LECTURE NOTE SERIES ON PHM 221: RENAL PHYSIOLOGY AND BODY FLIUD

TOPIC: THE SKIN

 The skin is the body's largest and primary protective organ, covering its entire external
surface and serving as a first-order physical barrier against the environment.
 Skin is a complex organ. An average square inch of skin contains 650 sweat glands, 20
blood vessels, and more than 1,000 nerve endings. Despite being just a few millimeters
thick, the skin makes up around one-seventh of a person’s body weight.
 Its functions include temperature regulation and protection against ultraviolet (UV) light,
trauma, pathogens, microorganisms, and toxins.
 The skin also plays a role in immunologic surveillance, sensory perception, control of
insensible fluid loss, and homeostasis in general.
 The skin is also highly adaptive with different thicknesses and specialized functions in
different body sites.
 People cannot live for long without the skin
 It is the cardinal member of the integumentary system.

FUNCTIONAL ANATOMY OF THE SKIN

 Embryologically, the epidermis originates from the surface ectoderm. It is infiltrated with
pigment-producing cells known as melanocytes, which originate from the neural crest.
 Other cell types normally present in the epidermis include keratinocytes, antigen
processing Langerhans cells, and Merkel cells (tactile receptors that sense pressure
changes at the bottom of the epidermis).
 The dermis is embryologically derived from the mesoderm and contains connective tissue
macromolecular components and cells, including elastic fibers, collagen, nerves, blood
vessels, adipocytes, and fibroblasts

Several skin receptors play specific roles in our ability to physically perceive the changes in the
external environment.

 Meissner receptors detect light touch.

 Pacinian corpuscles perceive deep pressure and vibrational changes.
 Ruffini endings detect deep pressure and stretching of the skin’s collagen fibers.
 Free nerve endings located in the epidermis respond to pain, light touch, and temperature
variations.
 Merkel receptors associated with the Merkel cells respond to sustained light touch
induction over the skin.
 Dermatomes are areas of skin mainly supplied by a single spinal nerve. Eight cervical
nerves contribute to the dermatomes (except for C1), 12 thoracic nerves, five lumbar
nerves, and five sacral nerves. Each of these nerves relays sensation (including pain)
from a particular region of the skin to the brain

 The skin is highly vascularized and is supplied by plexuses found between the reticular
and papillary layers of the dermis.
  The blood supply originates from an extensive network of larger blood vessels and
capillaries that extend from regional branches of the systemic circulation to local sites
throughout subcutaneous tissue and dermis, respectively
 An extensive lymphatic framework runs alongside many of the skin’s blood vessels,
particularly those attached to the venous end of the capillary networks.
 Arrector pili muscles, the smallest skeletal muscles of the body, are found in all areas of
the skin that contain hair follicles. These tiny muscular structures control the positioning
of hairs and the activity of sebaceous glands in response to environmental induction, such
as heat and abrasion.
 The arrector pili muscles contract and raise the hairs under conditions of stress when the
sympathetic nervous system is activated, such as during the fight or flight response and in
response to cold, creating the phenomenon colloquially known as "goosebumps."

LAYERS OF THE SKIN

The skin is primarily made up of three layers.

 The upper layer is the epidermis, the layer below the epidermis is the dermis, and the third
and deepest layer is the subcutaneous hypodermis) is made of fat and connective tissue.

A. Epidermis

The epidermis is the outermost layer. It is a waterproof barrier that gives skin its tone. It’s main
roles are:

 to make new skin cells

 to give the skin its color
 to protect the body from the external environment
Humans shed around 500 million skin cells each day. In fact, the outermost parts of the
epidermis consist of 20–30 layers of dead cells.

The epidermis constantly makes new cells in its lower layers. Over the course of around four
weeks, these cells make their way to the surface, become hard, and replace the shedding, dead
cells.

Keratinocytes are the most common type of cells within the epidermis. Their job is to act as a
barrier against bacteria, parasites, fungi, viruses, heat, ultraviolet (UV) rays, and water loss.

The epidermis contains no blood vessels. The color of the skin comes from a pigment called
melanin, which is produced by melanocytes. These are found in the epidermis and protect the
skin from UV rays.

