SKIN

Structure of the skin (epidermis, dermis, hypodermis); skin color (melanin, other pigments); functions of the skin
(protection, sensation, flexibility, excretion, vitamin D production, immunity, homeostasis of body temperature);
appendages of the skin (hair, nails, skin glands).

I. STRUCTURE OF THE SKIN

A. EPIDERMIS

Cell types
• Keratinocytes
• Melanocytes
• Langerhans cells (epidermal dendritic cells)
• Merkel cells (tactile epithelial cells)

Cell layers
• Stratum basale–mitosis
• Stratum spinosum
• Stratum granulosum–keratin formation begins; granules called keratohyalin
• Stratum lucidum (eleidin →→ keratin)
• Stratum corneum
Keratinization
Hyperkeratosis–thickening of stratum corneum beyond normal limits

Epidermal growth and repair

Epidermal growth factor (EGF) is used clinically to stimulate skin repairs in diabetic and pressure ulcers and
other conditions. Insulin-like growth factor 1 (IGF-1) is required for epidermal growth factor (EGF) to have its full effect
on epidermal growth and repair. Growth hormone (GH) also contributes to epidermal growth and repair. Exfoliation and
abrasion stimulate keratinocytes to undergo mitosis in the stratum basale while increasing desquamation, or de-shedding
of epithelial cells at the skin surface. Calluses are the result of excessive exfoliation and abrasion.

B. DERMOEPIDERMAL JUNCTION (DEJ)

Serves as the “glue” for the epidermis and dermis. When it fails, forms blisters.

C. DERMIS Corium

The dermis stores water and electrolytes. It is rich in blood vessels, which plays a critical role in regulating body
temperature (see below). Somatic sensory receptors in the dermis sense pain, pressure, touch, and temperature. It is
divided into papillary and reticular layers. The dermal papillary layer is made up of loose fibrous connective tissue
(collagenous and elastic fibers); dermal papillae form epidermal ridges (friction ridges). The dermal reticular layer is
mostly dense bundles of white collagenous fibers. Arrector pili muscles, as well as hair follicles and skin glands, are
located in the reticular layer of the dermis

Dermal growth and repair

The dermis does not regenerate unless it’s during repair and scar formation. Stretch marks are a result of over-
stretched and torn elastic fibers in the dermal layer of the skin.
II. HYPODERMIS Subcutaneous layer ∙ Superficial fascia

The hypodermis is not part of the skin. However, it carries blood vessels and nerves to the dermis and
is the site of subcutaneous injections via hypodermic needle.

III. SKIN COLOR

A. MELANIN

Melanocytes are located in the stratum basale. The number of melanocytes is about the same in all humans; it is
the amount and type of melanin pigment produced by these melanocytes that is subsequently deposited in keratinocytes
that determine skin color. Darker skinned people have higher concentrations of eumelanin (very dark brown) while
lighter skinned people have higher concentrations of pheomelanin (lighter reddish/orange color). Melanocytes convert
tyrosine into melanin by the enzyme tyrosinase; this melanin in packaged into melanosomes and transferred to
surrounding keratinocytes where they form a protective coat around the nucleus in order to protect DNA damage by
ultraviolet (UV) radiation. Albinism is the hereditary lack of the expression of the enzyme tyrosinase. UV radiation can
also damage vitamin folic acid (B9).
α-MSH (alpha melanocyte-stimulating hormone)–produced by the anterior pituitary gland and keratinocytes in
response to UV radiation–stimulate melanocortin receptors on the surface of melanocytes, triggering melanin production.
Endothelin-1 (ET-1) also regulates tanning. Defects in the genes that express α-MSH or melanocortin receptors lead to
failure in producing melanin in response to UV radiation.

B. OTHER PIGMENTS

β-carotene (yellow pigment), which can be converted into vitamin A, is stored in skin tissue. Lipofuscin (brown-
yellow pigment) accumulates with age, causing age spots.

III. FUNCTIONS OF THE SKIN

A. PROTECTION
The skin acts as a physical barrier, prevents dehydration, and produces melanin, thereby also protecting us from
UV radiation-induced DNA damage. Desquamation is the shedding of epithelial cells from the skin surface. Surface film
is a combination of dead epithelial cells, sebum and sweat.

B. SENSATION

C. FLEXIBILITY

D. EXCRETION
Sweat (water, ammonia, lactic acid, urea and uric acid)

E. HORMONE (VITAMIN D) PRODUCTION

Upon UV radiation, 7-dehydrocholesterol–stored in skin cells–is converted to cholecalciferol (i.e., vitamin D3),
which is then transported via the blood to the liver, where it is converted to 25-hydroxycholecalciferol, which is then
transported to the kidneys to be converted into 1,25–dihydroxycholecalciferol (i.e., the active form of vitamin D3).
Excessive melanin production can lead to inability to synthesize vitamin D3.

F. IMMUNITY
Epidermal dendritic cells (Langerhans cells) are antigen-presenting cells located in the skin.

G. REGULATION OF BODY TEMPERATURE

 Approximately 80% of heat loss occurs through the skin; the rest is through mucous membranes. If heat must be
retained to maintain normal body temperature, the dermal blood vessels vasoconstrict in order to keep all of the warm
blood within the core of the body; if heat must be dissipated to maintain normal body temperature (due to increased
metabolism or muscle activity such as during exercise), the dermal blood vessels vasodilate, allowing more warm blood to
flow to the epidermis where heat is transferred through evaporation, radiation, conduction, and convection.
Evaporation–water has very high specific heat, meaning a lot of heat can be transferred to sweat on our skin before it is
evaporated. Radiation–in cooler temperatures, heat can be dissipated through the air according to laws of
thermodynamics (heat energy moves from hot skin to cold environment), while in hotter temperatures, especially when it
is hotter than body temperature, radiation increases body temperature instead.
Homeostatic regulation of heat loss. Temperature receptors in the hypothalamus (sensors) detect increase in
body temperature. The effectors: sweat glands (increased sweating increases heat loss through evaporation) and blood
vessels of the skin (vasodilation increases heat loss through radiation). Typically, twice as much heat is lost through
radiation heat loss from vasodilation of blood vessels in the dermis than from heat loss from evaporation of sweat on our
skin.

IV. APPENDAGES OF THE SKIN

A. HAIR
Dermal papilla, which protrudes into the base of the hair follicle, contains capillaries that supply the germinal
matrix, which has clinical significance in that it can be a site of keratinocyte and melanocyte stem cells. Sebaceous glands
secrete sebum into the hair follicle.

B. NAILS
Onycholysis is the loosening of the nail from the nailbed. Nails are used in surgery to detect cyanosis, an indirect
way to monitor oxygenation levels.

C. SKIN GLANDS
Sweat glands (sudoriferous glands) are classified into eccrine and apocrine glands. Eccrine glands secrete sweat.
Apocrine glands secret pheromones.

D. SEBACEOUS GLANDS
Sebum has antifungal activity, prevents water loss from the epidermis.

E. CERUMINOUS GLANDS
Special type of apocrine sweat glands that produce cerumen in the external ear canal, protecting the skin in this
area from dehydration.