Chapter 5: Integumentary System

 Consists of:
o Skin
o Hair
o Nails
o Glands
 Sweat glands
 Sebaceous (oil) glands
o Functions:
 Regulates body temperature
 Stores blood
 Protects body from external environment
 Detects cutaneous sensations
 Synthesize vitamin D
 Structure of the Skin
o Skin consists of two distinct regions:
 Epidermis: superficial region
 Consists of epithelial tissue and is avascular
 Dermis: underlies epidermis
 Mostly fibrous connective tissue, vascular
 Hypodermis (superficial fascia)
 Subcutaneous layer of deep to skin
 Not part of skin but shares some functions
 Mostly adipose tissue that absorbs shock and insulates
 Anchors skin to underlying structures: mostly muscles


 
o Epidermis
 Superficial
 Epithelial tissue
 avascular
 Cells of the Epidermis
 Epidermis- one or more layers of cells forming the tough and protective outer layer of the skin or
integument (natural coating)
 Dermis- layer of dense irregular connective tissue lying deep to the epidermis (vascular)
 Subcutaneous Layer (hypodermis)- continuous sheet of areolar connective tissue and adipose
tissue between the dermis of the skin and the deep fascia of the muscles
 Lamellated Corpuscles (Pacinian corpuscle)- oval-shaped pressure receptor located in the dermis
or subcutaneous tissue and consisting of concentric layers of a connective tissue wrapped around
the dendrites of a sensor neuron
 Consists mostly of keratinized stratified squamous epithelium
 Four cell types found in epidermis:
 Keratinocytes
 Produce fibrous keratin (protein that gives skin its protective properties)
 Major cells of epidermis
 Arranged in 4-5 layers and produce keratin
 Produce lamellar granules which release a water repellant sealant to dec water entry/loss,
inhibits entry of foreign material
 Tightly connected by desmosomes
 Million slough ff every day
 Keratinocyte- a cell of the epidermis that produces keratin, is formed in the basal epidermal
layer above the dermis, divides to produce more keratinocytes, and ultimately migrates into
the outer protective layers of the skin and undergoes final differentiation into a corneocyte
 Melanocytes
 Melanocyte- a cell in the skin and eyes that produces and contains the pigments called
melanin
 Spider-shaped cells located in deepest epidermis
 Produce pigment melanin, which is packaged into melanosomes
♥ Melanosomes are transferred to keratinocytes, where they protect nucleus from UV damage
 Dendritic (Langerhans) Cells
 Star-shaped macrophages that patrol deep epidermis
♥ Are key activators of immune system
 Dendritic Cell- named after their shape and are not neurons with dendrites, as was thought
when first discovered in the late nineteenth century
 Tactile (Merkel) Cells
 Sensory receptors that sense touch
 Tactile Cell- any of the epithelial-like cells of the tactile corpuscle
 Tactile Disc- saucer-shaped free nerve endings that make contact with Merkle cells in the
epidermis and function as touch receptors
 Layers of the Epidermis
 Made up of four or five distinct layers
 Thick skin contains five layers (strata) and is found in high-abrasion areas (hands, feet)
  Think skin contains only four strata
 Five layers of skin:
 Stratum basale
 Stratum spinosum
 Stratum granulosum
 Stratum lucidum (only in thick skin)
 Stratum corneum
 Stratum basale (basal layer)
 Deepest of all epidermal layers (base layer)
 Layer that is firmly attached to dermis
 Consists if a single row of stem cells that actively divide (mitotic), producing two daughter cells
each time
 One daughter cell journeys from basal layer to surface, taking 25-45 days to reach surface
♥ Cell dies as it moves toward surface
 Otter daughter cell remains in stratum basale as stem cell
 Layer also known as stratum germinativum because of active mitosis
 10-25% of layer also composed of melanocytes
 Stratum spinosum (prickly layer0
 Several cell layer thick
 Cells contain weblike system of intermediate prekeratin filaments attached to desmosomes
 Allows them to resist tension and pulling
 Keratinocytes in this layer appear spikey, so they are called prickle cells
 Scattered among keratinocytes are abundant melanosomes and dendritic cells
 Stratum granulosum (granular layer)
 Four to six cells thick, but cells are flattened, so layer is thin
 Cell appearance change
 Cells flatten, nuclei and organelles disintegrate
 Keratinization begins
♥ Cells accumulate keratohyaline granules that help form keratin fibers in upper layers
