Institute of Health Services – Francistown Campus

Natural Science: Human Anatomy & Physiology

Course content: NSC 111 Year one. Semester one UNIT IV

Topic: INTEGUMENTARY SYSTEM

The Integumentary system is an organ system consisting of the skin, its derivatives
(sweat and oil glands), and its appendages (including hair, scales, feathers, hooves,
and nails). This organ system protects the body from various kinds of damage, such
as loss of water or abrasion from outside. The basic function of the skin is protection.
The variety of functions include; it may serve to waterproof, cushion, and protect the
deeper tissues, excrete wastes, and regulate temperature, and is the attachment site
for sensory receptors to detect pain, sensation, pressure, and temperature. In most
terrestrial vertebrates with significant exposure to sunlight, the integumentary
system also provides for vitamin D synthesis.

The skin consists of epidermis - the superficial layer made up of stratified squamous
epithelium and dermis –a deeper layer made of connective tissue.

The junctions between these two layers is the dermal papillae (finger-like extensions
from the dermis). The downward projections of epidermis (in the intervals between
the dermal papillae) are called epidermal papillae.

STRUCTURE OF SKIN

I. EPIDERMIS

A. Cells of the Epidermis

Epidermis consists of stratified squamous keratinizing epithelium.

CELLS:
Consists of keratinocytes, melanocytes, Merkel cells and Langerhans cells.
 Keratinocytes: Tightly packed and connected to desmosomes; originate from
stratum basale; produce keratin. The basal layer is also known as the germinal
layer.
 Melanocytes: spider-like cells that produce melanin (forms a pigment shield
that protects the nucleus from the UV rays). Melanocytes are derived from
melanoblasts.

1
  Langerhans cells: Star-shaped cells from bone marrow. Function to activate
the immune system as macrophages.
 Merkel cells: Function as sensory receptors

B. Layers of the Epidermis

There are five layers. From deep to superficial: Stratum basale; Stratum spinosum;
Stratum granulasum; Stratum lucidum; Stratum corneum.

 Stratum basale: Consist of predominantly single row of keratinocytes; some

melanocytes (10-25%) and Merkel cells;
 Stratum spinosum: Several layers thick; Contains flattened irregularly-
shaped keratinocytes, pre-keratin intermediate filaments.
 Stratum granulasum: Consist of flattened keratinocytes which accumulate
keratohyaline granules (granules form keratin) and lamellated granules
(produce water-resistant chemical).
 Stratum lucidum: Present only in thick skin and made up of a few rows of
clear, flat, dead keratinocytes.
 Stratum corneum: Outermost layer, consists many layers of cells –corneocytes
are dead (cornified or horny cells). These have lost their nuclei and organelles.
These cells contain keratin. They are held together by a layer of lipid, which
makes the layer “waterproof”. Dead skins slough off.

2
II. DERMIS

Richly supplied with nerves (sensory receptors), blood vessels, lymphatic vessels,
sweat and sebaceous glands derived from the epidermis. Contains two layers:
papillary and reticular.

 Papillary layer: Consists of areolar connective tissue made up of loose

collagen and elastic fibers, projections called papillae which contain touch and
pain receptors (Messsner’s corpusles). The papillae also form epidermal
ridges found on the surfaces of palms, fingers and feet. On the palm and
fingers they form the fingerprints (genetic markers of individualilty).
 Reticular layer: Account for about 80% of thickness of dermis; consist
of dense irregular connective tissue. The ECM (extracellular matrix) of this
layer consist of bundles of collagenous fibers which run in parallel and
opposite directions. The fibers give strength and resilience (toughness) and
recoil, while collagen absorbs water and keep the skin hydrated. Stretch
marks found on the buttocks, thighs, abdomen and breast are due to these
fibers.

Types of skin:
Two types: Thick or glabrous skin & Thin or hairy skin.
 Thick or glabrous skin: In this skin type, epidermis is very thick (made up of
keratinized stratified squamous epithelium) with a thick layer of stratum
corneum. Sweat glands are present in the dermis. It is found on palms of
hands and soles of feet and has no hair.
 Thin or hairy skin: In this skin type, epidermis is very thin. It contains hair
and is found in all other parts of the body except palms and soles.

