loss on the vertex and middle front of head. The great majority of dermatologists agree that this is currently the No.1 cure for hair loss. In tests, 66% of men grew hair in back and 42% grew hair up front. Almost all the rest stopped losing hair. It cannot be used by women. Dutasteride is another pill that may be receiving FDA approval soon. It appears to be at least as powerful as finasteride, but it is more expensive.

Hair Loss Medicines MINOXIDIL (Rogaine) comes as a pill and a topical foam that are both used by the patient. It is available over the counter. Minoxidil is a vasodilator that was originally used to treat severe blood pressure. Its bizarre side effects, such as the ability to reverse or slow down the balding process, were accidentally discovered in the late 1970s. Minoxidil promotes enhanced follicular size, resulting in larger hair shaft diameters. It also stimulates and prolongs the growth phase of the hair growth cycle. It takes 4 months to notice results Rogaine's effectiveness is established in front and back for women but only in back (vertex) for men. After 1 year of use, 48% reported moderate to dense re-growth of hair, 36% reported minimal re-growth, and 16% reported no re-growth. Once started, topical minoxidil treatment is a lifetime commitment if the treatment proves effective. If regular application of topical minoxidil is halted, all hair grown in response to the therapy will be rapidly lost over the next 3 to 6 months.

Hair Loss Medicines SPIRONOLACTONE is a diuretic used to lower high blood pressure. In addition, it possesses anti-androgenic properties as it binds to the androgen receptor in the hair follicle and thus prevents it from interacting with DHT. Hence, spironolactone is also used to treat acne, hirsutism (excess body hair) and hair loss in women. It is not for oral use by men, because it causes impotence, loss of sex drive, and breast development.

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Split end of hair

Head louse

Eyelash Mite

Eyelash Mites VIDEO

FUN FACTS The 'bone' in a rhinoceros' horn is simply a mass that is not attached to the skull and is made of a protein found in our hair and fingernails called keratin. At birth, the dolphin arrives into the world with a moustache. But due to a natural depilatory process, within a short period of time the moustache falls off by itself. The stripes on a tiger are not found just on its coat; the skin of this predator is also striped. But curiously enough, even though the zebra's coat is striped, its skin is not.

Chemotherapy causing hair loss
Chemotherapy causes hair loss because the drugs target any cell that is rapidly dividing. Since the hair roots divide rapidly, they are killed off along with the cancer cells. The stomach lining is also rapidly dividing, so they also get nausea. Fun fact: Men without hair on their chests are more likely to keep the hair on their head, but are more likely to get cirrhosis of the liver. Men with hairy chests are more likely to go bald.

Electrolysis Electrolysis involves sticking a fine wire into the follicle and administering an electrical current to kill the hair papillae. Treatments are repeated weekly for up to 18 months. Hair follicles that are in the telogen phase are more difficult to destroy than hair follicles in the anagen phase. Shaving approximately 3 days before an electrolysis treatment ensures that the hairs that are visible and encourage them to enter into the anagen phase. Finally, side effects can include pain, infection, keloid formation (for people who are susceptible), hyperpigmentation, or hypopigmentation.

Piebaldism: a rare autosomal dominant disorder of melanocyte development, causing a congenital white patch of hair.

HAIR FOLLICLES

Fun Fact: How does heat straighten hair?
There are three types of bonds that make up hair. Salt (hydrogen) bonds are broken by heat. When the heat hits the hair the salt bonds break. When the hair cools the bonds rebuild themselves in its new shape. When the hair gets wet, it goes back to its normal position. Chemicals can be applied to hair to straighten it or to curl it. The chemicals break the stronger (covalent) bonds in the hair and cause the bonds to reform in the desired position. When the hair gets wet, it stays in the new shape. Coloring hair strips the color from the shaft and replaces it with a dye. The new color may fade with time.

Structures Associated With Hair Follicles
SEBACEOUS GLANDS Each hair has a sebaceous gland. These glands are therefore found all over the body Produce sebum (oil that coats the hair and epidermis) When you wash it away, the skin gets dry if you don’t put on lotion right away. The best moisturizer is lanolin, which is made from sheep sebum.