 Cells also accumulate lamellar granules, a water-resistant glycolipid that slows water loss
 Cells above this layer die
 Too far from dermal capillaries to survive
 Stratum lucidum(clear layer)
 Found only in thick skin
 Consists of thin, translucent and of two to three rows of clear, flat dead keratinocytes
 Lies superficial to the stratum granulosum
 Stratum corneum (horny layer)
 20-30 rows of flat, anucleated, keratinized dead cells
 Accounts for three-quarters of epidermal thickness
 Callus- abnormal thickening of the stratum corneum
 Though dead, cells still function to:
 Protect deeper cells from the environment
 Prevent water loss
 Protect from abrasion and penetration
 Act as a barrier against biological, chemical, and physical assaults
 Cells change by going through apoptosis (controlled cell death)
  Dead cells slough off as dandruff and dander
 Humans can shed 50,000 cells very minute


 Dermis
o Strong, flexible connective tissue
o Cells include fibroblasts, macrophages, and occasionally mast cells and white blood cells
o Fibers in matrix bind body together
 Makes up the “hide” that is used to make leather
o Contains nerves, blood vessels, and lymphatic vessels
o Deeper, thinker CT, avascular
o Contains epidermal hair follicles, oil glands, and sweat glands
o Two layers
 Papillary
 Peticular
o Papillary layer
 Superficial layer of areolar connective tissue consisting of loose, interlacing collagen and elastic
fibers and blood vessels
 Loose fibers allow phagocytes to patrol for microorganisms
 Superficial papillary region
 Superficial portion of the dermis (about one-fifth)
 Consists of areolar connective tissue with thin collagen and fine elastic fibers
 Contains dermal ridges that house blood capillaries, corpuscles of touch, and free nerve endings.
  Dermal papillae- superficial region of dermis that sends fingerlike projections up into epidermis
that may contain blood capillaries or corpuscle of touch
 Free nerve Endings- sensations of warmth, coolness, pain, tickling, and itching
 Corpuscles of Touch- sensory receptor for touch; found in dermal papillae, especially in the
palms and soles
 Thick Reticular Region
 Deeper portion of the dermis (about four0fiths)
 Consists of dense irregular connective tissue with bundles of thick collagen and some coarse
elastic fibers
 Spaced between fibers contain some adipose cells, hair follicles, nerves, sebaceous glands, and
sudoriferous glands
 Extensibility- ability of tissue to stretch when it is pulled
 Elasticity- ability of tissue to return to its original shape after contraction or extension
 Projections contains capillary loops, free nerve endings, and touch receptors (tactile corpuscles,
also called Meissner’s corpuscles)
 Reticular Layer
 Makes up 80% if dermal thickness
 Consists of coarse, dense fibrous connective tissue
 Many elastic fibers provide stretch-recoil properties
 Collagen fibers provide strength and resiliency
 Bind water, keeping skin hydrated
 Cutaneous plexus: network of blood vessels between reticular layer and hypodermis
 Extracellular matrix contains pockets of adipose cells
 Cleavage (tension) lines in reticular layer are caused by many collagen fibers running parallel to
skin surface
 Externally invisible
 Important to surgeons because incisions parallel to cleavage lines heal more readily
 Flexure lines of reticular layer are dermal folds at or near joints
 Dermis is tightly secured to deeper structures
 Skin’s inability to slide easily for joint movement causes deep creases
 Visible on hands, wrists, fingers, soles, toes
 Skin Color
o Carotene
 Yellow to orange pigment
 Most obvious in palms and soles
 Accumulates in stratum corneum and hypodermis
 Can be converted t vitamin A for vision and epidermal health
o Hemoglobin
 Pinkish hue of fair skin is due to lower levels of melanin
 Skin of Caucasians is more transparent, so color of hemoglobin shows through
o Three pigments contribute to skin color
 Melanin
 Only pigment made in the skin; made by melanocytes
 Packaged into melanosomes that are sent to keratinocytes to shield DNA from sunlight
 Sun exposure stimulates melanin production
 Two forms: reddish yellow to brownish black
  All humans have same number of keratinocytes, so color differences are due to the amount and
form of melanin
 Freckles and pigmented moles are local accumulations of melanin
 Carotene
 Yellow to orange pigment
 Most obvious in palms and soles
