SKIN PHYSIOLOGY

Medical Physiology Laboratory Brawijaya University

Function of Integumentary System

1. 2. 3. 4. Regulation of Body Temperature Protection from Dehydration and Infection Respond to Temperature, Pressure, Pain Excretion of Water, Salts, Urea (nitrogenous waste) 5. Synthesis Vitamin D3 (essential for Ca + P absorption) 6. First Defensive Barrier of Immune Response
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Anatomy of Skin
Skin = Cutis = Integument (Integere ~ to cover) Surface area: 1.5 ~ 2.0 m2 The largest organ Its appearance & thickness are vary:
The skin of the soles of the feet: 8 mm (thickest) The skin of the eyelids : 1 mm (thinnest)

Its divided into 2 layers:

The epidermis or cuticle The dermis or corium

The subcutaneous tissue is deep to dermis; sometimes included as part of anatomy of the skin
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Anatomy of Skin (contd)

The epidermis is completely cellular Organized into 5 layers:
1. 2. 3. 4. 5. Stratum Stratum Stratum Stratum Stratum cornium lucidum granulosum spinosum Stratum germinativum basale

Structure of Epidermis (epithelial tissue)

A. Different Cells of Epidermis 1. Keratinocyte - produce protein "keratin" (structure) 2. Melanocyte - produce "melanin" (pigment) 3. Nonpigmented granular dendrocytes a. Langerhan's cells b. Granstein cells both assist in immunity B. Stratum Corneum 1. Stratified squamous epithilium 2. 25-30 rows of dead keratinized cells 3. Keratinization occurs as cells rise from below 4. Protects against light, heat, bacteria, chemicals 5. Most superficial layer of epidermis C. Statum Lucidum 1. Present only in thick areas (palms, feet) 2. Contain clear substance called eleidin 3. Eleidin eventually changes into keratin at surface 6

Structure of Epidermis (epithelial tissue)

D. Stratum Granulosum 1. Cells from lower layers begin to die here 2. Contain granules with keratohyalin 3. Keratohyalin is precursor to eleidin and keratin E. Stratum Spinosum 1. 8-10 rows of polyhedral shaped cells 2. Contain spine-like projections ("spinosum") F. Stratum Basale (Stratum Germinativum) (germination) 1. Deepest layer of the epidermis 2. Single layer of cuboidal-columnar shaped cells 3. Origin of all cells of epidermis through mitosis 4. Origin of cells for sweat-oil glands and hair
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Anatomy of Skin (contd)

The dermis is subdivided into 2 layers:
1. The Papillary dermis 2. The Reticular dermis

The papillary dermis contains:

Blood vessels Nerve endings Thermo-receptors Cryo-receptors
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Anatomy of Skin (contd)

The reticular dermis:
Connective tissue (fibroblast surrounded by a matrix): collagen, elastin, & proteoglycans Provide the structural support for the skin. Dermal appendages: hair follicles & sweat glands The crypts of the hair follicle:
In continuity with the epidermis Be a source of epidermal regeneration.
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Anatomy of Skin (contd)

The subcutaneous tissue:
Is deep to the dermis Contains a variety of cells:
Adipocytes, Fibroblasts, Histiocytes, Plasma cells, Lymphocytes, and Mast cells.

Many of them are involved in the processing of foreign antigen that traumatically introduced into skin.
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Thermal Regulation by The Skin

Heat is transferred from deeper organ and tissues to the skin. Insulator system of the body:
The skin; subcutaneous tissues & fat. Effective in maintaining normal internal core temperature.

Radiator system of the body:

Blood vessels: Artery capillaries Veins Venous plexusVein Artery Arterio-venous anastomosis The rate of blood flow into the venous plexus can vary tremendously (Almost zero 30 % Cardiac output).

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Control of Heat Conduction to the Skin By the degree of vasoconstriction of arterioles and the arteriovenous anastomoses that supply blood to venous plexus of the skin Vasoconstriction is controlled almost entirely by the sympathetic nervous system in response to changes in body core & environmental temperature. Basic Physics of How Heat is Lost from the Skin: RADIATION, CONDUCTION & EVAPORATION.
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Epidermis

Dermis Artery Veins

Venous plexus
Artery Arteriovenous anastomosis Subcutane ous tissue
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 Radiation:
Los of heat in the form of infrared heat rays 60 %

Conduction:
Loss of heat by direct conduction from surface of the body to solid objects 3%

Convection:
Loss of heat by convection air currents 15 %

Evaporation:
Loss of heat by water evaporation (22 %)
Evaporation of sweat Insensible from the skin & lung
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Effect of changes in the environmental temperature on heat conductance from the body core to the skin surface

Vasodilatation

Heat conductance through skin (times the vasoconstricted rate)

Vasoconstriction
1

0 50 60 70 80 90 100 110 120

Environmental temperature oF 16

Evaporation by The Skin

0.58 Calorie / gram of water that evaporated (sweat & insensible evaporation) Sweating:
Sweat gland innervated by cholinergic sympathetic nerve fibers Can also be stimulated by Epinephrine or Nor-epinephrine

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Sensory Receptor in The Skin

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Tactile Sensation
There are three principal differences among TACTILE sensations:
Touch sensation: Generally results from stimulation of tactile receptors in the skin or in the tissues immediately beneath the skin. Pressure sensation: Generally results from deformation of deeper tissues. Vibration sensation: Results from rapidly repetitive sensory signals.
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At least six type of Tactile Receptors