PIMPLES Some of the largest sebaceous glands are associated with the smallest hairs (face). Pimples begin when oil gland ducts (sebaceous glands) become blocked by viscous (thick) sebum and the gland swells. The sebum in the gland is exposed to oxygen and turns black, called a blackhead. The black part of a blackhead is oxidized sebum. In puberty, there is an increase in hormones, and an increase in gland secretion, leading to pimples.

Pimple

Sebaceous and Sweat Glands
Figure 5.1

Acne and skin aging: http://www.skintactix.com/free_radical_damage.htm
After years and years these cells become more and more damaged. Eventually, the collective cells that make up organs become so damaged the organ fails to function, such as the loss of vision or hearing as people age. This process of damage and dysfunction of the vital organs eventually leads to death. Most of this damage is caused by free radicals. Free radicals are minute chemical particles (atoms or groups of atoms) which are frequently the by-products of chemical processes. For example, when two chemicals join together to form another chemical, some particles are eliminated and these can be free radicals. Free radicals have at least one unpaired electron, causing the chemical particle to be unstable. To become stabilized the particle must obtain an electron from some another chemical. By taking an electron from another chemical, the free radical becomes a stable chemical, but the other chemical now becomes a free radical and its chemical structure is changed. It must then steal an electron. Thus the chain reaction (of atoms stealing electrons) continues and can be thousands of events long. The skin produces hydrogen peroxide to fight each acne infection and this may continue for weeks, until the infection is resolved. Hydrogen peroxide is a free radical which causes skin damage and skin aging. Over a period of time the volume of hydrogen peroxide acts just like continual sun exposure, damaging skin components such as collagen and causing the skin to sag and wrinkle.

Acne Vulgaris Acne develops as a result of blockages in hair follicles. Hyperkeratinization and formation of a plug of keratin and sebum (a microcomedo) is the earliest change. Enlargement of sebaceous glands and an increase in sebum production occur with increased androgen (DHEA-S) production at adrenarche. The microcomedo may enlarge to form an open comedone (blackhead) or closed comedone (milia).

Acne Vulgaris Comedones are the direct result of sebaceous glands' becoming clogged with sebum, a naturally occurring oil, and dead skin cells. In these conditions, the naturally occurring largely commensal bacterium Propionibacterium acnes can cause inflammation, leading to inflammatory lesions (papules, infected pustules, or nodules) in the dermis around the microcomedo or comedone, which results in redness and may result in scarring or hyperpigmentation.

Clinical Manifestations
Closed comedone (Whitehead): when a pore clogs up beneath the skin and closes. Open comedone (Blackhead): when a pore clogs up and reaches the surface of the skin, but stays open. Papules: inflamed, tender lesions that pop up as small, pink bumps on the skin. Pustules: pimples topped by white or yellow pus-filled lesions. Cysts and nodules - large, inflamed, pus filled lesions deep under the skin that can cause pain and scarring.

Acne Vulgaris Lesions Lesions can be described in 3 categories, as follows: Comedonal: The open comedo appears as a flat or slightly raised lesion with a central dark-colored follicular impaction of keratin and lipid. The closed comedo is a pale, slightly elevated, small papule without a visible orifice and is a potential precursor for the larger inflammatory lesions. Open comedone (blackhead) Closed comedone (whitehead)

Acne Vulgaris Lesions (con’t)
Inflammatory: Inflammatory lesions vary from small papules with an inflammatory areola to pustules to large, tender, fluctuant nodules (nodular). Scars: These appear as depressed or hypertrophic papules of varying sizes and shapes. Inflammatory Scars acne

Acne Vulgaris: Cause GENETIC PSYCHOLOGICAL DIETARY HORMONAL
The tendency to develop acne runs in families. PSYCHOLOGICAL It is associated with increased stress levels DIETARY A high glycemic load diet is associated with worsening acne. There is also a positive association between the consumption of milk and a greater rate and severity of acne. Other associations such as chocolate and salt are not supported by the evidence. However, products with these ingredients often contain a high glycemic load. HORMONAL

Acne Vulgaris: CAUSE HORMONAL CAUSES Hormonal activity, such as menstrual cycles and puberty, may contribute to the formation of acne. During puberty, an increase in male sex hormones called androgens cause the follicular glands to grow larger and make more sebum. Use of anabolic steroids may have a similar effect.