 Accumulates in stratum corneum and hypodermis
 Can be converted to vitamin A for vision and epidermal health
 Hemoglobin
 Pinkish hue of fair skin is due to lower levels of melanin
 Skin of Caucasians is more transparent, so color of hemoglobin shows through
 Hair
o Consists of dead keratinized cells
o None located on palms, soles, lips, nipples, and portion of external genitalia
o Functions:
 Warn of insects on skin
 Hair on head guards against physical trauma
 Protect from heat loss
 Shield skin from sunlight
o Structure of a Hair
 Hairs (also called pili)- flexible strands of dead, keratinized cells; threadlike structure produced by
hair follicles that develops in the dermis
 Produced by hair follicles
 Contains hard keratin, not like soft keratin found in skin
 Hard keratin is tougher and more durable, and cells do not flake off
 Regions:
 Shaft: area that extends above the scalp, where keratinization is complete; superficial portion of
the hair, which projects above the surface of the skin
 Root: area within scalp, where keratinization is still going on; the portion of the hair deep to the
shaft that penetrates into the dermis, and sometimes into the subcutaneous layer
 Three parts of the shaft
 Medulla: central core of large cells and air spaces; composed of two or three rows of irregularly
shade cells that contain large amounts of pigment granules in dark har, small amounts of pigment
granules in gray hair, and a lack of pigment granules and the presence of air bubbles in white
hair
 Cortex: several layers flattened cells surrounding medulla; forms the major part of the shaft and
consists of elongated cells
 Cuticle: outer layer consisting of overlapping layers of single cells; outermost layer, consists of a
single layer of thin, flat cells that are the most heavily keratinized, arranged like shingles on the
side of a house
o Hair pigments are made by melanocytes in hair follicles
 Combinations of different melanins (yellow, rust brown, black) create all the hair colors
 Red hair has additional pheomelanin pigment
 Gray/white hair results when melanin production decreases and air bubbles replace melanin in
shaft
o Structure of a Hair Follicle
 Extends from the epidermal surface to the dermis
 External root sheath- a downward continuation of the epidermis
 Internal root sheath- produced by the matrix and forms a cellular tubular sheath of epithelium
between the external root sheath and the hair
 Together referred to as an epithelial root sheath
 Dermal root sheath- dermis surrounding the hair follicle
 Hair Follicle- structure composed of epithelium and surrounding the root of a hair from which
hair develops
 Papilla- contains areolar connective tissue and many blood vessels that nourish the growing hair
follicle
 Hair Bulb- the bulbous expansion at the base of a hair from which the hair shaft develops;
expanded area at deep end of follicle; onion shaped structure surrounding the dermal root sheath
which houses the papilla f the pair
 Hair Follicle Receptor (or root hair plexus)- sensory nerve endings that wrap around bulb
 Hair is considered a sensory touch receptor
 Wall of follicle composed of:
 Peripheral connective tissue sheath
 Derived from the dermis
 Also called fibrous sheath
 Glassy membrane- thickened basal lamina
 Epithelial root sheath
 Derived from the epidermis
 Hair Matrix- actively dividing area of bulb that produces hair cells; arise from the stratum
basale, the site of cell division, responsible for the growth of existing hairs, and they produce
new hairs when old hairs are shed
 This replacement process occurs within the same follicle, cells also giver rise to the cells of
the internal root sheath
 As matrix makes new cells, it pushes older ones upward
 Arrector Pili- small band of smooth muscle attached to follicle; smooth muscles attached to
hairs; contraction pulls the hairs into a vertical position
 Responsible for “goose bumps”
 Hair Root Plexus- a network of dendrites arranged around the root of a hair as free or naked
nerve endings that are stimulated when a hair shaft is moved
 Hair papilla
 Dermal tissue containing knot of capillaries that supplies nutrients to growing hair
 Vellus hair- pale, fined body hair of children and adult females
 Terminal hair- coarse, long hair
 Found on scalp and eyebrows
 At puberty
♥ Appear in axillary and pubic regions of both sexes
♥ Also on face and neck of males
 Nutrition and hormones affect hair growth
 Follicles cycle between active and regressive phases
 Average 2.25mm growth per week
 Lose 90 scalp hairs daily
 
o Hair Growth
 Growth Stage
 Cells of the hair matrix divide
 As new cells from the hair matrix are added to the base of the hair root, existing cells of the hair
root are pushed upward and the hair grows longer, while the cells of the hair are being pushed
upward, they become keratinized and die
 Regression Stage
 Cells of the hair matrix stop dividing, the hair follicle atrophies (shrinks), and the hair stops
growing
 Resting Stage
 New hair begins the growth phase
o Type of Hair
 Lanugo- fine downy hairs that cover the fetus
 Terminal Hairs- long, coarse, heavily pigmented hairs
 Vellus Hair- short, fine, pale hairs that are barely visible to the naked eye (peach fuzz)
o Hair Color
 Due primarily to the amount and type of melanin in its keratinized cells
 Melanin is synthesized by melanocytes scattered in the matrix of the bulb and passes into cells of
the cortex and medulla of the hair
 Dark-colored hair contains mostly eumelanin (brown to black)
 Blond and red hair contain variants of pheomelanin (yellow to red)
 Hair becomes gray because of a progressive decline in melanin production
 Gray hair contains only a few melanin granules
 White hair results from the lack of melanin and the accumulation of air bubbles in the shaft
 Hair coloring is a process that adds or removes pigment
  Temporary hair dyes coat surface of hair shaft and usually wash out within 2 or 3 shamppos
 Semipermanent dyes penetrate the hair shaft moderately and do fade and wash out of hair after
about 5 to 10 shampoos
 Permanent hair dyes penetrate deeply into the hair shaft and don’t wash but eventually lost as the
hair grows out
o Hair Thinning and Baldness
 Alopecia- hair thinning in both sexes after age 40
 True (frank) baldness
 Genetically determined and sex-influenced condition
 Male pattern baldness caused by follicular response in DHT (dihydrotestosterone)
 Skin Glands
o Glands are epithelial cells that secrete a substance
o Several kinds of exocrine glands are associated with the skin:
 Sebaceous Gland/Oil gland- exocrine gland in the dermis of the skin, almost always associated
with a hair follicle, that secretes sebum
 Sebum- oil substance secreted by sebaceous glands
 Sudoriferous Gland/Sweat Gland- release sweat, r perspiration, into hair follicles or onto the skin
surface through pores
 Eccrine Sweat Glands- simple, coiled tubular glands that are much more common than apocrine
sweat glands, main function of eccrine sweat glands is to help regulate body temperature through
evaporation
 Thermoregulation- homeostatic regulation of body temperature
 Apocrine Sweat Gland- gland in which the secretory products gather at the free end of the
secreting cells and are pinched off, along with some of the cytoplasm, to become the secretion, as
in mammary glands (have larger ducts and lumens than eccrine glands), found mainly in the skin
of the axilla (armpit), groin, areolae (pigmented areas around the nipples) of the breasts, and
bearded regions of the face in adult males
 Ceruminous Gland- modified sweat glands in the external ear that produce a wax lubricating
secretion, secretory portions of ceruminous glands lie in the subcutaneous layer
 Nails
o Scale-like modifications of epidermis that contain hard keratin
o Nail- a hard plate, composed largely of keratin, that develops from the epidermis of the skin to from
a protective covering on the dorsal surface of the distal phalanges of the fingers and toes
o Act as a protective cover for distal, dorsal surface of fingers and toes
o Consist of free edge, nail plate, and root
o Nail bed is epidermis underneath keratinized nail plate
o Nail Matrix- thickened portion of bed responsible for nail growth; portion of the epithelium
proximal to the nail root, cells divide mitotically to produce new nail cells
o Nail Fold- skin folds that overlap border of nail
o Eponychium- nail fold that projects onto surface of the nail body
 Also called cuticle
o Hyponychium- area under free edge of plate that accumulates dirt
o Nail normally appear pin because of underlying capillaries
 Lunule- thickened nail matrix, appears white
o Abnormal color or shape can be an indicator of disease
o Provide support and counterpressure to the palmer surface of the fingers to enhance touch
perception and manipulation
o Allow us to grasp and manipulate small objects, and they can be used to scratch and groom the