Disturbances of the skin

 Stretch and tear; blisters

Blood supply:
Skin is a highly vascular organ. One plexus (a network of vessels in the body) of
arteries is present over the deep fascia; another plexus, just below the dermis is
called reticular plexus; the papillary plexus lies just below the dermal papilla.

The epidermis has no blood supply. It derives its nutrition entirely by diffusion from
the capillary loops of the dermal papillae.

3
Nerve Supply:

The skin is richly supplied with sensory nerves. Dense network of nerve fibers are
seen in the superficial parts of the dermis. Apart from sensory nerves, the skin
receives autonomic nerves that supply smooth muscle in the walls of blood vessels;
the arrector pilorum muscles, and myoepithelial cells present in relation to sweat
glands.

Skin Coloration
Skin color is due to a combination of three pigments: Melanin, carotene and
haemoglobin.
Melanin is a brown-black pigmentation formed in cells called melanocytes. Cells are
found in the stratum basale and spinosum. The amount of melanin produced by an
individuals is based on inheritance. Freckles are small patches of Melanin on the skin
due to uneven distribution.

Hemoglobin is the molecules found in RBC that gives blood its red coloration. It is
made of non-protein (heme which contains iron) and the protein (globin).

Carotene is the yellowish pigment found in the corneum and the dermis.

Skin color of human races occur as a result of the relative abundance of melanin and
carotene. Dark-skin coloration is due to melanin. Caucacians produce more carotene
than melanin.

Melanin protects the skin and cells of the skin by shielding the UV light of the sun
against the nucleus.

III. Functions of the skin

 Protective Functions:
- The skin provides mechanical protection to the underlying tissues.

- The skin also acts as a physical barrier against entry of micro-organisms and other
substances.

 The skin prevents loss of water from the body.

- The pigment present in the epidermis protects tissues against harmful effects of
light (especially ultraviolet light). However, some degree of exposure to sunlight is
essential for synthesis of vit D. (Ultraviolet light converts 7-dehydrocholesterol –present
in skin –to vitamin D).

4
- The skin offers protection against damages of tissues by chemicals, by heat, and by
osmotic influences.

 The skin is a very important sensory organ, containing receptors for touch
and related sensations.
 The skin plays an important role in regulating the body temperature.

IV. ACCESSORY STRUCTURES

Accessory structures include hair, nail, and glands (Sebaceous glands, Sweat glands
& Ceruminous glands).

Hair: Formed of keratinized cells and consist of two parts: a shaft and root. The
shaft is above the skin and root embedded in the dermis, in a hair follicle connected
to blood supplies and arrector muscle. The root has an expanded lower end called
the bulb. The bulb is invaginated from below by part of the dermis that constitutes
the hair papilla. The root of each hair is surrounded by a tubular sheath called the
hair follicle. The sites where hairs are absent are palms, soles, sides of the fingers.

Nail: They are formed of keratinized epidermal cells and occur on the finger and
toes. They are solid plates of modified horny cells. Consist of a visible area (body)
and the root (embedded in the dermis). The function of the nails is to provide a firm
support for finger tips.

5
NB: In iron deficiency anemia, the nails become concave and spoon-shaped, a condition
called koilonychias. The nails become thin and brittle.

6
Glands: There are three exocrine (consists ducts) glands: sebaceous, sudoriferous
(sweat) and ceruminous glands. These glands secrete their contents to the exterior
unlike endocrine which secrete their contents directly into blood.

a. Sebaceous glands: Produce oil (sebaum) which keeps the skin oily. The glands
are branched and attached to the hair follicle. Each gland consists of a number of
alveoli, that are connected to a duct. When the arrector pili muscle contracts, it
squeezes the gland to discharge its secretions “sebum” into the hair follicle. Blockage
of the gland causes acne.
NB: The tarsal glands of eyelids are modified sebaceous glands. They are called
meibomian glands.

b. Sudoriferous (sweat) gland: Produce sweat or perspiration composed of water,

salt, urea and uric acid. They are coiled and tubular shaped and of two types:
Eccrine (with the highest density on forehead, back of palm and soles), and
Apocrine (larger than eccrine, found in pubic regions and secrete into hair
follicles). Mammary glands: are specialized form of sudoriferous gland secrete
milk.

7
c. Ceruminous glands: Any of the modified sudiferous (sweat) glands producing a
waxy secretion. Found only in the external auditory canal where they secrete
cerumen (earwax). They are classed as apocrine glands. Cerumen is an insect
repellant and also keep the eardrum (tympanic membrane) from drying out. Excess
amount may block.

V. TEMPERATURE REGULATION

Man (mammals) are homeothermic i.e. their body temperature will not vary
according to the environment. Normal human body temperature is 37oC (98.6 oF).
Rectal temperature is usually 0.5oC more than that of oral temperature.

Sources of Body heat

Heat gain by the body occurs during rest as well as during physical activities. Heat is
produced during digestion. The internal muscular activities like pumping generate
heat. Also heat is gained from the environment by radiation and conduction. Brown
fat (mitochondria-packed brown-fat), mostly found in babies, has a high metabolic

8
rate and is located between and around the scapulae and neck, behind the sternum
and around the kidneys.

Channels of heat loss

Heat is lost from the body through skin by conduction, convection, radiation and
evaporation. Heat is also lost through urine, faeces and the respiratory tract.

NB: The hypothalamus plays an important role in keeping the body temperature near to
constant level. The anterior hypothalamus integrates the mechanisms responding to increase in
body temperature or exposure to hot environment. Posterior hypothalamus integrates body
responses to cold. Both these responses consist of automatic, somatic, hormonal and behavioural
mechanisms. Cold and warm receptors present in the skin, abdominal visceral organs, internal
organs and in the spinal cord sense the temperature changes and activate the hypothalamus.

Mechanisms Activated by Heat

Heat gain by the body activates the anterior hypothalamus to cause:

 Cutaneous Vasodilation: by this process, the core heat is brought to the skin
surface to be lost by conduction, convection and radiation.
 Sweating
 Anorexia: Anorexia or loss of appetite results in decreased food intake and
decreased metabolic reactions, thus causing decreased heat production.
 Behavioural responses: This includes moving to a shade or cooler place and
decreased muscular activities. All these decrease the body temperature.
 Panting: This is seen in some animals like dogs but not humans. Panting
means rapid shallow breathing. This can cause increased evaporation through
the mouth and respiratory passages.

Mechanisms Activated by Cold

Exposure to cold can reduce the body temperature through the following
mechanisms:

 Mechanisms for heat conservation

 Mechanisms for heat production

Mechanisms for heat conservation:

o Cutaneous vasoconstriction: Activation of posterior hypothalamus increases
the sympathetic discharge, when the body is exposed to a cold atmosphere.
This can cause vasoconstriction of the cutaneous blood vessels throughout the
body, thus decreasing the cutaneous blood flow. Heat lose is then prevented.

9
 o Piloerection: Cold can induce contraction of erector pili (which is a cutaneous
muscle). The body hairs stand up forming an additional insulating layer to
conserve heat. (“Goose Flesh”).
 Mechanisms for Heat production
o Shivering: Shivering is due to increased discharge from the anterior horn
cells of spinal cord, causing increased muscle tone throughout the body.
o Increased catecholamine secretion: Cold stimulates secretion of
catecholamines (epinephrine and norepinephrine), which may induce
chemical thermogenesis, by increasing the rate of cellular metabolism.
o Increased secretion of thyroxine: Continous exposure to severe cold can
increase the secretion of thyroid stimulating hormone (TSH), which can
cause hyperplasia of thyroid gland.
o Heat production by the brown fat: This occurs in infants in whom
shivering does not occur. Increased metabolism of brown fat in infants
causes increased heat production and this is called nonshivering
thermogenesis.