Acne Vulgaris Development of acne vulgaris in later years is uncommon, although this is the age group for rosacea, which may have similar appearances. True acne vulgaris in adult women may be a feature of an underlying condition such as pregnancy and disorders such as polycystic ovary syndrome or the rare Cushing's syndrome.

Acne Vulgaris Menopause-associated acne occurs as production of the natural anti-acne ovarian hormone estradiol fails at menopause. The lack of estradiol also causes thinning hair, hot flushes, thin skin, wrinkles, vaginal dryness, and predisposes to osteopenia and osteoporosis as well as triggering acne (known as acne climacterica in this situation).

Propionibacterium acnes
When a pore is blocked, P. acnes, an anaerobic bacterium, overgrows and secretes chemicals that break down the wall of the pore and form an acne lesion (folliculitis). This leads to the possible spilling of bacteria such as Staphylococcus aureus into the broken skin. Preliminary research shows healthy pores are only colonized by P. acnes while unhealthy ones universally include the non-pore-resident Staphylococcus epidermidis, amongst other bacterial contaminants.

Propionibacterium acnes
Under normal conditions, P. acnes is beneficial: creates low pH skin environment hostile to pathogens. P. acnes can be killed by benzoyl peroxide, tetracyclines, Clindamycin, azithromycin, Fluoroquinolones such as nadifloxacin, ciprofloxacin, ofloxacin and levofloxacin. These are normally prescribed 500 mg by mouth, three times weekly for 4 to 6 weeks. There are also many antibacterial preparations, including clove oil, PCMX, and chlorhexidine gluconate. Tetracycline-resistant P. acnes is now quite common. To decrease acne, wash pillowcases often!

Furuncles (BOILS) Unlike pimples, boils are caused by bacteria that enter a gland and invade into the hypodermis. They are local infections that swell to a size that is larger than pimples. They are not blackheads.

Most boils run their course within four to ten days
Most boils run their course within four to ten days. For most people, self-care by applying a warm compress or soaking the boil in warm water can help alleviate the pain and hasten draining of the pus ("bringing the boil to a head"). Once the boil drains, the area should be washed with antibacterial soap and bandaged well. In serious cases, prescription oral or topical antibiotics are used.

Carbuncles A carbuncle is a mass of boils which drains pus onto the skin. It is usually caused by bacterial infection, most commonly Staphylococcus aureus, or Streptococcus pyogenes, which can turn lethal. The infection is contagious and may spread to other areas of the body, or other people; those living in the same residence may develop carbuncles at the same time (mass of boils)

Carbuncle: a mass of furuncles (boils)

WARTS Warts are caused from a virus that can only get in if there is a break in the skin. It starts multiplying itself, forming a benign local tumor. Therefore they are found on the hands of people who get a lot of scratches and the feet of those who go outside without shoes. That’s it for the organ called hair; now we’ll move on to the organ called NAILS

NAILS At the nail matrix, there is rapid division of skin cells, and as they die, the skin moves up and creates the nail, similar to hair formation. Taking calcium does not make nails stronger because there is no calcium in skin cells.

2. NAILS The EPIDERMIS gives rise to the nails. The nails are made of keratin (no collagen or calcium) Taking calcium won’t make the nails any stronger because there is no calcium in keratinocytes. At the nail matrix, there is rapid division of keratinocytes (cells that make keratin), and as they die, the skin moves up and creates the nail.

Structure of a Nail The proximal nail fold creates the cuticle. The cuticle is called the eponychium. The white half-moon visible under the proximal part of a fingernail is the lunula. Figure 5.9

ECCRINE (MEROCRINE) SWEAT GLANDS. APOCRINE GLANDS
PUBIC HAIR GLANDS MAMMARY GLANDS CERUMINUS GLANDS

ECCRINE (MEROCRINE) SWEAT GLANDS
ECCRINE (MEROCRINE) SWEAT GLANDS. These are found all over the body, and produce a watery secretion which evaporates and cools the body. -Fun Facts: A pair of human feet contains 250,000 sweat glands. -There is about one trillion bacteria on each of your feet. -Your body gives off enough heat in 30 minutes to bring half a gallon of water to a boil.