body in various ways
o Nail Body/Plate- the visible portion of the nail
o Free Edge- is the part of the nail body that may extend past the distal end of the digit
o Nail Root- is the portion of the nail that is buried in a fold of the skin
o Lunula- whitish, crescent-shaped area of the proximal ed of the nail body
o Hyponychium- portion of the nail beneath the free edge composed of a thickened region of stratum
corneum, secures the nail to the fingertip
o Nail Bed- is the skin below the nail plate that extends from the lunula to the hyponychium
o Eponychium/Cuticle- is a narrow band of the epidermis that extends from and adheres to the margin
(lateral border) of the nail wall

o
 Sweat Glands
o Also called sudoriferous glands
o All skin surfaces except nipples and parts of external genitalia contain sweat glands
 About 3 million per person
o Two main types
 Eccrine (merocrine) sweat glands
 Apocrine sweat glands
o Contain myoepithelial cells
 Contract upon nervous system stimulation to force sweat into ducts
o Eccrine (Merocrine) Sweat Glands
 Eccrine Gland- a type of simple sweat gland that produce sweat that reaches the surface of the
skin by way of coiled ducts (tubes)
 Ost numerous type
 Abundant on palms, soles, and forehead
 Ducts connect to pores
  Function in thermoregulation
 Regulated by sympathetic nervous system
 Their secretion is sweat
 99% water, salts, vitamin C, antibodies, dermcidin (microbe-like peptide), metabolic waste


o Apocrine Sweat Glands
 Apocrine Sweat gland- a gland and especially a sweat gland that secretes a viscous fluid into a
hair follicle (as in the armpit or groin), is lined with a single layer of usually columnar cells, and
typically does not become active until puberty
 Confined to axillary and anogenital areas
 Secrete viscous milky or yellowish sweat that contains fatty substances and proteins
 Bacteria break down sweat, leading to body odor
 Larger than eccrine sweat glands with ducts emptying into hair follicles
 Begin functioning at puberty
 Function unknown but may act as sexual scent gland
 Modified apocrine glands
 Ceruminous Gland- one of the modified sweat glands of the ear that produce earwax; lining
external ear canal; secrete cerumen (ear wax)
 Mammary Gland- one of the two half-moon-shaped glands on either side of the adult female
chest, which with fatty tissue and the nipple make up the breast
o Sebaceous (Oil) Glands
 Sebaceous Gland- normal gland of the skin which empties an oily secretion into the hair follicle
near the surface of the skin
 Widely distributed except for thick skin of palms and soles
 Most develop from hair follicles and secrete into hair follicles
 Relatively inactive until puberty
 Stimulated by hormones, especially androgens
  Secrete sebum
 Oily holocrine secretion
 Bactericidal (bacteria-killing) properties
 Softens hair and skin
 Functions of the Skin
o Skin is first and foremost a barrier
o Its main function includes:
 Protection
 Body temperature
 Cutaneous sensations
 Metabolic functions
 Blood reservoir
 Excretion of wastes
o Protection
 Ski is exposed to microorganisms, abrasions, temperature extremes, and harmful chemicals
 Constitutes three barriers:
 Chemical barrier
 Physical barrier
 Biological barrier
 Chemical Barrier
 Skin secretes many chemicals, such as:
 Sweat, which contains antimicrobial proteins
 Sebum and defensins, which kill bacteria
 Cells also secrete antimicrobial defensin
 Acid Mantle- low pH of skin retards bacterial multiplication
 Melanin provides a chemical barrier against UV radiation damage
 Physical Barrier
 Flat, dead, keratinized cells of stratum corneum, surrounded by glycolipids, block most water
and water-soluble substances
 Some chemicals have limited penetration of skin
 Lipid-soluble substances
 Plant oleoresins (poison ivy)
 Organic solvents (acetone, paint thinner)
 Salts of heavy metals (lead, mercury)
 Some drugs (nitroglycerin)
 Drug agents (enhancers that help carry other drugs across the skin)
 Biological Barriers
 Epidermis contains phagocytic cells
 Dendritic cells of the epidermis engulf foreign antigens (invaders) and present to white blood
cells, activating the immune response
 Dermis contains macrophages
 Macrophages also activate immune system by presenting foreign antigens to white blood cells
 DNA can absorb harmful UV radiation, converting it to harmless heat
o Body Temperature Regulation
 Under normal, resting body temperature, sweat glands produce about 500 ml/day of unnoticeable
sweat
  Called insensible perspiration
 If body temperature rises, dilation of dermal vessels can increase sweat gland activity to produce
12 L (3 gallons) of noticeable sweat
 Called sensible perspiration; designed to cool body
 Cold external environment
 Dermal blood vessels constrict
 Skin temperatures drops to slow passive heat loss
o Cutaneous Sensations
o Cutaneous sensory receptors are part of the nervus system
 Exteroceptors respond to stimuli outside the body, such as temperature and touch
 Free nerve endings sense painful stimuli
o Metabolic Functions
 Skin can synthesize vitamin D needed for calcium absorption in intestine
 Chemicals from keratinocytes can disarm some carcinogens
 Keratinocytes can activate some hormones
 Example: convert cortisone into hydrocortisone
 Skin makes collagenase, which aids in natural turnover of collagen to prevent wrinkles
o Blood Reservoir
 Skin can hold up to 5% of the body’s total blood volume
 Skin vessels can be constricted to shunt blood to other organs, such as exercising muscle
o Excretion
 Skin can create limited amounts of nitrogenous wastes, such as ammonia, urea, and uric acid
 Sweating can cause salt and water loss
 Thin Skin
o Distribution-all parts of the body except areas such as pals, palmar surface of digits and soles
o Epidermal thickness is 0.10-0.15 mm (0.004-0.006 in)
o Epidermal strata- stratum lucidum essentially lacking; thinner strata spinosum or corneum
o Epidermal ridges- lacking due to poorly developed, fewer, and less-well-organized dermal papillae
o Hair follicles and arrector pili muscles- present
o Sebaceous glands- present
o Sudoriferous glands- fewer
o Sensory receptors- sparser
 Thick Skin
o Distribution- areas such as palms, palmar surface digits, and soles
o Epidermal thickness is 0.6-4.5 mm (0.024-0.18 in) due mostly to a thicker stratum corneum
o Epidermal strata- stratum lucidum present; thicker strata spinosum and corneum
o Epidermal ridges- present due to well-developed and more numerous dermal papillae organized in
parallel rows
o Hair follicles and arrector pili muscles-absent
o Sebaceous glands- absent
o Sudoriferous glands- more numerous
o Sensory receptor- denser
 Skin Cancer and Burns
o Skin can develop over 1000 different conditions and ailments
o Many internal diseases reveal themselves on skin
o Most common disorders are infections
o Less common, but more damaging, are:
 Skin cancer
 Burns
o Skin cancer
 Most skin tumors are benign (not cancerous0 and do not spread (metastasize)
 Risk factors:
 Overexposure to UV radiation
 Frequent irritation of skin
 Some skin lotions contain enzymes that can repair damaged DNA
 Three major types of skin cancer
 Basal cell carcinoma
 Squamous cell carcinoma
 Melanoma
 Basal cell Carcinoma
 Least malignant and most common
 Stratum basale cells proliferate and slowly invade dermis and hypodermis
 Cured by surgical excision in 99% of cases
 Squamous Cell Carcinoma
 Second most common type; can metastasize
 Involves keratinocytes of stratum spinosum
 Usually is a scaly reddened papule on scalp, ears, lower lip, or hands
 Good prognosis if treated by radiation therapy or removed surgically
 Melanoma
 Cancer of melanocytes; is most dangerous type because it is highly mestastic and resistant ro
chemotherapy
 Treated by wide surgical excision accompanied by immunotherapy
 Key to survival is early detection: ABCD rule
 A: asymmetry; the two sides of the pigmented area do not match
 B: border irregularity; exhibits indentations
 C: color; contains several colors (black, brown, tan, sometimes red or blue)
 D. diameter; larger than 6mm (size of pencil eraser)
o Burns
 Tissue damage caused by heat, electricity, radiation, or certain chemicals
 Damage caused by denaturation of proteins, which destroys cells
 Immediate threat is dehydration and electrolyte imbalance
 Leads to renal shutdown and circulatory shock
 To evaluate burns, the Rule of Nines is used
 Body is broken into 11 sections, with each section representing 9% of body surface (except
genitals, which account for 1%)
 Used to estimate volume of fluid loss
 Can be classified by severity
 First Degree
 Epidermal damage only
 Localized redness, edema (swelling,), and pain
 Second-Degree
  Epidermal and upper dermal damage
 Blisters appear
 First- and second-degree burns are referred to as partial-thickness burns because only
epidermis and upper dermis are involved
