The Integumentary system:

– Integument the skin.

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– also called cutaneous membrane or cutaneous layer.
– the system consists of skin and its derivatives like nails, hair, sweat glands and sebaceous
glands.
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Structure and functions of the integument

Integument structure:
– covers the entire body.
– forms 7-8% body weight.
– three main layers: epidermis, dermis and hypodermis.

Functions of the integument:

. Protection: - acts as the first line of defense.
– it is selectively permeable.
– Protects deeper tissues from solar rays.
. Prevention of water loss or gain: - it is water resistant.
 – TEWL (Trans Epidermal Water Loss): some interstitial fluid slowly escapes the epidermis and
evaporates into the environment.
– Insensible Perspiration: release of water vapor from sweat glands even when we are not
sweating.
– Sensible Perspiration: visible sweating.
. Temperature Regulation:
– when the body temp increases, the blood vessels in the dermis dilate to allow flow of more
blood and sweat glands secrete sweat. This causes the heat to dissipate in the skin & the body
cools off by the evaporation of sweat.
– when the body temp decreases, the blood vessels in the dermis contract to constrict the blood
flow and more blood is shunted to the deeper body tissues.
. Metabolic regulation: - vitamin D also called cholecalciferol is produced by some epidermal
cells on exposure to UV rays.
– this vitamin is important for regulating the levels of calcium and phosphate in the blood.
. Immune defense: - Epidermal dendritic cells or langerhans cells play an important role as the
phagocytosize the pathogens that have penetrated the epidermis and also against cancerous
cells.
. Sensory reception: - skin receptors are associated with nerve endings that detect heat, cold,
touch, pressure, texture and vibration.
. Secretion: - it secretes sweat to cool off the body.
– it also produces oil or sebum which lubricates the skin & hair.

Epidermis:

Epidermal strata (layers of the epidermis):

5 main layers:
. Stratum corneum (outermost)
. Stratum lucidum
. Stratum granulosum
. Stratum spiniosum
. Stratum basale (innermost).
Layers 1 and 2 have dead keratinocytes and 3,4 & 5 have living keratinocytes.
Stratum Basale:
– single layer of cells range from cuboidal to low columnar.
– tightly attached to the basement membrane.
– Has 3 main types of cells:
a. keratinocytes:
– most abundant cell type in the epidermis.
– dominates the stratum basale.
– Its division helps replace both the stem cells & the dead keratinocytes.
– they produce fibrous protein keratin which is tough and insoluble.
– keratin found in epidermis are called cytokeratins.

b. Melanocytes:
– they produce and store pigment melanin in response to UV exposure.
– they have long cytoplasmic processes.
– these long processes transport pigment granules (melanosomes) to the keratinocytes which
gets accumulated around the keratinocyte nucleus and protects its DNA from UV exposure.

c. Tactile cells: (Merkel cells)

– fewer in number.
– they are touch sensitive.

Stratum Spinosum:
– Consists of several layers of polygonal keratinocytes.
– each time a keratinocyte stem cell in the stratum basale divides, a cell is pushed towards the
external surface of the skin.
– when the cell enters stratum sipinosum, it becomes A highly specialized non dividing
keratinocyte which is connected to its neighbor by several intercellular junctions called
desmosomes.
 – they also have the epidermal dendritic cells which elicit immune responses.

Stratum Granulosome:
– Made of 3 to 5 layers of keratinocytes.
– Two types of granules are present here: keratohyaline granules which are involved in the
process of keratinization and lamellar granules which fuse with the plasma membrane and
extrudes its contents (lipids primarily) in the extracellular space.
– keratinization occurs in this layer.
– In this process, keratinocytes get filled up with the protein keratin.
– as cells pass through this layer, they become thinner and flatten as true keratin filaments are
formed.
– their membranes thicken and become less permeable.
– the cells eventually die and the remaining material is keratin fibers sandwiched between thick
phospholipid layer.

Stratum Lucidum:
– it is a clear, thin translucent layer which is 2-3 cell layers thick.
– only found in thick skin such as palms of hands and soles of feet.
– cells in this layer are pale, featureless with indistinctive plasma membrane.
– the cells are filled with eleidin (an intermediate product in keratin maturition).

Stratum Corneum:
– 20 - 30 layers of dead anucleate cells tightly packed together called corneocytes.
– hornlike layer.

It takes about 2 weeks for a cell formed in stratum basale to reach the stratum corner after being
formed and it stays on the skin for 2 more weeks. Thus, a keratinocyte is shedded by the skin one
month after its formation.

Variations of the epidermis:

Thick skin versus Thin skin:

Thick skin:
– found on palms of hands and soles of feet.
– it has all 5 epidermal layers.
– it has sweat glands but lacks hair follicles and sebaceous glands.
– 0.4 mm to 0.6 mm thick

Thin skin:
– covers most of the body.
– it lacks stratum lucid.
– it has sweat and sebaceous gland and also the hair follicles.
 – 0.075 mm to 0.150mm thick..

