CHAPTER FIVE

The Integumentary System

I. Functional Anatomy of Skin

A. Most accessible but often least appreciated organ system.
1. The skin, or simply integument, accounts for approximately 16% of your total body
weight.
2. The skin’s surface, 1.5 - 2.0 m2, is constantly worn away, attacked by micro-organisms,
irradiated by sunlight, and exposed to environmental chemicals.
3. Skin is composed of two major components:
a. Cutaneous membrane:
i. The epidermis consists of stratified squamous.
ii. The dermis consists of a papillary layer of areolar tissue and a reticular
layer of dense irregular connective tissue.
b. Accessory Structures:
i. Nerve fibers and corpuscles
ii. Hair follicles, hair shafts, and arrector pili muscles
iii. Oil glands and sweat glands
iv. Arteries, veins, and lymph vessels forming the cutaneous network
4. The hypodermis (also known as the subcutaneous layer or superficial fascia) separates
the integument from the fascia around the deeper organs. Note this layer is NOT part
of the integument.

5.1 The Layers of the Skin

1. The EPIDERMIS is composed of layers with various functions.
A. The epidermis is dominated by keratinocytes, the body’s most abundant epithelial cells. These cells
form several layers called strata.
1. Thin skin, which covers most of the body surface, contains four strata and is about as thick as the
wall of a plastic sandwich bag (roughly 0.08 mm).
2. Thick skin, which occurs on the palms of the hands and soles of the feet, possesses five strata. It
is about as thick as a standard paper towel (roughly 0.50 mm).
3. Note that the terms “thick” and “thin” refer to the relative thickness of the epidermis, not the
integument as a whole.
B. Strata of the Epidermis
1. Stratum Basale
a. The deepest epidermal layer consisting of a single row of basal cells, or germinative
cells, that are undergoing rapid mitotic divisions. These cells are sometimes called stem
cells because their mitotic divisions replace the more superficial keratinocytes that are
lost or shed at the surface.
b. Hemidesmosomes attach the cells of this layer to the basal lamina that separates the
epidermis from the areolar tissue of the adjacent papillary layer of the dermis.
c. Approximately 10 – 25% of cells in this layer are melanocytes which produce melanin, a
brown, yellowish-brown, or black skin pigment.
d. In hairless skin, specialized cells called merkel cells exist in small numbers. These cells
are sensitive to touch and when compressed, they release chemicals that stimulate
sensory nerve endings.
2. Stratum Spinosum
a. Consists of approximately 8 – 10 layers of keratinocytes bound together by desmosomes
and microfilaments of pre-keratin.
b. The name stratum spinosum, which means “spiny layer”, refers to the fact that the cells
look like miniature pincushions in standard histological sections.
 c. Large numbers of dendritic cells are found in this layer. These are specialized cells that
participate in the immune response by stimulating a defense mechanism against 1)
microorganisms that manage to penetrate the superficial layers of the epidermis and 2)
superficial skin cancers.
3. Stratum Granulosum
a. Consists of 3 – 5 cell layers where the keratinocytes appearance begins to change. The
name stratum granulosum means “grainy layer”.
b. These cells become flattened, the plasma membrane becomes less permeable, and the
organelles deteriorate.
c. By the time the cells reach this layer, most have stopped dividing and have started
making large amounts of keratin and keratinohyalin stored in numerous visible
granules.
d. Beyond this layer, there is no nutrient availability.
4. Stratum Lucidum
a. In the thick skin of the palms and soles, a stratum lucidum separates the stratum corneum
from deeper layers.
b. The cells of this layer are flattened, densely packed, largely devoid of organelles, and
filled with the proteins keratin and keratohyalin.
c. By the time they reach the stratum lucidum, the cells are dead and undergoing
dehydration.
5. Stratum Corneum
a. Outermost layer of keratinocytes (sometimes called the “horny layer”).
b. A broad zone of 15 – 30 layers of keratinized cells that accounts for up to three-quarters
of the epidermal thickness.
c. Keratinization is the formation of protective, superficial layers of cells filled with keratin.
d. The dead cells in each layer of the stratum corneum remain tightly interconnected by
desmosomes. It takes 7 to 10 days for a cell to move from the stratum basale to the
stratum corneum. The dead cells generally remain in the exposed stratum corneum for an
additional two weeks before they are shed or washed away.
e. Glycolipids in this layer provide a waterproofing quality to the epidermis.
C. The deeper layers of the epidermis form epidermal ridges which extend into the dermis and are
adjacent to the dermal projections called dermal papillae that project upward to the epidermis. These
ridges and papillae are significant because they greatly increase the surface area for attachment, firmly
binding the epidermis to the dermis.
D. The ridge patterns in the thick skin on the surface of the fingertips produce fingerprints, which have
been used to identify individuals in criminal investigations for more than a century.
E. Like all other epithelia, the epidermis lacks local blood vessels. Epidermal cells rely of the diffusion of
nutrients and oxygen from capillaries within the dermis. As a result the cells with the highest metabolic
demand are closest to the underlying dermis.

2. The DERMIS supports the epidermis, and the hypodermis connects the dermis to the rest of the body.
A. The dermis lies between the epidermis and hypodermis. The dermis consists of two layers:
1. Papillary layer = consists of a highly vascularized areolar tissue with all of the typical cell types
within it.
a. This layer also contains the capillaries, lymphatic vessels, and sensory neurons that
supply the surface of the skin.
b. The papillary layer gets its name from the dermal papillae that project between the
epidermal ridges.
c. This layer nourishes and supports epidermis.
2. Reticular layer = consists of an interwoven meshwork of dense irregular connective tissue
containing both collagen and elastic fibers.
 a. Bundles of collagen fibers extend superficially to blend into those of the papillary layer
and deeply to blend with the hypodermis.
b. The collagen fibers provide strength while the elastic fibers provide flexibility.
c. This layer restricts the spread of pathogens, stores lipid reserves, attaches skin to deeper
tissues, possesses sensory receptors, and contains blood vessels for temperature
regulation.
B. Cleavage Lines = within the dermis, the collagen and elastin fibers are arranged in parallel bundles
oriented to resist the forces applied to the skin during normal movements. The resulting pattern of fiber
bundles establishes the lines of cleavage. These lines are clinically significant: a cut parallel to a
cleavage line will usually remain closed and heal with little scarring whereas a cut at a right angle to a
cleavage line will be pulled open as movement occurs and result in greater scarring.

3. The hypodermis separates the skin from deeper structures.

1. It stabilizes the position of skin in relation to underlying tissues (such as skeletal muscles or other
organs) while permitting independent movement.
2. Because it is often dominated by adipose tissue, the hypodermis also represents an important site for 1)
insulation, 2) cushioning, and 3) the storage of energy reserves.
3. At puberty men accumulate subcutaneous fat at the neck, on the arms, along the lower back, and over
the buttock. In contrast, women accumulate subcutaneous fat at the breasts, buttocks, hips, and thighs.
In both genders, there are almost no fat cells on the back of the hands and feet but distressingly large
numbers in the abdominal regions (resulting in the “potbelly”).

4. Factors influencing skin color include epidermal pigmentation and dermal circulation.
A. The color of one’s skin is genetically programmed. However, increased pigmentation, or tanning, can
result in response to ultraviolet radiation.
B. Skin color is influenced by the presence of pigments in the epidermis:
1. Melanin = a brown, yellowish-brown, or black pigment produced by melanocytes.
a. Melanocytes are located within the stratum basale, squeezed between or deep to the
keratinocytes. Melanocytes manufacture melanin from the amino acid tyrosine, and
package it in intracellular vesicles called melanosomes.
b. Melanosomes travel within the processes of melanocytes and are transferred intact to
keratinocytes. The transfer of pigmentation colors the keratinocyte temporarily, until the
melanosomes are destroyed by fusion with lysosomes.
c. In individuals with pale skin, this transfer occurs in the stratum basale and stratum
spinosum, and the cells of more superficial layers lose their pigmentation. In dark-
skinned individuals, the melanosomes are larger, and the transfer may occur in the
stratum granulosum as well; thus skin pigmentation is darker and more persistent.
d. The skin covering most areas of the body has about 1000 melanocytes per square
millimeter. Differences in skin pigmentation among individuals do not reflect different
numbers of melanocytes but instead different levels of melanin production.
2. Carotene = an orange-yellow pigment that normally accumulates in epidermal cells. It is most
apparent in cells of the stratum corneum of light-skinned individuals, but it also accumulates in
fatty tissues in the deep dermis and hypodermis. Carotene is found in a variety of orange and
yellow vegetables (sweet potatoes, carrots, squash).
C. The blood supply affects skin color because blood contains red blood cells filled with the red pigment
hemoglobin.
1. When bound to oxygen, hemoglobin is bright red, giving capillaries in the dermis a reddish tint
that is most apparent in light-skinned individuals.
2. If those vessels are dilated, the red tones become much more pronounced. For example, your
skin becomes flushed and red when your body temperature rises because the superficial blood
vessels dilate so that the skin can act like a radiator and lose heat.
 3. When the blood flow decreases, oxygen levels in the tissues decline, and under these conditions
hemoglobin releases oxygen and turns a much darker red. Seen from the surface the skin takes
on a bluish color. This coloration is called cyanosis. In individuals of any skin color, cyanosis
is most obvious in areas of very thin skin (lips and under the fingernails).