INFLAMMATION
Inflammation is part of the complex biological response of body tissues to harmful
stimuli, such as pathogens, damaged cells, or irritants, and is a protective response
involving immune cells, blood vessels, and molecular mediators. The function of
inflammation is to eliminate the initial cause of cell injury, clear out necrotic cells
and tissues damaged from the original insult and the inflammatory process, and to
initiate tissue repair. It can be defined as the local response of living mammalian tissues
to injury due to any agent. Inflammation does not mean infection, even when an
infection causes inflammation. Infection is caused by a bacterium, virus or fungus,
while inflammation is the body's response to it.

The classical signs of inflammation are heat, pain, redness, swelling, and loss of
function. Redness and heat are due to increased blood flow at body core temperature
to the inflamed site; swelling is caused by accumulation of fluid; pain is due to the
release of chemicals such as bradykinin and histamine that stimulate nerve endings.
Inflammation involves two basic processes with some overlapping, viz. early
inflammatory response and later followed by healing

Agents Causing Inflammation

 Infective agents like bacteria, viruses and their toxins, fungi, parasites.

10
  Immunological agents like cell-mediated and antigen-antibody reactions.
 Physical agents like heat, cold, radiation and mechanical trauma.
 Chemical agents like organic and inorganic poisons.
 Inert materials, such as foreign bodies.

Signs of Inflammation
The Roman writer Celsus in first century AD named the famous four cardinal signs
of inflammation as:
Rubor (redness)
Tumor (swelling)
Calor (heat) and
Dolor (Pain)
To these, fifth sign functio laesa (Loss of function) was later added by Virchow

Types of Inflammation:

Inflammation maybe divided into acute or chronic variety.

Acute Inflammation: It is characterised by: Its rapid onset; Has a short duration; has
neutrophils (also called polymorphonuclear leukocytes) as predominant cells; When
causative agents are removed, the reaction subsides and if not, it progress to a
chronic phase

Chronic Inflammation: It is characterised by: May follow acute inflammation or

insidious in onset; Has longer duration; Lymphocytes, macrophages and sometimes
plasma cells are predominant cells; The inflammatory cells associated with the
proliferation of blood vessels, tissue destruction and fibroblasts proliferation; fibrosis
and scare formation.

BURNS

A burn is a type of injury to skin, or other tissues, caused by heat, cold, electricity,
chemicals, friction, or radiation. Most burns are due to heat from hot liquids, solids,
or fire.

Burns are usually caused by fires, kitchen spills, or excessively hot bath water, but
they also can be caused by sunlight, ionizing radiation, strong acids and bases, or
electrical shock. Burn deaths results primarily from fluid loss, infection, and the toxic
effects of eschar –the burned, dead tissue.

11
The amount of damage that a burn can cause depends upon the type of burn, its
location, its depth, and how much body surface area that it involves.

How are burns classified?

Burns are classified based upon their depth.

 A first degree burn is superficial and causes local inflammation of the skin,
they involve only the epidermis. Sunburns often are categorized as first
degree burns. The inflammation is characterized by pain, redness, and a mild
amount of swelling. The skin may be very tender to touch.

First degree burn

 Second degree burns are deeper and in addition to the pain, redness and
inflammation, there is also blistering of the skin. They involve the epidermis
and part of the dermis but leave some of the dermis intact. First- and second-
degree burns are therefore also known as partial-thickness burns. A second
degree burn may be red, tan, or white and is blistered and very painful.

Second degree burn

12
  Third degree burns are also called full-thickness burns are deeper still,
involving all layers of the skin, in effect killing that area of skin. Because the
epidermis, dermis, and often some deeper tissue are completely destroyed including
nerves and blood vessels are damaged, third degree burns appear white and leathery
and tend to be relatively painless. Third-degree burns often require skin grafts. If left
to itself to heal, contracture (abnormal connective tissue fibrosis) and severe
disfigurement may result.