Skin color:
– normal skin color is a combination of hemoglobin, melanin and carotene.

Melanin:
– produced and stored in the melanocytes.
– two types: eumelanin and pheomelanin.
– all individuals have about the same number of melanocytes.
– melanocyte activity and color of melanin produced varies in individuals and ethnicities.
– dark-skinned people have more melanocytes producing relatively more and darker melanin than
do light skinned people.

Carotene:
– yellow-orange pigment acquired by eating yellow-orange vegetables such as carrots, corns,
etc.
– present in the keratinocytes of stratum corneum and subcutaneous layer.
– converted to vitamin A which is important for normal vision.
– it also eliminates potentially danger metabolites and improves immune cell number and activity.
Skin markings:
– Nevus: (mole): A localized area of melanocyte overgrowth. Can become malignant rarely due to
UV exposure.
– Freckles: yellowish or brown spot representing localized areas of excess melanocyte activity.
– Hemangioma: congenital anomaly resulting in skin discoloration due to blood vessels that
proliferate and form a benign tumor.
– Capillary hemangioma: strawberry colored birthmarks appear as bright red to deep purple
nodules that at usually disappear in childhood, may develop in adults.
– Cavernous hemangioma: (portwine stains) involve larger dermal blood vessels and may last a
lifetime.
– Friction ridges: contours of skin surface follow a ridge pattern varying from small conical pegs
in then skin to complex arches and whorls on thick skin called friction ridges.
– friction ridges occur in tips of fingers and toes, in palms and soles.
– they are formed from large folds and valleys of both epidermis and dermis.
– they secrete sweat from the merocrine sweat glands that help to maintain friction while lifting
things and walking barefoot.
– Dermatoglyphics: study of friction ridge patterns.

Dermis:
– Lies deep to the epidermis
– Thickness of about 0.5mm to 3.0mm.
– has 2 types of conn tissues: areolar and dense irregular.
– also has sweat gland, sebaceous glands, nerve endings, tactile receptors, hair follicles, nail root
and smooth muscle (arrector pilli)
– Two major regions: A. Papillary layer B. Reticular layer.
Papillary Layer of the Dermis:

– Superficial layer of the dermis composed of areolar conn tissue.

– connects to the epidermis.
– Dermal papillae: projections of the dermis towards the epidermis.
– they interlock with deep projections of the epidermis called epidermal ridges.
– dermal papillae has capillaries that provide nutrients to the cells of the epidermis.
– also contains sensory receptors.

Reticular Layer of the Dermis:

– deeper major portion of the dermis.

– consists of dense irregular connective tissue through which large bundles of collagen fibers
spread out in a meshwork that surrounds structures like hair follicles, sweat & sebaceous
glands, nerves, blood vessels, etc.

Lines of Cleavage and stretch marks:

Lines of cleavage: Identify the predominant orientation of collagen fiber bundles.
– clinically and surgically important.
– Any cut at a right angle to the cleavage line is usually pulled open due to the recoil of cut elastic
fibers, often resulting in slow healing and scarring.
– An incision made parallel to a cleavage line will heal quickly.

Stretch marks: when skin is stretched beyond its capacity due to excessive weight gain or pregnancy,
some elastic fibers a torn resulting in stretch marks called striae.
Innervation and Blood Supply:

– Innervation means supply with nerves.

– dermis is richly innervated.
– nerves monitor sensory receptors in the epidermis and dermis, control blood flow & gland
secretion rates.
– As the epidermal layer is avascular, blood vessels within the dermis supplies nutrients to the
living cells of the epidermis.
– Dermal blood vessels play an important role in temp regulation..
– Vasoconstriction: diameter of the blood vessels become narrow to shunt the blood away to the
deeper layers of the body.
– Vasodilation: diameter of blood vessels increase so more blood can travel through them
dissipating excessive heat..

Subcutaneous layer:

– Also called the hypodermis or superficial fascias.

– not a part of the integument.
– consists of areolar connective tissue and adipose tissue.
– In some areas, the adipose tissue dominates, thus also called subcutaneous fat.
– the connective tissues of the reticular layer of the dermis are extensively interwoven with those
of the subcutaneous layer to stabilize the position of the skin and bind to underlying tissues.
– drugs are often injected in this layer due to its excessive vascular environment that promotes
rapid absorption.
– distribution of this layer varies in male and female.
– males: mostly accumulated in the neck, upper arms, abdomen and lower back.
– females: mostly accumulated in breasts, thigh, buttocks and hips.
Integumentary structures derived from epidermis:
– includes nails, hair and exocrine glands of the skin.

