INTEGUMENTARY

SYSTEM
ANPHY211
COLLEGE OF NURSING
2ND SEM SY 2021-2022
DR. SONNIE P. TALAVERA
 ✓Keeps water and other
precious molecules in the body
✓Keeps water out (so one can
swim for hours without
becoming waterlogged)
✓Protects the body from
external agents
FUNCTIONS: ✓Insulates and cushions deeper
organs
✓Protects body from mechanical
damage (bumps and cuts),
chemical damage ( from acids
and bases), thermal damage
(heat and cold), ultraviolet
radiation and bacteria.
 ✓ Regulates heat loss from the
body surface
✓ Acts as a mini excretory
system; urea, salt, water are
loss when we sweat
FUNCTIONS: ✓ Manufactures several proteins
important to immunity
✓ Storage of vitamin D precursor
✓ Contains cutaneous receptor
that serve as sensors for touch,
pressure, temperature, and pain
 2 Principal Layers
LAYERS OF ✓Epidermis
THE SKIN ✓Dermis
EPIDERMIS

✓ Superficial protective layer of the skin

✓ Composed of Stratified Squamous Keratrinized
Epithelium that varies in thickness
✓ All but the deepest layers of epidermis are
composed of dead cells
✓ Composed of 4-5 layers, depending on its location
within the body
✓ Palms and soles have five layers because these
areas are exposed to most friction
 LAYERS OF EPIDERMIS
Stratum Basale
✓ Composed of single layer of cells in contact with dermis
✓ 4 types of cells in the stratum basale:
Keratinocytes
✓ Produce keratin which toughens and waterproofs skin
Melanocytes
✓ Synthesize the pigment melanin providing a protective barrier to UV
radiation in sunlight
Tactile cells (Merkel cells)
✓ Aid in tactile (touch) reception
Non pigmented granular dendrocytes (Langerhans cells)
✓ Protective macrophagic cells that ingest bacteria and other foreign
debris
LAYERS OF EPIDERMIS
Statum Spinosum (Spiny layer)
✓ Contains several stratified layer of cells
✓ Spiny appearance due to changed shaped of keratinocytes
✓ With limited mitosis
✓ This layer plus stratum basale are collectively called
Strat5um Germinativum

Stratum Granulosum (Granular layer)

✓ Consist of only 3-4 flattened rows of cells
✓ Cells here appear granular due to the presence of
keratohyaline granules
LAYERS OF EPIDERMIS

Stratum Lucidum (Clear layer)

✓ Nuclei, organelles and cell membranes are no longer visible so this layer appear
clear
✓ Exist only in the lips and the thickened skin and soles and palms
✓ Contains a translucent substance called eleidin

Stratum Corneum (Hornlike layer)

✓ Composed of 25-30 layers of flattened, scale like anucleated cells, which are
continuously shed as flake like residues of cells
✓ This surface layer is cornified and is the real protective layer of the skin
✓ Cornification is brought on by keratinization and the hardening, flattening process
that takes places as the cells die and are pushed to the surface
✓ Friction at the surface of skin stimulates additional mitotic activity of stratum basale,
resulting in the formation of a callus for additional protection
COLORATION OF THE SKIN

Caused by expression of a combination of 3 pigments:

✓ Melanin
✓ Carotene
✓ Hemoglobin
VITILIGO
WHITE SKIN PATCHES
FRECKLES
AGGREGATED PATCH OF MELANIN
MELANIN
✓ Brown-black pigment produced by the melanocytes of
stratum basale
✓ Guard skin against damaging effect of ultraviolet rays of
sunlight
✓ Gradual exposure to sunlight promotes increased
production of melanin; hence tanning of the skin
✓ In albino, there is a normal number of melanocytes but
lacks enzymes tyrosinase, that converts the amino acid
thyrosine to melanin
✓ “freckles” – caused by aggregated patch of melanin
✓ “vitiligo” – lack of melanocytes in localized areas of the
skin causing distinct white spots
 CAROTENE

✓ A yellowish pigment found in epidermal cells and fatty parts

of dermis
✓ Abundant in skin of Asians
✓ Together with melanin, accounts for the yellowish-tan color
in Asians
HEMOGLOBIN

✓ Not a pigment of the skin, rather it is the oxygen-

binding pigment found in RBC
✓ Oxygenated blood flowing through the dermis gives
its pinkish tones
SURFACE PATTERNS
Congenital Patterns:

Positive fingerprints or friction ridges

✓ Present on palms and soles
✓ Formed by the pull of elastic fibers within the dermis
✓ Function to prevent slipopage when grasping objects

Acquired Lines:
✓ Deep Flexion Creases
✓ Found on the palms
✓ Shallow Flexion Lines
✓ Seen on knuckles and surface of other joints
SURFACE PATTERNS
Furrows in the forehead and face (wrinkles)
✓ Acquired from continual contraction of facial muscles,
such as from smiling or squinting in bright light or against
the wind; facial lines become more strongly delineated as
person ages

Langer Lines
✓ Lines of tension in the skin produced by the orientation of
collagen and elastic fibers in nonrandom pattern of
arrangement
✓ Surgical incision should be made parallel to Langer lines
to promote better wound healing
DERMIS