Third degree burn

 A fourth-degree burn additionally involves injury to deeper tissues, such as muscle,

tendons, or bone. The burn is often black and frequently leads to loss of the burned
part.

Fourth-Degree burn (Check out the bone exposure)

Burns are not static and may mature. Over a few hours a first degree burn may
involve deeper structures and become second degree. Think of a sunburn that
blisters the next day. Similarly, second degree burns may evolve into third degree
burns. Regardless of the type of burn, inflammation and fluid accumulation in and
around the wound occur. Moreover, it should be noted that the skin is the body's
first defense against infection by microorganisms. A burn is also a break in the skin,

13
and the risk of infection exists both at the site of the injury and potentially
throughout the body.

Only the epidermis has the ability to regenerate itself. Burns that extend deeper may
cause permanent injury and scarring and not allow the skin in that area to return to
normal function.

The treatment of burns depends on the depth, area and location of the burn. Burn
depth is generally categorized as first, second or third degree. A first degree burn is
superficial and has similar characteristics to a typical sun burn. The skin is red in
color and sensation is intact. In fact, it is usually somewhat painful. Second degree
burns look similar to the first degree burns; however, the damage is now severe
enough to cause blistering of the skin and the pain is usually somewhat more
intense. In third degree burns the damage has progressed to the point of skin death.
The skin is white and without sensation. The two most urgent consideration in
treating a burn patient are fluid replacement and infection control. As fluid is lost
from the tissues, more is transferred from the blood stream to replace it, and the
volume of the circulating blood declines. Fluid contains proteins & electrolytes.

In addition to the depth of the burn, the total surface area of the burn is significant.
Burns are measured as a percentage of total body area affected. The "rule of nines" is
often used, though this measurement is adjusted for infants and children. This
calculation is based upon the fact that the surface area of the following parts of an
adult body each correspond to approximately 9% of total (and the total body area of
100% is achieved):

 Head = 9%
 Chest (front) = 9%
 Abdomen (front) = 9%
 Upper/mid/low back and buttocks = 18%
 Each arm = 9%
 Each palm = 1%
 Groin = 1%
 Each leg = 18% total (front = 9%, back = 9%)

14
As an example, if both legs (18% x 2 = 36%), the groin (1%) and the front chest and abdomen
were burned, this would involve 55% of the body.

Only second and third degree burn areas are added together to measure total body burn
area. While first degree burns are painful, the skin integrity is intact and it is able to do its
job with fluid and temperature maintenance.

If more than15%-20% of the body is involved in a burn, significant fluid may be

lost. Shock may occur if inadequate fluid is not provided intravenously. As the percentage of
burn surface area increases, the risk of death increases as well. Patients with burns involving
less than 20% of their body should do well, but those with burns involving greater than 50%
have a significant mortality risk, depending upon a variety of factors, including underlying
medical conditions and age.

Summary
DEGREES OF BURNS
Burns are classified by the depth of injury, which helps determine the appropriate
treatment.

 1st Degree: Superficial - redness of skin without blisters

 2nd Degree: Partial thickness skin damage - blisters present
 3rd Degree: Full thickness skin damage - skin is white and leathery
 4th Degree: Same as third degree but with damage to deeper structures such as
tendons, joints and bone

15
 Layers Healing
Type Appearance Texture Sensation Prognosis
involved Time

Heals well;
Repeated sunburns
Superficial Red without
st Epidermis Dry Painful 5 – 10 days increase the risk of skin
(1 -degree) blisters
cancer later in life
Extends
Superficial Redness with
into
partial clear blister. less than 2 Local infection/cellulitis but
superficial Moist Very painful
thickness Blanches with – 3 weeks no scarring typically
nd (papillary)
(2 -degree) pressure.
dermis
Extends Yellow or white.
Deep partial Pressure Scarring, contractures (may
into deep Less blanching.
thickness May be
Fairly dry and 3 – 8 weeks require excision and skin
nd (reticular)
(2 -degree) blistering. discomfort grafting)
dermis
Extends Stiff and Prolonged Scarring, contractures,
Full
through
thickness entire
white/brown Leathery Painless (months) & amputation (early excision
rd
(3 -degree) dermis No blanching incomplete recommended)
Extends Black; charred
through with eschar (a
entire skin, dry, dark scab Amputation, significant
th Requires
4 -degree and into or falling away Dry Painless functional impairment, and,
underlying of dead skin excision
in some cases, death.
fat, muscle normally cause
and bone by a burn)