Nails:
– scale like modification of stratum corneum.
– protect the exposed distal tips of fingers and toes.
– each nail has a distal whitish free edge, pinkish nail body and a nail root embedded in the skin.
Together they form the nail plate.
– nail body covers a deeper live layer of epidermis called the nail bed.
– nail matrix: thickened nail bed at the nail root and proximal end of the nail body, which is
actively growing.
– lunula: whitish semilunar area of the proximal end of the nail body, lighten appearance due to
thickened stratum basale.
– nail fold: folds of skin at the proximal and lateral borders of the nail.
– eponychium: (cuticle): narrow band of epidermis extending from the margin of the nail wall onto
the nail body.
– hyponychium: region of thickened stratum corneum over which the free nail edge
projects.
Hair:

Found everywhere except the palms of hands, the sides and soles of the feet, the lips, the sides of
fingers and toes and portions of external genitalia.

Hair types:
– A single hair is also known as a pilus.
– 3 main kinds of hair:
a. Lanugo: fine, unpigmented downy hair that first appears on the fetus in the 2nd trimester.
b. Vellus: At birth most of the lanugo has been replaced by similarly fine, unpigmented or lightly
pigmented hair called vellus.it is the primary human hair.
c. Terminal hair: coarser, pigmented and longer than vellus, grows on scalp, eyebrows and eyelashes,
replaces vellus on pubic areas and axillary areas at puberty, forms beard under the influence of
testosterone.

Hair structure and follicles:

– three main zones: hair bulb, root and shaft
– hair bulb has living epithelial cells and the root and shaft have dead epithelial cells.
– hair papilla: the epithelium at the base of the bulb surrounds a small hair papilla made of tiny
amounts of connective tissues and small blood vessels and nerves.
– Root is the portion of the hair deep to the skin surface.
– shaft is the portion that extends beyond the skin surface..
 – shaft is the portion that extends beyond the skin surface..

–
Hair production:
– involves specialized type of keratinization that occurs in the hair matrix.
– epithelial cells in the center of the matrix produces new cells that are gradually pushed
outwards.
– the medulla which is not found in all hair types is the remanant of soft core matrix and
composed of loosely packed cells and air spaces and contains flexible, soft keratin.
– several layers of flattened cells closer to the outer surface of the developing hair form the
relatively hard cortex.
– multiple cell layers around the cortex forms the cuticle.
Hair follicle:
– on oblique tube that surround the hair root.
– extends into the dermis and subcutaneous layer.
– follicle wall has 2 concentric layer:
a. Outer connective tissue root sheath.
b. Inner epithelial tissue root sheath.
– arrector pili: extending from the dermal papillae to the side region of hair follicle are thin
ribbons of smooth muscles responsible for goosebumps (erection of hair).

Functions of the hair:

. Protection.
. Heat retention
. Sensory Reception
. Visual identification.

Hair color:
– results of the synthesis of melanin in the matrix adjacent to the papillae.
– determined genetically.
– determined also by environmental and hormonal factors.
– with aging pigment production decreases, and thus hair becomes grey.
– Grey hair: reduction in melanin production
– white hair : no melanin production.

Hair growth cycle:

. Anagen:active growth phase. (18. months to 7 years)
. Catagen: brief regression period where cell division ceases. (3 to 4 weeks)
. Telogen: hair shed.

– Alopecia: thinning of hair usually as a result of aging.

– Diffuse hair loss: hair is shed from all parts of scalp (primarily affects females and may be due
to hormones, medication and iron deficiency).
– Male pattern baldness: loss of hair from the crown region. Sex-influenced genetic trait.
– hirsutism: excessive hair growth on the face, chest and back. Caused by excess secretion of
male androgens, may affect both sexes.

Exocrine glands of the skin:

Aging of the integument:

The integument ages in the following ways:

. Skin repair takes longer due to reduced stem cell activity.
. Collagen fibers decrease in number and organization and elastin fibers decrease in elasticity.
. Immune responsiveness is diminished by decrease in the number and efficiency of epidermal
dendritic cells.
. Skin becomes dry and scaly due to decrease in the activity of sebaceous gland.
. Decrease in melanocytes causes altered skin pigmentation and liver spots (exposure to UV
leads to increased pigmentation resulting in flat, brown or black spots).
. Decreased sweat gland activity.
. Dermal blood vessels lose some permeability due to decreased elasticity. Impaired thermos
regulation.
. Hair follicles produce thinner or no hair.
. Integumentary production of vitamin D3 dec.
. Chronic overexposure to UV rays can damage the DNA in epidermal cells and accelerate aging.

Skin Cancer:
– Exposure to UV rays can mutate p53 gene in the normal skin and cause cancers.
– fair skinned individuals are at a greater risk.
– most common type of cancer.
– The table below describes 3 main types of skin cancers: