Lecture 2.
Integumentary System
Compiled by: Heirich Fevrier P. Manalili,
RPh MD
Major organs: skin, hair, nails, cutaneous
glands
The functions of the integumentary system
include:
• Protection from pathogens and UV
light
o Body’s first line of defense
o Difficult for pathogens to
penetrate
o Dry, acidic surface is
unfriendly to bacteria
o Melanin protects underlying
cells from UV light damage
• Vitamin D production
o UV light encourages skin to
produce vitamin D.
o Important for the absorption
of calcium.
• Temperature regulation
o Blood vessels in the dermis
§ Constrict to preserve
heat for the body’s
core
§ Dilate to increase
blood flow to the skin
so that heat can
radiate out of the
body
• Water retention
o The skin’s epidermis
waterproofs the body by
keeping water from the
environment out and body
fluids in.
• Sensation
o Nerve endings are located in
the stratum basale, and
dermis respond to stimuli:
§ Temperature
§ Pain
§ Touch
§ Pressure
• Nonverbal communication
o Blushing when embarrassed
o Pale when frightened
o Color, texture, silkiness, and
other qualities of the skin
and hair can all be indicative
of overall health
Skin- 15% of total body weight, surface area
1.2-2.2 m2, weighs about 4-5 kg (9-11lbs),
varying thickness from 0.5 mm (0.02 in.) on
the eyelids to 4.0 mm (0.16 in.) on the
heels. Over most of the body it is 1–2 mm
(0.04–0.08 in.) thick.
Main layers:
Epidermis – most superficial layer,
composed of stratified squamous epithelial
tissue
Dermis – loose/areolar connective tissue
over dense irregular connective tissue
Ø Where the cutaneous glands,
hair follicles and nerve endings
are found.
Hypodermis/subcutaneous layer – adipose
connective tissue
Ø Connects the skin to the
underlying fascia
Ø Serves as insulating layer,
cushioning layer, energy source
Ø Thicker in women

Layers of the epidermis aka strata (from the
most exterior) –
Stratum corneum
Ø Composed of tough, waterproof
dead cells that eventually flake off
(exfoliate)
Ø consists on average of 25 to 30
layers of flattened dead
keratinocytes, but can range in
thickness from a few cells in thin
skin to 50 or more cell layers in
thick skin.
Ø The cells are extremely thin, flat,
plasma membrane–enclosed
packages of keratin that no longer
contain a nucleus or any internal
organelles.
o They are the final product
of the differentiation
process of the
keratinocytes.
Stratum lucidum
Ø is present only in the thick skin of
areas such as the fingertips, palms,
and soles.
Ø It consists of four to six layers of
flattened clear, dead keratinocytes
that contain large amounts of
keratin and thickened plasma
membranes.
Ø This probably provides an additional
level of toughness in this region of
thick skin.
Stratum granulosum
Ø consists of three to five layers of
flattened keratinocytes that are
undergoing apoptosis.
Ø A distinctive feature of cells in this
layer is the presence of darkly
staining granules of a protein called
keratohyalin which assembles
keratin intermediate filaments into
keratin.
Ø Also present in the keratinocytes
are membrane-enclosed lamellar
granules which fuse with the
plasma membrane and release a
lipid-rich secretion.
o This secretion is deposited
in the spaces between cells
of the stratum granulosum,
stratum lucidum, and
stratum corneum.
o The lipid-rich secretion acts
as a water-repellent
sealant, retarding loss and
entry of water and entry of
foreign materials.
Stratum spinosum
Ø consists of numerous keratinocytes
arranged in 8–10 layers.
Ø Cells in the more superficial layers
become somewhat flattened.
Ø The keratinocytes of this layer
produce coarser bundles of keratin
in intermediate filaments than
those of the basal layer.
Ø cells of the stratum spinosum shrink
and pull apart when prepared for
microscopic examination, except
where the membranes join at
 desmosomes, so that they appear
to be covered with thornlike spines
(thus, the name)
Stratum basale
Ø composed of a single row of
cuboidal or columnar keratinocytes.
Some cells in this layer are stem
cells that undergo cell division to
continually produce new
keratinocytes.
Ø The cytoskeleton within
keratinocytes of the stratum basale
includes scattered intermediate
filaments, called keratin
intermediate filaments
(tonofilaments).
o The keratin intermediate
filaments form the tough
protein keratin in its more
superficial epidermal layers.
o Keratin protects the deeper
layers from injury.
Cells of the epidermis
Keratinocytes
• Make up the majority of
epidermal cells
• Grow and divide pushing the
older cells up toward the
surface
• Produce and fill themselves
with keratin (a hard,
waterproof protein) as they
move toward the surface
• Stratum corneum contains
the keratinocytes that have
completely filled with keratin
and died
• This process is called
cornification.
Melanocytes
• Produce skin pigments called
melanin.
• Cells stay in the stratum
basale

Keratinocytes take in melanin-
filled vesicles called
melanosomes by endocytosis
• Melanocytes may not be
evenly distributed across the
skin, and denser patches of
these cells account for
freckles and moles
Tactile cells
• Receptors for fine touch
• Found in the stratum basale
associated with nerve cells
in the underlying dermis
Dendritic cells
• Immune system cells found
in the stratum spinosum and
the stratum granulosum
• Alert the body’s immune
system to the invasion of
pathogens
Dermis
Referred to as "true skin."
a. Papillary dermis
Ø makes up about one-fifth of the
thickness of the total layer
Ø Its surface area is greatly
increased by dermal papillae
small, nipple-shaped structures
that project into the
undersurface of the epidermis.
Ø All dermal papillae contain
capillary loops (blood vessels).
Ø Some contain tactile receptors
called - corpuscles of touch or
Meissner corpuscles (MIS-ner),
nerve endings that are sensitive
to touch.
Ø Other dermal papillae also
contain free nerve endings,
dendrites that lack any apparent
structural specialization
are quite a few local variations related to thickness of the epidermis, tion, and synthesis of vitamin D.
initiate signals that give
o
TABLE 5.4 Comparison of Thin and Thick Skin rise to sensations of
FEATURE THIN SKIN THICK SKIN
Distribution All parts of body except areas such as palms, Areas such as palms, palmar surface of digits,
palmar surface of digits, and soles. and soles.
Epidermal thickness 0.10–0.15 mm (0.004–0.006 in.). 0.6–4.5 mm (0.024–0.18 in.), due mostly to a
thicker stratum corneum.
Epidermal strata Stratum lucidum essential y lacking; thinner Stratum lucidum present; thicker strata
strata spinosum and corneum. spinosum and corneum.
Epidermal ridges Lacking due to poorly developed, fewer, and Present due to well-developed and more
less-well-organized dermal papil ae. numerous dermal papil ae organized in
parallel rows.
Hair follicles and arrector Present. Absent.
pili muscles
Sebaceous glands Present. Absent.
Sudoriferous glands Fewer. More numerous.
Sensory receptors Sparser. Denser.
warmth, coolness, pain,
tickling, and itching.
b. Reticular dermis
Ø Deeper portion of dermis (about
four-fifths); consists of dense
irregular connective tissue with
bundles of thick collagen and
some coarse elastic fibers.
Spaces between fibers contain
some adipose cells, hair follicles,
nerves, sebaceous glands, and
sudoriferous glands.
Structural basis of color:
Ø Melanin, hemoglobin, and carotene
are three pigments that impart a
wide variety of colors to skin.
 Ø The amount of melanin causes the
skin’s color to vary from pale yellow
to reddish-brown to black.
Ø The difference between the two
forms of melanin, pheomelanin
(yellow to red) and eumelanin
(brown to black), is most apparent
in the hair.
Ø Because the number of
melanocytes is about the same in
all people, differences in skin color
are due mainly to the amount of
pigment the melanocytes produce
and transfer to keratinocytes.
Accessory Organs of the Skin
Ø Hair
Ø Nails
Ø Sebaceous glands
Ø Oil glands
Hair
Ø A hair can be divided into three
sections: the bulb, the root, and
the shaft.
Ø There are three layers to a hair:
the inner medulla, the cortex,
and the cuticle.
Ø Each hair grows about a half inch
per month, and its growth stage
lasts for approximately three
years
Ø Each hair then goes into a one-
to two-year resting stage, and
then it falls out
Ø Roughly 90 percent of the hairs
on your head are somewhere in
the growing stage at any given
time
Ø Normally lose about 100 hairs
from your scalp every day
Three types:
Ø Lanugo hair
o Very fine and unpigmented
(colorless)
o Forms on a fetus during the
last three months of its
development
o Lanugo hair is usually
replaced by birth
Ø Vellus hair
o Unpigmented and very fine,
replaces lanugo hair around
the time of birth
o Vellus hair is the body hair on
most women and children
Ø Terminal hair
o Thick, coarse, and heavily
pigmented, forms the
eyebrows, eyelashes, and
hair on the scalp.
o At puberty, terminal hair
forms in the axillary and
pubic regions of both sexes.
It also forms on the face and
possibly on the trunk and
limbs of men.
Ø Final: Males – 95% terminal, 5%
vellus, Female- 35% terminal,
65% vellus
Ø Layers to a hair (3): the inner
medulla (soft keratin), the cortex
(hard keratin), and the cuticle
(interlocking scaly plates of dead
keratinocytes).
Ø Parts (3):
o Bulb- thickening of the hair
at the end of the hair follicle
o Root – extends from bulb to
the skin’s surface
o Shaft- section of the hair
extending out from the skin’s
surface
Ø Stages (3):
o Anagen (early)
§ Growing Phase, 6-8
years
§ Stem cells multiply
and follicle grows into
the deep dermis, hair
matrix cells multiply
and keratinize,
causing hair to grow
upward, old club hair
may persist
temporarily alongside
new growing hair
o Catagen
§ Degenerative phase,
2-3 weeks
§ Hair growth ceases,
hair bulb keratinizes
and forms club
hair,lower follicle
degenerates
o Telogen
§ Resting phase, 1-3
months
§ Dermal papilla has
ascended to level of
bulge, club hair falls
out, usually in telogen
or next anagen
Nails
Parts
Ø Nail body (plate)
o is the visible portion of the
nail.
Ø Free edge
o is the part of the nail body
that may extend past the
distal end of the digit.
o white because there are no
underlying capillaries.
Ø Nail root
o is the portion of the nail that
is buried in a fold of skin.
Ø Lunula
o whitish, crescent-shaped
area of the proximal end of
the nail body
o appears whitish because the
vascular tissue underneath
does not show through due
to a thickened region of
epithelium in the area.
Ø Hyponychium
o is the junction between the
free edge and skin of the
fingertip and secures the nail
to the fingertip.
Ø Nail bed
o is the skin below the nail
plate that extends from the
lunula to the hyponychium.
o The epidermis of the nail bed
lacks a stratum granulosum.
Ø Eponychium
o is a narrow band of
epidermis that extends from
and adheres to the margin
(lateral border) of the nail
wall.
 o It occupies the proximal
border of the nail and
consists of stratum corneum.
Ø Nail matrix
o The portion of the epithelium
proximal to the nail root
o The superficial nail matrix
cells divide mitotically to
produce new nail cells.
o The growth rate of nails is
determined by the rate of
mitosis in matrix cells
o The average growth in the
length of fingernails is about
1 mm (0.04 in.) per week.
o The growth rate is somewhat
slower in toenails.
Sebaceous glands
Ø Oil-producing
Ø Empty sebum into hair follicles
Ø Functions to moisturize the skin
and hair
Ø Estrogen and testosterone increase
sebum production.
Ø are simple, branched acinar
(rounded) glands.
Ø In some locations, such as the lips,
glans penis, labia minora, and tarsal
glands of the eyelids, sebaceous
glands open directly onto the
surface of the skin.
Ø Absent in the palms and soles,
sebaceous glands are small in most
areas of the trunk and limbs, but
large in the skin of the breasts, face,
neck, and superior chest.
Sweat glands
Ø 3-4 million in the body
Ø Main division: eccrine and apocrine
glands
Ø Eccrine glands
o simple, coiled tubular glands
that are much more common
than apocrine sweat glands
o They are distributed throughout
the skin of most regions of the
body, especially in the skin of
the forehead, palms, and soles
o Eccrine sweat glands are not
present, however, in the
margins of the lips, nail beds of
the fingers and toes, glans
penis, glans clitoris, labia
minora, or eardrums.
o The secretory portion of eccrine
sweat glands is located mostly
in the deep dermis (sometimes
in the upper subcutaneous
layer).
o The sweat produced by eccrine
sweat glands (about 600 mL per
day) consists primarily of water,
with small amounts of ions
(mostly Na+ and Cl−), urea, uric
acid, ammonia, amino acids,
glucose, and lactic acid.
§ The main function of
eccrine sweat glands is
to help regulate body
temperature through
evaporation.
 § As sweat evaporates, Apo- Delivers Lipid-rich Serves as
large quantities of heat crine its sweat sweat that scent to
energy leave the body sweat through bacteria influence
surface. gland a duct feed on. It the
Ø Apocrine glands leading is not the behavior
o simple, coiled tubular glands to a hair sweat itself of
but have larger ducts and follicle, but the others.
lumens than eccrine glands associate waste from
o They are found mainly in the d with the
skin of the axilla (armpit), groin, axillary bacteria
areolae (pigmented areas hair, feeding on
around the nipples) of the pubic the sweat
breasts, and bearded regions of hair and that
the face in adult males. beard. creates
o These glands were once They body odor.
thought to release their begin to
secretions in an apocrine produce
manner by pinching off a their
portion of the cell (decapitation sweat at
secretion), but now known as puberty
exocytosis. Cerumi- This is Cerumen Keeps
Gland Location Product Function nous the (earwax). the
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ne numerou sweat cool the gland sweat flexible,
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gland; water, perspirat ous ear
delivers lactic acid, ion glands canal,
sweat nitrogenou are kills
through s waste found bacteria,
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whose and some the ear protects
opening salt canal. the ear
is called canal
a pore; from
located foreign
all over debris.
the body Mam- Modified Breast Nourishe
and are mary sweat milk, which s an
highly gland gland Is infant.
concentr found in composed
ate in the of water,
the breast. carbohydra
palmar Develop tes, lipids,
and at proteins
plantar puberty and
regions and fully minerals
develop
 during
pregnan
cy;
deliver
product
to ducts
that end
at the
nipple
Pathology to the skin
Effects of Aging on the Skin:
All parts of the integumentary system are
affected by aging:
Ø Loss of sebaceous and sweat glands
in the dermis
Ø Loss of melanocytes causing uneven
tanning and age spots
Ø Dermis thins and the number of
collagen and elastic fibers is
reduced
o This, along with gravity, causes
sagging and wrinkling of the
skin
Ø Blood vessels become more fragile
and are less efficient in regulating
temperature
Ø Bumps that lead to bruises are
more frequent because of thinner
dermis
Ø Nail plate and matrix thins
Ø Hair thins and turns gray due to the
loss of melanocytes
Regeneration versus fibrosis:
Skin can heal by regeneration or fibrosis.
Ø In regeneration, normal function
returns.
§ The stratum basale cells
reach contact inhibition
before the fibroblasts
fill the area with scar
tissue.
Ø In fibrosis, normal functioning
tissue is replaced by scar tissue.
o Fibroblasts’ collagen fibers
produce granulation tissue to
fill in the wound’s clot.
o Fibroblasts reach contact
inhibition before the cells of the
stratum basale cells.
Burns
Burns can be classified by degree.
Ø First-degree burns involve only the
epidermis Symptoms are redness,
pain, and swelling
Ø Second-degree burns involve the
epidermis and dermis. Symptoms
include redness, pain, swelling, and
blisters
Ø Third-degree burns involve the
epidermis, dermis, and hypodermis.