5.2 Accessory Organs of the Skin

A. Hair and its associated structures:
1. Hair follicles are a complex structure composed of epithelial cells and connective tissues that are
responsible for the formation of a single hair. The hair follicle has three regions (the internal
root sheath, the external root sheath, and glassy membrane).
2. Hair production begins at the base of the hair follicle. Here a mass of epithelial cells forms a
cap, called the hair bulb that surrounds a smaller hair papilla, a peg of connective tissue
containing capillaries and nerves.
3. Root hair plexus are sensory nerves that surround the hair bulb and give hair the ability to detect
touch.
4. Associated with each hair follicle is a bundle of smooth muscle cells called an arrector pili
muscle. These muscles will contract and cause hairs to stand up or become erect.
5. The human body has about 2.5 million hairs and 75% of them are on the general body surface
and not on the head. Hairs are non-living structures composed of keratinocytes.
6. Parts of a Hair:
a. Hair shaft is the portion of the hair that extends through the follicle and protrudes above
the skin line.
b. Hair root the portion that anchors the hair into the skin
c. Cuticle forms the surface of the hair. Composed of hard keratin.
d. Cortex an intermediate layer of cells deep to the cuticle. Contains thick layers of hard
keratin, which give hairs their stiffness.
e. Medulla, or core, consists of cells at the center of the hair matrix filled with soft keratin.
f. Hair matrix consists of superficial cells of the hair bulb. These germinative cells in the
hair matrix produce the hair.
7. Variations in hair color reflect differences in hair structure and variation in the pigment produced
by melanocytes at the hair papilla. Different forms of melanin give a dark brown, yellow-brown,
or red color to the hair. As pigment production decreases with age, hair color lightens. White
hair results from the combination of a lack of pigment and the presence of air bubbles in the
medulla of the hair shaft.
B. Nails = thick sheets of keratinized epidermal cells.
1. Nails protect the exposed dorsal surfaces of the tips of the fingers and toes. They also help limit
distortion of the digits whey they are subjected to mechanical stress.
2. The cells producing the nails can be affected by conditions that alter body metabolism, so
changes in the shape, structure, or appearance of the nails can provide useful diagnostic
information.
3. Parts of a nail:
a. Nail body = consists of dead, tightly compressed keratinocytes packed with keratin. The
nail body is the portion of the nail to which polish might be applied.
b. Nail bed = the nail body covers an area of the epidermis that contains rapidly dividing
cells that divide to replace the cells that are lost.
c. Nail root = the epidermal fold not visible from the surface and anchors the nail body into
the underlying tissues; the deepest portion of the nail root lies very close to the bone of
the fingertip.
d. Hyponychium = the free edge of the nail composed of a thickened stratum corneum; the
distal portion that continues past the nail bed.
e. Eponychium = a portion of stratum corneum of the nail root that extends over the
exposed nail; more commonly called the cuticle.
 f. Lunula = a pale crescent shaped area near the root where the dermal blood vessels are
obscured; may not be present in all nails.
C. Glands
1. Sebaceous glands = oil glands
a. Simple alveolar glands that are found all over the body except on the palms and the soles.
Sebaceous follicles secrete onto skin surfaces located on the face, back, chest, nipples,
and external genitalia.
b. Contractions of the arrector pili muscles squeeze the sebaceous gland and force the
sebum (a mixture of triglycerides, cholesterol, proteins, and electrolytes) into the hair
follicle and onto the surface of the skin.
c. These glands are the holocrine type, the cells fill up with oil then bust.
d. Sebum is secreted into a hair follicle, or occasionally a pore, or follicle, on the skin
surface.
e. Sebum softens and lubricates hair and surrounding skin and also has anti-bacterial
properties.
2. Sweat glands
a. Distributed all over the surface of the body except the nipple, parts of the external
genitalia, and the lips.
b. Eccrine (merocrine) sweat glands are very numerous in the palms, soles of the feet and
forehead.
i. Eccrine gland secretions, commonly called sweat, are a hypotonic filtrate of the
blood that passes through secretory cells of the sweat gland and is release by
exocytosis.
ii. Once released, the sweat travels via a duct to the surface of the skin where it
opens into a funnel-shaped pore.
iii. Normal pH of sweat is between 4 and 6.
c. Apocrine sweat glands* are largely confined to the axillary and anogenital areas.
i. Larger than eccrine sweat glands and release their secretions into hair follicles.
ii. The secretions produced are similar to sweat but they also contain fatty substances
and proteins.
iii. Apocrine glands begin functioning at puberty.
d. Ceruminous glands
i. Modified Apocrine glands that line the external ear canal and secrete a sticky,
bitter substance called cerumen.
ii. Cerumen=earwax.
e. Mammary glands
i. Specialized Apocrine sweat gland that secretes milk.

