INTEGUMENTARY SYSTEM

The integumentary system is the largest organ in the body and accounts for 815% of a persons body weight. It must be tough to protect us but supple so that we can move and stretch.

Skin structure
Epidermis The epidermis is the outer layer of skin. The majority of cells (95%) are specialised epithelial cells called keratinocytes which produce a tough protein called keratin. There are five distinct sub-layers of cells that represent the different stages in the keratinisation process. New skin cells are produced at the basal membrane (deepest epidermal layer) pushing the older cells towards the surface. As the keratinocytes get older and migrate closer to the skin's surface they change from being squareshaped to flat, they become engorged with keratin and eventually die, losing all of their internal structures. These overlapping, closely packed layers of keratinized cells form a permeable barrier and are able to withstand scuffs and scrapes. It takes 40-60 days for keratinocytes to reach the surface of the skin where they are sloughed away. Other cells in the epidermis include melanocytes and Langerhans cells. Melanocytes are responsible for the surface colour of the skin, they produce melanin which protects the skin from UV radiation. Langerhans cells are part of the skin's immune response and engulf foreign material. The epidermis does not contain any blood vessels but is nourished by the capillaries in the dermis below. Dermis The dermis is much thicker than the epidermis and lies immediately underneath it. It is a collagen rich connective tissue that contains fibroblast cells that produce collagen and elastin, which are responsible for the pliability and strength of skin. It is connected below to the hypodermis. The dermis is made up of two layers, reticular (deeper) and papillary (superficial). The dermis contains the sensory nerve endings, hair follicles, arrector pili muscles, sweat glands, sebaceous glands, lymphatics and capillaries.

Hypodermis The hypodermis is not a skin layer but lies below the dermis, and is a subcutaneous tissue which contains fat, blood vessels and sensory receptors. CROSS SECTION OF SKIN

Skin Layers Epidermis

Properties Outer layer of skin, composed of 5 zones of stratified epithelium (keratinocytes); contains melanocytes and Langerhans cells. 15-25 layers of dead, flat, keratinized squamous epithelial cells, without nuclei. Normally thin but thick over the soles of the feet and palms of the hands. Only found in thick skin (palms and soles of the feet). Transition between the corneum and lucidum layer. 3-5 layers of keratinocytes containing keratin granules.

Function Responsible for the continual replenishing of skin, resists friction, waterproof, prevents water loss. Resists friction, waterproof, prevents water loss.

Stratum corneum (Horny layer) Stratum lucidum (Clear layer) Stratum granulosum (Granular layer)

Resists friction, waterproof, prevents water loss. They form keratin and expel lipids which stick the cells together and form a waterproof barrier.

Stratum spinosum Usually the thickest layer of keratinocyte cells, they are joined Langerhans cells are part of the immune (Prickly layer) together by desmosomal connections. Also contains response. Langerhans cells. Stratum basale (Basal cells) Dermis A layer of cuboidal-shaped cells, lined up on a basal membrane. It contains stem cells, keratinocytes, and melanocytes (pigment cells). Deep layer of skin, composed of collagen and elastin rich connective tissue. It contains hair follicles, sebaceous Keratinocyte cell division occurs here to replenish skin. Melanocytes protect the skin from UV. It is responsible for the elasticity and mechanical support of skin. Supplies the epidermis with

glands, blood vessels and sense receptors. Papillary Reticular Hypodermis Projections push into the epidermis. Highly vascular and innervated. Dense, interlacing connective tissue, predominantly parallel to the skin's surface. Not part of skin layer. Subcutaneous connective tissue, rich in fat and vessels.

nutrients. Important in thermoregulation. Forms finger prints, brings capillaries closer to the avascular epidermis. Forms lines of skin tension, cleavage lines. Protective cushion and insulator.

In summary;

Clinical Considerations
Cleavage lines Burns Cleavage lines are the tension lines in skin which follow the direction of the arrangement of collagen bundles in the dermis. Incisions along theses lines heal faster and give minimum scarring. Burns are classified according to how deep the burn has penetrated, as well as the percentage of surface area affected. Depth; Burns can be classified as partial or full thickness burns, first, second or third degree burns. Partial thickness First degree burns Second degree burn Fullthickness Third degree burn Surface area;; In adults the Wallace's 'Rule of Nines' is used to work out an approximate percentage of total skin surface area that has been affected by the burn. Each area is approximately divided into multiples of 9. In infants and children (under 15) the body proportions are different and so this rule is not the same. Body area Surface area Head Upper limb (single) Genitals 9% 9% 1% The burn has destroyed the epidermis and Painless, the colour can be dermis and penetrated the hypodermis. white, tan, brown black or red. The burn has penetrated the epidermis only. The burn has penetrated the epidermis and the dermis. Red and painful, only slight swelling. Red and painful, swelling and blistering.