The epidermis is further divided into five layers on thick skin like the palms and soles (stratum
basale, stratum spinosum, stratum granulosum, stratum lucidum, and stratum corneum, while
in other places, the epidermis only has four layers, lacking the stratum lucidum).

A thin sheet of fibers known as the basement membrane divides the epidermis and the dermis.

B. Dermis

The dermis serves as connective tissue and protects the body from stress and strain. It also gives
the skin strength and elasticity. In addition, its main roles are:

 to make sweat and oil

 to provide sensation and blood to the skin
 to grow hair

The reason the dermis can perform these functions is that it houses the hair follicles, blood
vessels, and lymphatic vessels. It is home to a number of glands, including sweat glands and
sebaceous glands, which produce sebum, an oil that lubricates and waterproofs hair.

The dermis also contains the receptors that detect pressure (mechanoreceptors), pain
(nociceptors), and heat (thermoreceptors).

If the dermis stretches a lot, such as during pregnancy, then it can tear. This will show up later as
stretch marks.

The dermis further splits into two layers:

Papillary region
The papillary region contains loose connective tissue. It has finger-like projections that push into
the epidermis. These projections give the dermis a bumpy surface and are responsible for the
patterns of a person’s fingertips.

Reticular region
The reticular region contains dense, irregularly organized connective tissue. Protein fibers in the
reticular region give the skin its strength and elasticity.

C. Hypodermis

The deepest layer of the skin is the subcutaneous tissue, the hypodermis, or the subcutis. It is not
technically part of the skin, but it helps attach the skin to the bones and muscles. Subcutaneous
tissue also provides the skin with nerves and blood supply.

The hypodermis contains mostly fat, connective tissue, and elastin, which is an elastic protein
that helps tissues return to their normal shape after stretching. The high levels of fat help insulate
the body and prevent a person from losing too much heat. The fat layer also acts as protection,
padding the bones and muscles.

THE FUNCTIONS OF THE SKIN

 Protection against microorganisms, dehydration, ultraviolet light, and mechanical

damage; the skin is the first physical barrier that the human body has against the external
environment.
 Sensation of pain, temperature, touch, and deep pressure starts with the skin.
 Mobility: The skin allows smooth movement of the body.
 Endocrine activity: The skin initiates the biochemical processes involved in Vitamin D
production, which is essential for calcium absorption and normal bone metabolism.
 Exocrine activity: This occurs by the release of water, urea, and ammonia. Skin secretes
products like sebum, sweat, and pheromones and exerts important immunologic functions
by secreting bioactive substances such as cytokines.
 Immunity development against pathogens.
 Regulation of Temperature. Skin participates in thermal regulation by conserving or
releasing heat and helps maintain the body’s water and homeostatic balance.

FACTS ABOUT SKIN TEXTURE AND COLOR

 Skin color is a phenotype, which is an observable trait like eye color or height. The color
results from different types of a pigment called melanin.
  Melanin’s primary role is to protect the skin from damaging UV light from the sun,
which can cause skin cancer. When skin is exposed to UV light, melanocytes start
producing melanin, creating a sun tan.
 People who have more pheomelanin will have paler skin. People who have more
eumelanin will have darker skin.

Research shows that populations closer to the equator evolved to have darker skin for better
protection again the sun’s UV rays. On the other hand, people in colder climates evolved lighter
skin to better maintain Vitamin D.

 The multiple layers of the skin are dynamic, shedding and replacing old inner layers. The
thickness of skin varies based on its location, age, gender, medications, and health
affecting the skin’s density and thickness.

The varying thickness is due to changes in the dermis and epidermis.

 Thick skin is present on the palms and soles, where there is marked keratinization and
the stratum lucidum layer.
 Thinner skin is present on eyelids, axillae, genitals, and the mucosal surfaces exposed to
the external environment, such as oral mucosa, vaginal canal, and other selected internal
body surfaces.
 Primarily due to the effects of androgens, adult males typically have thicker skin than
females in most areas of the body.
 Children have thin skin, which gradually thickens until the fourth decade of life, affected
by the concentration of sex steroids, general health, and hydration.

The skin begins to thin again during the fifth decade of life, primarily due to changes in the
dermis with loss of epithelial appendages, elastic fibers, and ground substance, among others.
Genetic and environmental factors also affect skin thickness