 Third-Degree
 Entire thickness of skin involved (referred to as full-thickness burns)
 Skin color turns gray-white, cherry red, or blackened
 No edema is seen, and area is not painful because nerve endings are destroyed
 Skin grafting usually necessary
 Burns are considered critical if:
 >25% of body has second degree burns
 >10% of body has third-degree burns
 Face, hands, or feet bear third-degree burns
 Treat includes:
 Debridement (removal) of burned skin
 Antibiotics
 Temporary covering
 Skin grafts
 Thermoregulation
o Skin contributes to thermoregulation in two ways:
 By liberating sweat at its surface
 By adjusting the flow of blood in the dermis
 Response to High Temperature
 Sweat production from eccrine sweat glands increases
 The evaporation of sweat from the skin helps lower body temperature
 Blood vessels in the dermis of the skin constrict (become narrow), which decreases blood flow
through the skin and reduces heat loss from the body and skeletal muscle contractions generate
body heat
o Blood Reservoir- systematic vein and venules that contain large amounts of blood that can be
moved quickly to parts of the body requiring the blood
o Protection
 Keratin- protects underlying tissues from microbes, abrasion, heat, and chemicals, and the tightly
interlocked keratinocytes resist invasion by microbes
 Lipids- released by lamellar granules inhibit evaporation of water from the skin surface, thus
guarding against dehydration; they also retard entry of water from the skin surface during showers
and swims
 Sebum- from the sebaceous glands keeps skin and hairs from drying out and contains bactericidal
chemicals (substances that kill bacteria)
 Perspiration- acidic pH retards the growth of some microbes
 Melanin- helps shield against the damaging effects of ultraviolet light
 Intraepidermal macrophage- alert the immune system to the presence of potentially harmful
microbial invaders by recognizing and processing them
 Macrophages- in the dermis phagocytize bacteria and viruses that manage to bypass the
intraepidermal macrophages of the epidermis
o Cutaneous sensation- sensations that arise in the skin, including tactile sensations- touch, pressure,
vibration, and tickling-as well as thermal sensations such as warmth and coolness
  Pain- usually is an indication of impending or actual tissue damage
o Excretion and absorption- elimination of substances from the body and the passage of materials
from the external environment
o Synthesis of Vitamin D- enhance phagocytic activity, increase the production of antimicrobial
substances in phagocytes, regulate immune functions, and help reduce inflammation
 Epidermal Wound Healing
o Common types of epidermal wounds include:
 Abrasions, in which a portion of the skin has been scraped away
 Minor burns
o Response to an epidermal injury, basal cells of the epidermis surrounding the wound break contact
with the basement membrane, cells then enlarge and migrate across the wound
o Cells appear to migrate as a sheet until advancing cells from opposite sides of the wound meet
o Contact inhibition- epidermal cells encounter one another, they stop migrating due to a cellular
response
o Migration of the epidermal cells stops completely when each is finally in contact with other
epidermal cells on all sides
 Deep Wound Healing
o Occurs when an injury extends to the dermis and subcutaneous layer
o Inflammatory phase- a blood clot forms in the wound and loosely unites the wound edges
o Inflammation- localized, protective response to tissue injury designed to destroy, dilute, or wall off
the infecting agent or injured tissue; characterized by redness, pain, heat, swelling, and sometimes
loss of function
o Migratory phase- the clot becomes a scab, and epithelial cells migrate beneath the scab to bridge the
wound, fibroblasts migrate along fibrin threads and begin synthesizing scar tissue (collagen fibers
and glycoproteins), and damaged blood vessels begin to regrow
o Granulation tissue- tissue filling the wound
o Proliferative phase- characterized by extensive growth of epithelial cells beneath the scab,
deposition by fibroblasts of collagen fibers in random patterns, and continued growth of blood
vessels
o Maturation phase- the scab sloughs off once the epidermis has been restored to normal thickness
o Fibrosis- process by which fibroblasts synthesize collagen fibers and other extracellular matrix
materials that aggregate to form scar tissue