1. Free Nerve Endings:
Are found everywhere in the skin & in many other tissues Can detect touch and pressure

2. Meissners Corpuscle:
Are present in the nonhairy parts of the skin (Glabrous Skin)~ fingertips, lips. To discern spatial characteristics of touch sensation. Adapt in a fraction of second
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3. Merkels discs
Expanded tip tactile receptors Transmit an initially strong but partially adapting signal a continuing weaker signal that adapted slowly Play important role in localizing touch sensation & in determining the texture of what is felt

4. Hair end-organ:
Touch receptor Adapt readily ~ detects mainly movement of objects on the skin or initial contact with the body
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5. Ruffinis end-organs:
Are multibranched, encapsulated endings Adapt very slowly ~ Are important for signaling continuing state of deformation of the skin & deeper tissues. Also found in joint capsules ~ detects the degree of joint rotation Lie both immediately beneath the skin Are stimulated only by rapid movement of the tissues (adapt in a few hundredths of the second Are important for detecting tissue vibration or other rapid changes in mechanical state of the tissues
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6. Pacinian corpuscles:

Pain & Thermal Receptor in The Skin

Pain receptors are Free Nerve Endings Three types of stimuli excite pain receptors:
Mechanical Thermal Chemical: bradykinin; serotonin; histamin; potassium ion; acid; acetylcholine & protelytic enzymes

Adapt very little and sometimes not at all Rate of tissue damage as a stimulus for pain Tissue ischemia as a cause of pain Muscle spasm as a cause of pain
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 At least three types of thermal receptor:

Cold receptor
Suggested free nerve ending of type C nerve

Warmth receptors
Suggested free nerve ending of type A nerve

Pain Receptors

Very cold ~ freeze:

Cold pain fibers become stimulated

100 15 0C:
Cold-pain impulse ceases cold receptor begin to stimulated (reaching peak at 24 0C & fading out at 40 0C)

30 0C 49 0C:
warmth receptors become stimulated

Arround 45 0C:
The heat-pain begin to be stimulated + paradoxically some of the cold fiber begin to stimulated 24

Discharge frequencies at different skin temperatures

Warmth receptor
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Heat-pain

Impulse per second

Cold receptor Coldpain

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15

20

25

30

35

40

45

50

55

60

Freezing cold

Cold - Cool -

Indiffer- Warm --rent -Temperature (0C)

Hot --- Burning hot

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Synthesis of Vitamin D3
Cholecalciferol (vitamin D3) is formed in the skin.
Ultraviolet rays from the sun

7-dehydrocholesterol

Cholecaciferol (vit D3)

Liver

25-Hydroxycholecalciferol
Kidney

1,25-Hydroxycholecalciferol

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Specialized Cells in the Epidermis

Melanocytes
Produce pigment Melanin Responsible for skin color Produce keratin Generating hair and nails Secrete IL-1 influence T cells maturation.

Keratinocytes

Langerhans & Granstein cells

Langerhans: APC to T helper cells Granstein: APC to T suppressor cells Langerhans cells are more susceptible to damage by ultraviolet than Granstein
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Specialized Cells in the Subcutan They are involved in the processing of foreign antigen / micro organisms that traumatically introduced into skin:
1. 2. 3. 4. Histiocytes, Plasma cells, Lymphocytes, Mast cells.

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Skin-Associated Lymphoid Tissue (SALT)

Immune Cells in the Skin

Keratinocytes

Langerhans cells

Granstein cells

Form outer protective keratinized layer of skin

Generate hair & nails

Secrete IL-1

Process & present antigen to helper T cells

Process & present antigen to suppressor T cells

Nonimmune function
Influence maturation of T cells that localize in the skin Facilitate responses to skinassociated antigen Put brake on skinactivated immune responses
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Immune function

Dermal Wound Healing

The three principal mechanism of wound healing: 1. Contraction 2. Epithelialization 3. Connective tissue deposition Types of wound (according to therapeutic intervention): 1. Primary intention 2. Delayed primary intention 3. Secondary intention
To be closed shortly after injury

Are left open for 1 to 2 days and then surgically closed heal
It edges remain open heal
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Type of Wound
Healing Mechanism Sutured (Primary Intention) 0 + +++ Open (Secondary intention) +++ + ++ PartialThickness 0 +++ 0

Contraction Epithelialization Connective tissue deposition

Temporal sequence of normal healing: 1. Hemostasis 2. Inflamation 3. Proliferation 4. Remodelling

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The Healing Process : How Skin Repairs Itself Superficial and Deep Wound Healing: A. Superficial Wound Healing - Epidermal Repair 1. Epidermal cells of stratum basale migrate over area 2. Contact inhibition - cells stop when they meet 3. Dead cells sluff off (scab) as new cells replace

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B. Deep Wound Healing - Dermal Repair 1. Inflammatory phase - blood clot, fibroblasts 2. Migratory phase - scab forms, epidermal migration a. Fibroblasts make scar tissue (collagen fibers) b. Damaged vessels grow into place c. Granulation tissue - new scar tissue in place d. Fibroplasia - period of scar formation i. Hypertrophic scar - normal ii. Keloid scar - abnormal 3. Proliferative phase - new growth a. Epithelium grows beneath scab b. Fibroblasts make random collagen deposit (scar) c. Blood vessels continue to grow 4. Maturation phase - final healing process a. Epidermis is restored b. Fibroblasts disappear, collagen more organized c. Blood vessels repaired to normal 33

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Efek Testosterone & Estrogen

Testosterone:
Increases the thickness of the skin Increases the rate of secretion sebaceous gland, exp: in the face acne.

Estrogen:
The skin develop soft & smooth To become more vascular

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