ANATOMY & PHYSIOLOGY NAN 1013

NORSALAWATI BT ISMAIL
SUNWAY UNIVERSITY SEPT 2023
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 Integumentary System
• Skin and its derivatives (sweat & oil glands, hairs
& hair follicles, nails)

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 Basic Functions of the Skin
• Protection from:
–Mechanical damage (bumps & cuts)
–Chemical damage (acids & bases)
–Thermal damage (heat/cold)
–Bacteria
–UV radiation
–Desiccation (drying out)

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 Cont..Basic Functions of the Skin
• Temperature regulation (sweat glands)
• Excrete urea
• Synthesize Vitamin D
(7 dehydrocholesterol)
• Immunity
• Sensory reception (touch, heat, pain,
pressure)

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 Skin Structure

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 Structure of the Skin
• Two regions:
1. Epidermis
– keratinized stratified squamous epithelium

1. Dermis – fibrous connective tissue

• Hypodermis (subcutaneous fascia)

– Adipose tissue underneath skin
– Anchor skin to muscle below
– Shock absorber
– Store fat
– Insulation
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 Epidermis
Cells of the epidermis:
1. Keratinocytes
 Produce keratin = fibrous protein
 Growth starts in deepest epidermal
layer (stratum basale) → pushed
upward by new cells underneath
 Top layer = dead, scale like
structures
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 Epidermis
2. Melanocytes
Produce melanin = pigment
(yellow/brown/black)
Melanin granules taken up by
nearby keratinocytes
 Shields DNA from UV radiation

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 5 LAYERS (STRATA) OF EPIDERMIS:

• “Overcoat” for body

Stratum Corneum • Protect against abrasion, penetration, &
water loss (keratin & glycolipids)
(horny layer) • 20-30 cells thick

Stratum Lucidum • Clear, flat, dead cells

(clear layer) • Thick layer on palms of hands, soles of
feet
Stratum Granulosum
• Cells become flatter, full of keratin
(granular layer)
• Water-resistant glycolipid fills spaces
Stratum Spinosum • Thick bundles of pre-keratin
(prickly layer) • Abundant melanin granules

Stratum Basale • Single row of stem cells

(basal layer) • Receive nutrients from dermis
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 Skin Structure

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 Dermis
• Strong, flexible connective tissue
• Semi-fluid matrix with fibers (collagen, elastic)
• Leather “hide” of animals
• Contains:
– nerve fibers
– blood vessels
– lymph vessels
– hair follicles
– oil glands
– sweat glands
• Cells: fibroblasts, macrophages, mast cells, WBC’s
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 Dermis
Fibroblasts:
- Connective tissue cells which secrete matrix
substance rich in collagen.
Macrophages: (formed in response of infection)
- A large white blood cell, mostly found in
connective tissue & in blood stream
- Large specialized cells that recognize, engulf &
destroy target cells.
Mast Cell:
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 Layers of Dermis
1. Papillary Layer:
– Upper part of dermis
– Dermal papillae
• Contain capillary loops
• Free nerve endings
• Touch receptors (Meissner’s corpuscles)
(sensitive to light touch)
• Forms ridges (large mounds) → increases
friction to enhance gripping ability on
fingers & feet
• Friction ridge pattern = fingerprints
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 Layers of Dermis
2. Reticular Layer:
– Deepest skin layer
– Dense, fibrous connective tissue
– Contains blood vessels, sweat & oil
glands, deep pressure receptors
(Pacinian corpuscles), WBC’s

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 Sensory Organs Within the Skin
1. 4 Types of Mechanoreceptor

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 Fibers
Collagen: give skin strength; binds
water (hydrate skin)
Elastic fibers: stretch-recoil
properties of skin
Aging: fewer fibers, less
subcutaneous fat → skin loses
elasticity and sags/wrinkles
Extreme stretching of skin
(pregnancy): dermal tearing
leaves white scars = “stretch
marks – striae gravidarum)
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 Other info
Blister: separation of epidermal and dermal
layers
Blood vessels in dermis:
maintain body temp.
Cooling: Capillaries swell with heated
blood → skin becomes red and warm →
radiate heat
Conserve heat: blood bypasses capillaries
to skin
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 Other info
Bedsores: if blood
(O2) is restricted to
cells → skin cells die
& cause ulcers
- Bedridden patients
need to be turned
regularly
Tattoos: deposit
pigment within
dermis
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 SKIN COLOR