Trunk (front or back) 18% Lower Limb (single) 18% Skin The epidermis is able to absorb lipid soluble substances and therefore certain medications absorption can be applied to the surface of the skin. SELF-TEST Complete the following questions before you go onto the next section: In order, name the five layers of the epidermis. In which layer of the epidermis are the melanocytes produced? Name the two layers of the dermis; what is its function?

Accessory skin structures

The skin has the following appendages;

Skin Appendage Hair Structure Function

Hairs originate in the dermis and are shafts of Sensory role, retains heat of the head modified keratinized epithelium which grow from and protects it from UV, advertises the roots of hair follicles. sexual maturity and disperses scents. Smooth muscle cells which extend from the hair follicle to the papillary layer of the dermis. Cause the hair to stand on end "Goose Bumps".

Arrector pili muscles

Sweat glands There are two types; merocrine and apocrine. Produce a watery substance to cool They consist of coiled tubes embedded in the the body, excretion of wastes, dermis or hypodermis and open out onto the skin excretion of body scents. surface. Nails The nail plate is composed of dead hard keratinized cells which lie on top of a nail bed and which grow from the nail matrix under the skin. Flask shaped glands, located in the dermis and open into the hair follicles. Allows the tips of our fingers to be soft and sensory. They serve as tools to aid in the manipulation of objects. Produce sebum, an oily secretion which prevents the hair and skin becoming dry.

Sebaceous glands

SELF-TEST Complete the following questions before you go onto the next section: Name three functions of sweat. Name three accessory skin structures which originate in the dermis; describe their structure. What is the function of hair in the human?

Skin Function Skin has several important functions;

Skin Function Protects our bodies from trauma. Wound healing. Acts as a barrier to bacteria and viruses. Produces vitamin D, essential for growth and bone maintenance. Prevents us absorbing and losing excess water. Secretes waste products. Regulates our body temperature (thermoreceptors, sweat, vasodilation). Sense what is happening in our external environment (touch, pressure, heat). Pigments as well as hair on our heads protect us from the sun. Secretes sebum. Advertises sexual maturity. Disperses scents.

Clinical Considerations
Wound healing It is important for the skin to repair quickly to prevent infection. If the epidermis is damaged it will simply heal by regrowing to cover the damaged area. If the damage reaches into the dermis and cuts the vessels, the blood will form a blood clot and healing of the wound will begin. Phases of Wound Processes of wound healing Healing Inflammatory Response Migratory Phase Blood clotting occurs. White blood cells are brought to the wound site. Epithelial and fibroblast cells migrate beneath the clot and the blood vessels regenerate (angiogenesis).

Proliferation Phase Epithelial cells proliferate (epithelialisation) beneath the scab and the

fibroblasts produce collagen and the wound is pulled together. Maturation Phase Collagen fibres become more organized, pulling the wound together.

Temperature control (thermoregulation) It is very important to keep the core body temperature at a constant 37 degrees otherwise the bodies cells can not function properly. Sweat glands are present in the skin of the entire body, but are more frequent in the palms, soles, armpit, groin and forehead. Sweat is similar to blood plasma and consists of water, salts, and waste products such as urea. Sweat is forced to the skin surface where it immediately evaporates; this approximates to about 500-600 ml a day. When the body needs to lose more heat, such as when partaking in strenuous exercise, sweat is produced at higher rates. The blood supply to the skin also plays an important role in thermoregulation. The capillaries to the skin in someone who is cold constrict, decreasing the blood flow and conserving heat. If a person is hot then the capillaries in the skin dilate, increasing the blood flow to the skin and allowing the loss of heat.

Clinical Considerations
Temperature control in the elderly Older people have fewer sweat glands, blood vessels and subcutaneous fat and because of this thermoregulation can become a serious problem. They become increasingly susceptible to hyperthermia in cold weather and heat stroke in hot weather.

Sensation The skin has a variety of sensory receptors embedded in it. Touch receptors are found in the dermis and receptors for pain, heat, pressure and vibration are found in the dermis and hypodermis. Hair follicles have receptors that can detect the slight movement of a hair. Vitamin D production Sun exposure (UV) triggers the skin to produce vitamin D. Vitamin D is a hormone and is important in maintaining calcium blood levels.