5.3 Functions of the integument system

A. Protection
B. Sensory: The integument contains many sensory receptors:
1. Free nerve endings = numerous unencapsulated nerve endings for pain and temperature
detection
2. Tactile discs = extend from the dermis into the epidermis where they connect to Merkel cells
and monitor the chemical secretions from these cells which produce tactile stimuli.
3. Tactile corpuscles (Meissner’s corpuscles) = receptors located in the dermal papillae;
responsible for the detection of light touch
4. Lamellated corpuscles (Pacinian corpuscles) = receptors located in the reticular layer of the
dermis; responsible for detection of deep pressure and vibration
C. Thermoregulation: your skin can help regulate your body temperature via vasodilation and
vasoconstriction.
 D. Vitamin D synthesis: Hormonal Vitamin D = also known as calcitriol. When exposed to ultraviolet
light, epidermal cells in the stratum spinosum and stratum basale converts a cholesterol-related steroid
into cholecalciferol. Although cholecalciferol can be obtained from the diet, few foods contain it. In
fact most foods that contain cholecalciferol have been fortified with it. The liver then converts
cholecalciferol into an intermediary product used by the kidneys to synthesize the hormone calcitriol.
Calcitriol is required for stimulating normal absorption of calcium and phosphorus in the small intestine.
An inadequate supply of calcitriol leads to impaired bone growth and maintenance such as typical of
rickets.

5.4 Diseases, disorders and injuries of the immune system

A. Skin cancers are the most common types of cancer.
1. The most common form of skin cancer is basal cell carcinoma. This is a cancer that originates
in keratinocytes of the stratum basale, due to mutations caused by overexposure to the UV light.
Metastasis virtually never occurs in basal cell carcinomas, and most people survive these
cancers.
2. In contrast, melanoma is the least common form of skin cancer but is extremely dangerous. In
this condition cancerous melanocytes within the stratum basale grow rapidly and metastasize
through the lymphatic system. The outlook for long-term survival is in many cases determined
by how early the condition is diagnosed. If the cancer is detected early, while it is still localized,
the affected area can be surgically removed, and the 5-year survival rate is 99 percent. If the
condition is not detected until extensive metastasis has occurred, the 5-year survival rate drops to
14%.
3. Squamous cell carcinoma originates in the stratum spinosum layer and like basal cell
carcinoma, it rarely metastasizes.
B. Eczema is an allergic reaction that manifests as dry, itchy patches of skin that look like a rash. It may
swell, flake, crack and bleed and can be treated with corticosteroids and immunosuppressants.
C. Acne occurs from an overproductive, blocked sebaceous gland.
D. Injuries and Burns: First degree burn effects only the epidermis. Second degree burn goes deeper
and effects both epidermis and dermis. Third degree burn extends through the epidermis and dermis to
damage underlying tissue and nerve endings. Fourth degree burn includes damage to all of the above
as well as muscle and bone. Full thickness burns can NOT be repaired by the body and require a skin
graft.

E. Scars are collagen-rich skin formed after the process of wound healing that differs from normal skin.
Keloids are raised scars
F. Bedsores happen in areas exposed to prolong pressure resulting in loss of blood flow and necrosis of the
tissues.
G. Stretch Marks result from the skin is stretched beyond its normal capacity.
H. Calluses and Corns form from areas of constant abrasion.

5.5 Age-related changes alter the appearance of structure of the integument.

A. Melanocyte activity declines, and in light skinned individuals, the skin becomes pale. With less melanin
in the skin, people become more sensitive to sun exposure and more likely to experience sunburn.
B. Sebaceous gland secretions decreases with age and the skin becomes dry and often scaly.
C. The epidermis thins as germinative cell activity declines, and the connections between the epidermis and
dermis weakens, making older people more prone to injury, skin tears, and skin infections.
D. The metabolic activity in the skin decreases as well. Synthesis of calcitriol (vitamin D3) decreases
leading to muscle weakness and brittle bones.
E. The number of dendritic cells decreases to about half the levels seen at maturity. This reduction in cells
may decrease sensitivity of the immune response and further encourage skin damage and infection.
F. The dermis becomes thinner and has fewer elastic fibers, making the integument weaker and less
resilient. The results – sagging and wrinkling – are most pronounced in body regions with the most sun
exposure.
G. Merocrine sweat glands become less active and with impaired perspiration processes, older people
cannot lose hear at fast as younger people. Thus the elder are at greater risk of overheating in warm
environments.
H. A reduction in dermal blood supply cools the skin, which can stimulate thermoreceptors and make a
person feel cold even in a warm room. Reduced circulation and sweat gland function lessens their ability
to lose body heat, which can cause their body temperature to soar dangerously high.
I. With declining levels of sex hormones, differences in secondary sexual characteristics with respect to
hair distribution and body-fat distribution begin to fade. As a consequence, people age 90 – 100 of both
sexes tend to look alike.
J. Hair follicles stop functioning or produce thinner, finer hairs. With decreased melanocyte activity, these
hairs are gray or white.