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 Skin Pigments
1. Melanin
 Two forms: brown-black & pink-red
 Made by melanocytes
 Only found in deeper layers of
epidermis
 Freckles & moles = local
accumulations of melanin
 Protect DNA from UV radiation
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 Skin Pigments
2. Carotene
 Yellow-orange (from carrots)
 Accumulate in stratum corneum,
hypodermis
 Carotene converts to Vitamin A in body
 Asians: yellowish skin = melanin +
carotene
3. Hemoglobin
 Pinkish shade/tone
 Red blood cells in capillaries
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 Homeostatic Imbalances
• Cyanosis: poorly oxygenated blood,
blue color
• Excessive sun exposure: leathery skin,
rashes, skin cancer
• Redness: blushing, fever, allergy,
inflammation, hypertension (high BP)
• Pale skin (pallor): anemia, low blood
pressure, fear, anger
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 Homeostatic Imbalances
• Jaundice (yellow cast): liver disorder
(bile pigments = bilirubin)
• Bronzing: Addison’s disease, pituitary
gland tumors
• Bruises: blood clots under skin

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 APPENDAGES OF
THE SKIN

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 LANGERHANS CELLS
Langerhans cells are dendritic cells
(antigen – presenting immune
cells) of the skin & mucosa.
Contain large granules called
Birbeck granules.
Present in all layers of skin
(mostly in stratum spinosum)

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 SWEAT GLANDS
Two types:
1. Eccrine sweat glands:
releases sweat (99% water,
salts, vitamin C, antibodies, wastes)
–Abundant on palms, soles of feet,
forehead
–Evaporative cooling

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 Sweat glands
Two types:
2. Apocrine sweat glands:
–Sweat + fatty substances &
proteins → milky/yellowish
–With bacteria = body odor

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 SEBACEOUS GLANDS
• Secrete oil (sebum) into the hair follicle
• Waterproofing skin
• Soften & lubricate hair, skin
• Kills bacteria
• Whitehead
• = blocked sebaceous gland
• Blackhead
• = sebum oxidizes and dries

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• Acne = active inflammation of sebaceous
glands caused by bacterial infection (staph)
• Treatment:
–Reduce oil production
–Speed up skin cell turnover (prevent
plugged follicles)
–Fight bacterial infection
–Reduce inflammation

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 HAIR (PILI)
• 2 main regions: hair root & hair shaft
• Project from follicles in dermis
• Consists of dead, keratinized cells
• Arrector pili (smooth muscles)
attached to hair root → pulls hair
upright

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 NAILS

• Grows from nail

matrix
• Visible part of nail
is nail body
• Cuticle covers nail
root
• Contains hard
keratin

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 SKIN DISORDERS

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 Skin Cancer
• Affects 1 in 5 Americans
• Caused by UV damage to DNA
Types:
1. Basal cell carcinoma
– Least malignant, most common (80% skin
cancers)
– Stratum basale
– Sun-exposed areas of face
– Shiny, dome-shaped nodules
– Slow-growing; rarely metastasis (spreads)
– Removal by surgery (99% cases)
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 Skin Cancer

2. Squamous cell carcinoma

– 2nd most common
– Keratinocytes of stratum spinosum
– Scaly, reddened bump
– Grows rapidly and can metastasize if not
removed
– Removal by surgery or radiation therapy

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 Skin Cancer
3. Melanoma
– Most dangerous
– Highly metastatic, resistant to chemotherapy
– 1/3 from moles (spreading brown→black
patch)
– Key = Early detection!!!
– Surgery + immunotherapy

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 Burns
• Tissue damage caused by heat, electricity,
radiation, chemicals
• Main threat: loss of fluids (dehydration,
electrolyte imbalance)
– Kidney failure, circulatory shock

RULES OF NINE
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 Classifying burns

• 1st-degree burns: only epidermis damaged →

swelling, redness, pain (sunburn)
• 2nd-degree burns: injure epidermis & upper
dermis → redness and pain; blisters
• 3rd-degree burns: entire thickness of skin,
destroy nerve endings (no pain)
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 Developmental Aspects of Skin
• Fetus: downy coat of colorless hairs (lanugo)
• At birth:
– covered with white, cheesy substance (vernix
caseosa) to protect skin in watery environment
– Milia: white spots, accumulations in sebaceous
glands (baby acne)

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 Developmental Aspects of Skin
• Childhood: skin thickens; deposit subcutaneous fat
• Adolescence: sebaceous glands activated (oilier hair and
skin), acne appears

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 Developmental Aspects of Skin
• Adults:
– Environmental assaults (sun, wind,
chemicals)
• Old age: thin skin, less oil (dry skin), less fat,
less elasticity, less hair (greying and balding)

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