The skin

After studying this section, you should be able to:

■ describe the structure of the skin
■ explain the principal functions of the skin
■ compare and contrast the processes of primary and
secondary wound healing.
 The first part of this chapter explores the structure and
functions of the skin, which is also known as the
integumentary system.
 The effects of ageing on the skin are discussed in the
following section.
The chapter concludes with a review of common skin
conditions.
 The skin completely covers the body and is continuous
with the membranes lining the body orifices. It:
• protects the underlying structures from injury and
from invasion by microbes
• contains sensory nerve endings that enable
discrimination of pain, temperature and touch
• is involved in the regulation of body temperature.
Structure of the skin
 The skin is the largest organ in the body and has a surface
area of about 1.5–2 m2 in adults.
 In certain areas, it contains accessory structures: glands,
hair and nails.
 There are two main layers; the epidermis, which covers the
dermis.
 Between the skin and underlying structures is a
subcutaneous layer composed of areolar tissue and adipose
(fat) tissue.
Epidermis
 This is the most superficial layer and is composed
of stratified keratinised squamous epithelium.
 It varies in thickness, being thickest on the palms of the
hands and soles of the feet.
 There are no blood vessels or nerve endings in the
epidermis, but its deeper layers are bathed in interstitial fluid
from the dermis, which provides oxygen and nutrients, and
drains away as lymph.
 There are several layers (strata) of cells in the epidermis
which extend from the deepest germinative layer to the most
superficial stratum corneum (a thick horny layer).
 Epidermal cells originate in the germinative layer and
undergo gradual change as they progress towards the skin
surface.
 The cells on the surface are flat, thin, non-nucleated, dead
cells, or squames, in which the cytoplasm has been replaced
by the fibrous protein keratin.
The surface cells are constantly rubbed off and replaced by
those beneath.
Complete replacement of the epidermis takes about a
month.
 Healthy epidermis depends upon three processes
being synchronised:
• desquamation (shedding) of the keratinised cells from
the surface
• effective keratinisation of cells approaching the
surface
• continual cell division in the deeper layers with newly
formed cells being pushed upwards to the surface.
Skin colour is affected by various factors.
 Melanin, a dark pigment derived from the amino
acid tyrosine and secreted by melanocytes in the
deep germinative layer, is absorbed by surrounding
epithelial cells.
 The amount is genetically determined and varies between
different parts of the body, between people of the same ethnic
origin and between ethnic groups.
 The number of melanocytes is fairly constant so the
differences in colour depend on the amount of melanin
secreted.
It protects the skin from the harmful effects of ultraviolet
rays in sunlight.
 Exposure to sunlight promotes synthesis of melanin.
Dermis
 The dermis is tough and elastic. It is formed from
connective tissue and the matrix contains collagen fibres
interlaced with elastic fibres.
 Rupture of elastic fibres occurs when the skin is
overstretched, resulting in permanent striae, or stretch
marks, that may be found in pregnancy and obesity.
 Collagen fibres bind water and give the skin its tensile
strength, but as this ability declines with age, wrinkles
develop.
 Fibroblasts , macrophages and mast cells are the main
cells found in the dermis.
Underlying its deepest layer is the subcutaneous layer
containing areolar tissue and varying amounts of adipose
(fat) tissue.
The structures in the dermis are:
• blood and lymph vessels
• sensory nerve endings
• sweat glands and their ducts
• hairs, arrector pili muscles and sebaceous glands.
Blood and lymph vessels. Arterioles form a fine network
with capillary branches supplying sweat glands, sebaceous
glands, hair follicles and the dermis. Lymph vessels
form a network throughout the dermis.
Sensory nerve endings.
 Sensory receptors (specialised nerve endings) sensitive to
touch, temperature, pressure and pain are widely
distributed in the dermis.
Incoming stimuli activate different types of sensory receptors
(Fig. 14.2, Box 14.1); for example, the Pacinian corpuscle is
sensitive to deep pressure.
 The skin is an important sensory organ through which
individuals receive information about their environment.
 Nerve impulses, generated in the sensory receptors in the
dermis, are transmitted to the spinal cord by sensory nerves.
 From there impulses are conducted to the sensory area of the
cerebrum where the sensations are perceived.
Sweat glands
 These are widely distributed throughout the skin and are
most numerous in the palms of the hands, soles of the
feet, axillae and groins.
 They are formed from epithelial cells.
 The bodies of the glands lie coiled in the subcutaneous
tissue.
 There are two types of sweat gland.
Eccrine sweat glands are the more common type and open
onto the skin surface through tiny pores, and the sweat
produced here is a clear, watery fluid important in regulating
body temperature.
 Apocrine glands open into hair follicles
and become active at puberty.
 They may play a role in sexual arousal. These glands are
found, for example, in the axilla.
 Bacterial decomposition of their secretions causes an
unpleasant odour.