Sebaceous and Sweat Glands
Figure 5.1

Anhidrosis: Lack of sweat glands
Hyperhydrosis: Excessive sweating Microwave removal of sweat glands

APOCRINE GLANDS are associated with pubic hairs in the axilla and pubic region, as well as the mammary glands. The ones associated with pubic hairs produce a secretion to coat the hairs. The hairs function as a wick to draw the secretions to the surface. Apocrine glands also produce a type of protein. The protein in mammary glands is milk. The protein in the pubic hair secretions is a PHEROMONE (which acts as a hormone once it is inhaled).

Pheromones function for sexual attraction. There is no conscious odor
Pheromones function for sexual attraction. There is no conscious odor. The smell from the axilla is from bacteria that are attracted by the gland. Expensive perfumes have pheromones. Guess where they get them from? The anal glands of male cats! They are designed to attract females. They are used so women will buy expensive perfume. Pheromones also function to regulate menstrual cycles of females. If you put several women in one room for months, their menstrual cycles will all start to occur at the same time.

3. MAMMARY GLANDS are apocrine glands, so they secrete by the method of the top of the cell popping off. These apocrine glands secrete milk. Each breast has dozens of glands with their own duct to the surface in the nipple and areola. In a woman who is not lactating, the majority of tissue is adipose. To change the size of breasts, lose or gain weight!

4. CERUMINUS GLANDS are only found in the ear, and they produce wax.
They keep the ear canal from drying out They discourage insects from crawling in; they don’t like walking on the wax.

GLANDS Summary EXOCRINE GLANDS secrete substances into a duct that leads to the surface of the skin or into a lumen. ENDOCRINE GLANDS secrete hormones into the blood. They are ductless. A GOBLET CELL is a unicellular gland that secretes mucus. A PLASMA CELL is a type of blood cell that secretes antibodies. We’ll talk more about that when we get to the cardiovascular system.

CANCER Cancer starts out as a mutation in one gene in one cell. Then the mutated cell starts dividing itself rapidly and taking over the whole area.

Cancer

LEUKEMIA is a cancer in blood-forming cells.
LYMPHOMA is a tumor developing in lymphatic tissues. CARCINOMA is a tumor developing in any part of the epithelium. MELANOMA is a tumor developing in the pigment-producing cells of the skin. It is a particular type of carcinoma. SARCOMA is a tumor developing in muscles, bones, organs, and connective tissues.

Cancer CHARACTERISTICS OF CANCER CELLS 1. LACK DIFFERENTIATION
Normal cells have specialized functions, but cancer cells do not differentiate and do not contribute to the function of the body. 2. ABNORMAL NUCLEI They have large or multiple nuclei with mutated chromosomes. 3. FORM TUMORS Cancer cells grow and divide rapidly until they accumulate and form a lump of cancer cells called a tumor. A BENIGN tumor is an accumulation of non-cancerous cells because they stay in their own capsule (encapsulated) and do not invade.

Cancer

Cancer MALIGNANT tumors are cancerous cells that spread and invade.

Cancer 4. ANGIOGENESIS (INDUCE BLOOD VESSEL FORMATION)
Since these tumors need nutrients, they create new blood vessels just for them to feed on. 5. METASTASIZE Pieces of the tumor break off and travel in the bloodstream to any new location, invade nearby tissues and continue their massive cell division and growth there. If there is a tumor in the lung, it is biopsied (the doctor surgically takes out a piece). If the cells are lung cells, it is lung cancer. But if the cells are pancreas cells, it is pancreatic cancer that has metastasized.

NUMBER OF CANCER CASES BY SITE AND SEX

Cancer ORIGIN There are many factors that play a role in the development of cancer, including heredity factors, carcinogens, and mutagens. CARCINOGEN is an environmental agent that contributes to cancer. Not everyone exposed to it gets cancer. Examples of a carcinogen are ultaviolet radiation, toxic chemicals, and viruses. MUTAGEN is an agent that increases chances of DNA change or mutation. Everyone exposed for long enough will get DNA mutations, and possibly cancer. Examples are x-rays and some medicines (thalidimide; caused birth defects).