Symptoms include charring and no
pain at the burn site
Skin Cancer
Ø Basal cell carcinoma is the most
common skin cancer, and it tends
not to metastasize.
Ø Squamous cell carcinoma results
from keratinocytes in the stratum
spinosum. They commonly form on
the face, hands, ears, and neck and
can metastasize.
Ø Malignant melanoma is the rarest
form of skin cancer.
o It is the most deadly because it
metastasizes easily.
o Usually begins in a mole.
Acne
Ø Inflammation of the pilosebaceous
glands caused by oil, excess cells,
and bacteria found on the skin
Psoriasis
Ø Psoriasis is an inflammatory disease
that is characterized by an
overgrowth of skin cells and
improper keratinization of the
epidermis and nails
Ø Multiple factors contribute,
including genetics.
 Ø Common triggers include trauma,
infection, and certain drugs.
Ø Symptoms are usually minimal, but
mild to severe itching may occur.
Alopecia
Ø An autoimmune disease occurring
in both genders characterized by
non-scarring well-demarcated
round or oval bald spots on the
scalp or other parts of the body.
Vitiligo
Ø An acquired disease involving
multiple genes and nongenetic
environmental factors characterized
by progressive autoimmune-
mediated destruction of epidermal
melanocytes showing depigmented
macules and patches in the skin.
Keloid
Ø Keloids are smooth overgrowths of
fibroblastic tissue that arise in an
area of injury (eg, lacerations,
surgical scars, truncal acne) or,
occasionally, spontaneously.
Bacterial Infections
Impetigo
Ø is a superficial skin infection with
crusting or bullae caused by
Streptococci (group A beta
hemolytic Streptococci) ,
staphylococci (S. aureus), or both.
Ø Nonbullous impetigo typically
manifests as clusters of vesicles or
pustules that rupture and develop a
honey-colored crust (exudate from
the lesion base) over the lesions.
Ø Bullous impetigo is similar except
that vesicles typically enlarge
rapidly to form bullae. The bullae
burst and expose larger bases,
which become covered with honey-
colored varnish or crust.
Erysipelas
Ø is characterized clinically by shiny,
raised, indurated, and tender
plaques with distinct margins.
Ø High fever, chills, and malaise
frequently accompany this disease.
Ø Caused by group A beta hemolytic
Streptococcus.
Ø Infection up to the level of dermis.
Cellulitis
Ø Cellulitis is acute bacterial infection
of the skin and subcutaneous
tissue most often caused by
Streptococci or Staphylococci.
Viral skin infections
Verruca
Ø are common, benign, epidermal
lesions caused by human
papillomavirus infection.
Herpes Simplex Virus (HSV)
Ø small, painful blisters that appear
on the skin and on the mucous
membranes of the mouth (HSV-1)
or genitals (HSV-2). Contagious.
Herpes Varicella Zoster
Ø causes chicken pox in children and
shingles (herpes zoster) in adults
Tinea
Ø Contact with an infected person,
damp surfaces
Ø Includes ringworm, athlete’s foot,
and jock itch.
Ø a circular rash that clears from the
center, giving it a ringlike
appearance
Scabies
Ø Caused by an infestation of mites
(Sarcoptes scabiei var. hominis)
Ø Causes small red bumps on the skin
that itch severely
Atopic dermatitis
Ø Atopic dermatitis (AD) is a
chronically relapsing skin disease
that occurs most commonly during
early infancy and childhood.
Ø It is frequently associated with
abnormalities in skin barrier
 function, allergen sensiti- zation,
and recurrent skin infections.

Urticaria
Ø It is a skin reaction that can be
caused by insect bites or by contact
with substances that can cause an
allergic reaction, such as certain
foods or drugs.
Ø The symptoms include raised areas
of the skin, redness, and itching.

Scleroderma
Ø It involves the accumulation of
excess connective tissue in the skin
and various organs.
Ø The excess collagen causes
hardening of the skin and organs,
with decrease elasticity; this leads
to a decrease in function.
Ø It can be caused by exposure to
certain chemicals or can be
associated with autoimmune
diseases such as lupus.

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