 A specialised example of this type of gland is the
ceruminous gland of the outer ear, which secretes earwax
(Ch. 8).
 The most important function of sweat is in the regulation
of body temperature.
 Excessive sweating may lead to dehydration and serious
depletion of sodium chloride unless intake of water and salt is
appropriately increased.
 After 7–10 days’ exposure to high environmental
temperatures the amount of salt lost is substantially reduced
but water loss remains high.
Hairs
 These grow from hair follicles, downgrowths of epidermal
cells into the dermis or subcutaneous tissue.
 At the base of the follicle is a cluster of cells called the hair
papilla or bulb.
The hair is formed by multiplication of cells of the bulb and
as they are pushed upwards, away from their source of
nutrition, the cells die and become keratinised.
 The part of the hair above the skin is the shaft and the
remainder, the root hair growing through the skin and also
desquamation, which roughens the skin surface; the roughened
surface may harbour microbial growth although many are
removed by the constant rubbing off of the topmost layers.
 Hair colour is genetically determined and depends on
the amount and type of melanin present. White hair is the
result of the replacement of melanin by tiny air bubbles.
Arrector pili
 These are little bundles of smooth muscle fibres attached
to the hair follicles.
 Contraction makes the hair stand erect and raises the skin
around the hair, causing ‘goose flesh’. The muscles are
stimulated by sympathetic nerve fibres in response to fear and
cold.
 Erect hairs trap air, which acts as an insulating layer.
 This is an efficient warming mechanism, especially when
accompanied by shivering, i.e. involuntary contraction of
skeletal muscles.
Sebaceous glands.
These consist of secretory epithelial cells derived from the
same tissue as the hair follicles.
 They secrete an oily antimicrobial substance, sebum, into the
hair follicles and are present in the skin of all parts of the body
except the palms of the hands and the soles of the feet.
 Sebum keeps the hair soft and pliable and gives it a
shiny appearance. On the skin it provides some waterproofing
and acts as a bactericidal and fungicidal agent, preventing
infection. It also prevents drying and cracking of skin,
especially on exposure to heat and sunlight.
 The activity of these glands increases at puberty and is less
at the extremes of age, rendering the skin of infants and
older adults prone to the effects of excessive moisture
(maceration).
Nails
 Human nails are equivalent to the claws, horns and
hooves of animals.
 Derived from the same cells as epidermis
and hair these are hard, horny keratin plates that
protect the tips of the fingers and toes.
 The root of the nail is embedded in the skin and covered
by the cuticle, which forms the hemispherical pale area
called the lunula.
 Finger nails grow more quickly than toe nails and
growth is faster when the environmental temperature
is high.
Functions of the skin
 Protection
The skin forms a relatively waterproof layer, provided
mainly by its keratinised epithelium, which protects the
deeper, more delicate structures. As an important nonspecific
defence mechanism it acts as a barrier against:
• invasion by micro-organisms • chemicals
• physical agents, e.g. mild trauma, ultraviolet light
• dehydration.
 The epidermis contains specialised immune cells
called dendritic (Langerhans) cells, type of macrophage. They
phagocytose intruding antigens and travel to lymphoid tissue,
where they present antigen to T-lymphocytes, thus
stimulating an immune response.
 The pigment melanin protects against harmful ultraviolet
rays in sunlight.
Regulation of body temperature
 Body temperature remains fairly constant around 36.8°C
across a wide range of environmental temperatures ensuring
that the optimal range for enzyme activity required for
metabolism is maintained.
Heat production
When metabolic rate increases, body temperature rises,
and when it decreases body temperature falls. Some of
the energy released during metabolic activity is in the
form of heat; the most active organs produce most heat.
The principal organs involved are:
• skeletal muscles – contraction of skeletal muscles
produces a large amount of heat and the more
strenuous the muscular exercise, the greater the heat
produced. Shivering also involves skeletal muscle
contraction, which increases heat production when
there is the risk of body temperature falling below
normal.
• the liver is very metabolically active, which produces
heat as a by-product. Metabolic rate and heat
production are increased after eating.
• the digestive organs that generate heat during peristalsis
and the chemical reactions involved in digestion.
Heat loss
Most heat loss from the body occurs through the skin.
Small amounts are lost in expired air, urine and faeces.
Only heat loss through the skin can be regulated.
Heat loss through the skin is affected by the difference
between body and environmental temperatures.
Mechanisms of heat loss (Fig. 14.7). In radiation, the
main mechanism, exposed parts of the body radiate heat
away from the body. In evaporation, the body is cooled as
body heat converts the water in sweat to water vapour.
In conduction, clothes and other objects in direct contact
with the skin take up heat. In convection, air passing over
the exposed parts of the body is heated and rises, cool air
replaces it and convection currents are set up. Convection
also cools the body when clothes are worn, except when
they are windproof.