Cancer 1. CARCINOGENS a) RADIATION is from overexposure to sunlight. b) ORGANIC CHEMICALS include tobacco, foods (salted pork), and pollutants 2. HEREDITY Particular types of cancers run in families, such as breast, lung, and colon cancer.

Cancer DIAGNOSTIC PROCEDURES
PAP SMEARS detect cervical cancers. They just swab the cervix and look at the cells under a microscope. MAMMOGRAMS are diagnostic procedures to detect breast cancer. The breast is just placed on a special type of machine like an x-ray. 20% of breast cancers are not detected by mammogram and can only be detected by ultrasound. Those at high risk for breast cancer should get an MRI instead of a mammogram, since the x-ray might induce cancer. COLONOSCOPY is a diagnostic procedure to detect colon cancer. A scope is inserted into the rectum so the doctor can look for polyps.

Cancer The American Cancer Society says the following are signs of cancer: C-A-U-T-I-O-N Change in bowel or bladder habits (colon cancer) A sore that does not heal (skin cancer) Unusual bleeding or discharge Thickening or lump in breast or elsewhere (breast cancer) Indigestion or difficulty swallowing (GI system cancer) Obvious change in wart or mole (skin cancer) Nagging cough or hoarseness (lung cancer)

PREVENTION OF CANCER 1. BEHAVIORS
DON’T smoke, sunbathe, drink alcohol, or get too many x-rays. Smoking cigarettes is associated with many types of cancers, including cancer of the lung, larynx, throat, and urinary bladder. DO be tested (self-breast exams and testicular self-exams every month, and Dr. check-ups), be aware of chemical hazards at work, and be aware that using estrogen for menopause symptoms must be combined with progesterone, otherwise there is an increased risk of cancer.

PREVENTION OF CANCER 2. DIET
Avoid fats, salty, smoke-cured, pork, and pickled foods. Eat plenty of fiber, green leafy vegetables and fruits, and eat cabbage, broccoli, Brussels sprouts, and cauliflower, vitamins A and C. For more information on smoke-cured meat, read the articles posted at the bottom of our Lecture Unit 1 webpage. PREVENTION OF SKIN CANCER: A. use broad-spectrum sunscreen B. stay out of the sun altogether from 10-3 C. wear protective clothing D. wear sunglasses E. do not use tanning machines

TREATMENT OF CANCER 1. RADIATION
When someone has surgery to remove a tumor, it is often followed by radiation because the cancer cells may have spread throughout the body. Cells that are in the process of dividing are the most likely cells to be killed by exposure to radiation. Since cancer cells are always in the process of dividing, exposing them to x-rays may kill them. The x-ray beam is coned down so just the tumor is exposed. However, scatter radiation kills off other cells that rapidly divide (stomach lining and hair follicles), so the side effects include baldness and nausea.

TREATMENT OF CANCER 2. CHEMOTHERAPY This is for cancer that has metastasized. It is also good for cancer of the blood (leukemia). The drugs are designed to specifically kill just the cancer cells, but it tends to also kill off the normal blood cells that are just being formed in the bone marrow. Thus, bone marrow transplants are also needed sometimes.

TREATMENT OF CANCER 3. BONE MARROW TRANSPLANTS Someone needs to volunteer to donate a small piece of bone from the crest of their hip. This bone marrow will contain healthy new blood cells that can repopulate the depleted bone marrow of the sick person. These cells are injected into the sick person’s vein.

TREATMENT OF CANCER 4. IMMUNOTHERAPY Blood cells are taken from the sick person and are fused with an antibody that is specifically designed to seek out and destroy the cancer cell.

TREATMENT OF CANCER 5. GENE THERAPY This is new research, attempting to find a gene that will shrink tumors.

TREATMENT OF CANCER 6. COMPLEMENTARY THERAPIES This involves natural healing therapies such as biofeedback, acupuncture, and exotic foods. It’s worth a try if you’re going to die!

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