16
Skin Aging

 After 50 years, wrinkles and sagging of the skin become more noticeable.
 Effects of aging are a result of deterioration of collagen, elastic fibers; decrease
in sebaum production, decrease in melanin production, decrease in content
and decomposition of cutaneous fat.

Disorders of the skin

 There are several types of skin disorders associated with the skin. Some of
them are infectious (contagious) or non-infectious.
 These disorders include acne, athletes foot, boils, fever blisters, impetigo,
warts, alopecia, burns, calluses (corns), cancers, dandruff, eczema, moles
psoriasis and others.

Contagious skin disorders

A. Contagious disorders are caused by bacteria or virus or fungus

 Acne: characterized by plugged hair follicles that form pimples. Caused by

bacteria, prevalent in teenage years.
 Boils: painful infection of hair follicles and sebaceous glands by
Staphylococcus bacteria.
 Fever blisters: cold sores…fluid filled blisters on the lips or oral membrane
caused by Herpes simplex virus and transmitted by oral and respiratory
exposure. Genital Herpes are painful blisters on the genitals and transmitted
by sexual contact.
 Impetigo: highly contagious skin infection caused by bacteria, occurs in
children and characterized by fluid-filled pustules forming yellow crust over
infected area.
 Warts: small skin tumors caused by viral infection that stimulate excessive
growth of epithelial cells

B. Non-contagious skin disorders

 Alopecia: loss of hair (pattern baldness) is most prevalent in males and

inherited. May also be caused by factors such as poor nutrition, sensitivity to
drugs, and eczema.

17
  Eczema: inflammation producing redness, itching, scalding and cracking of
skin. Seborrheic eczema is produced by hyperactivity of the sebaceous glands.
 Psoriasis: a chronic dermatitis characterized by reddish raised patches of skin
covered with whitish scales. Result from excessive cell production caused by
emotional stress or poor health. Occurs often on the buttocks, elbows, scalp
and knees. Others conditions are: dandruff, cancers, calluses, hives, burnes.

Skin Cancers

 Basal cell carcinoma: originate from the stratum basel (about 70% of skin
cancers). Treated by excision.
 Squamous carcinoma: originate from cells immediately above the basale
layer. Treatment consist of X-ray and excision.
 Malignant melanoma: most life-threatening arises from melanocytes in the
basale. Most often begins as a mole-like growth and enlarges. May change
and metastatize. Often removed by excision, x-ray.

Layers
Type Appearance Texture Sensation Prognosis Example
involved

Heals well;
Superficial Repeated sunburns
st Epidermis Red without blisters Dry Painful
(1 degree) increase the risk of skin
cancer later in life

Superficial Extends into Redness with

Local infection
partial superficial clear blister.
Moist Very painful /cellulitis but no scarring
thickness (papillary) Blances with
nd typically
(2 degree) dermis pressure.

Extends into
Deep partial Yellow or white. Scarring, contractures
deep Pressure &
thickness Less blanching. Fairly dry (may require excision
nd (reticular) discomfort
(2 degree) May be blistering. and skin grafting)
dermis

Full Extends Scarring, contractures,

rd Stiff & white/brown
thickness (3 through entire Leathery Painless amputation (early
No blanching
degree) dermis excision recommended)

Extends
through entire Amputation, significant
th skin, & into Black; charred functional impairment,
4 -degree Dry Painless
underlying fat, with eschar and, in some cases,
muscle & death.
bone

18