✓ Deeper and thicker than epidermis

✓ A strong and stretchy envelop that helps to hold the
body together
✓ Blood vessels within the dermis nourish the living
portion of the epiudermis
✓ With numerous collagenous, elastic, and reticular
fibers that gives support to the skin
✓ Highly vascular and glandular
✓ Contains many nerve endings and hair follicles
LINES OF LANGER (TENSION LINES) – PRODUCED BY THE
ORIENTATION OF COLLAGEN AND ELASTIC FIBERS IN THE
BODY
EPIDERMAL RIDGES – PALMS AND SOLES
Acquired lines:
-Shallow Flexion
lines-knuckles
and surface of
other joint
-Deep Flexion
creases-palms

Deep Flexion
creases-palms
Dermis
• Two layers
•Papillary layer
• Projections called dermal papillae
• Pain receptors
• Capillary loops
•Reticular layer
• Blood vessels
• Glands
• Nerve receptors
SLIDE 4.13A
LAYERS OF THE DERMIS
Papillary Layer
✓ In contact with the epidermis
✓ Accounts for about 1/5 of the entire dermis
✓ With numerous projections called Dermal Papillae, that
extend from the upper portion of the dermis into the
epidermis
Dermal papillae contain capillary loops, which furnish nutrients
to the epidermis
✓ Some papillae house pain receptors (free nerve endings) and
touch receptors (Meissner’s Corpuscles)
✓ Dermal papillae form the base for the friction ridges on the
fingers and toes
LAYERS OF THE DERMIS

Reticular layer
✓ Deepest skin layer
✓ Contains blood vessels, sweat and oil glands, and
deep pressure receptors (Pacinian corpuscles)
✓ Many phagocytes are found here; they engulf
bacteria that have managed to get through the
epidermis
 Skin Structure

Figure 4.4

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings SLIDE 4.13B
CUTANEOUS GLANDS

✓ All enxocrine glands (they release secretions to skin

surface via ducts)

✓ Sebaceous glands
✓ Sweat glands
SEBACEOUS (OIL) GLANDS
✓ Found all over the skin, except on palms and soles
✓ Ducts usually empty into a hair follicle but some open directly
onto skin surface
✓ Secretion is called sebum, a mixture of oily substance and
fragmented cells that keeps skin soft and moist and prevents
hair from becoming brittle
✓ If the drainage pathway for sebaceous gland becomes blocked
for some reason, the glands become infected, resulting in acne
✓ Sebum also contains chemicals that kills bacteria
✓ Become very active when sex hormones are produced in
increased amounts during adolescence, thus skin is oilier
during this period of life
SWEAT GLANDS
✓ Also called sudoriferous glands
✓ Widely distributed in the skin; numerous in palms,
sole, axillary and pubic regions
✓ Secretion evaporates and cools the body

2 types:
✓ Merocrine
✓ Apocrine
SWEAT GLANDS
Merocrine Sweat Glands
✓More numerous and found all over body especially
in forehead, back, palms and soles
✓Secretion reaches skin surface via a duct that
opens directly on surface of skin through sweat
pores
✓Secretion is mostly water with few salts
SWEAT GLANDS
Apocrine Sweat Glands
✓Much larger, localized gland found in axillary and
pubic regions where they secrete into hair follicles
✓Not functional until puberty
✓Secretion is thick and rich in organic substance
which is odorless when released but quickly
broken down by bacteria into substances
responsible for body odor.
SWEAT GLANDS

Mammary Gland
✓Found within the breast
✓Specialized sudoriferous or sweat gland that
secrete milk during lactation
✓Under the stimulus of pituitary gland
✓Sweat (sudoriferous) glands
✓ Eccrine sweat glands
✓ Merocrine glands: forehead, back, palms, soles
✓ More numerous
✓ Secretion is mostly water, opens directly onto skin surface
✓ Function is to cool the body

✓ Apocrine sweat glands

✓ Larger, localized glands: axillary and pubic regions
✓ Become functional at puberty
✓ More viscous – fatty acids and proteins, empties into hair
follicles
✓ Released odorless until broken down by bacteria
✓ An apocrine gland, which produces little sweat but is responsible
for the body's natural '
✓ If the drainage pathway
becomes blocked for
some reason, the
glands may become
infected, resulting in
ACNE formation
✓Ceruminous
glands
✓ Modified
sudoriferous
glands
✓ Secrete
cerumen (ear
wax)
✓ Empties into
the ear canal
✓Mammary glands
✓Specialized sweat
gland
✓ Found within the
breast tissue
✓ Undergoes cell
hypertrophy (size
increase) and cell
hyperplasia
(increase in
number) under
pituitary influence
in pregnancy
✓ Secrete milk
during lactation
SEVERE BREAST HYPERTHROPHY
HAIR

✓ Characteristic of all mammals, but its distribution,

function, density and texture varies across
mammalian species

✓ Humans are relatively hairless, with only the scalp,

face, pubis and axilla being densely haired
HAIR

✓ Men with more obvious hair because of the male

hormone

✓ Certain regions of the body are hairless, like the

palms, soles, lips, nipples, penis, labia minora

✓ Lifespan 3-4 months for eyelash, 3-4 years in scalp

hair
 HAIR

Primary Function of Hair: Protection

✓ e.g. scalp hair, eyebrows are protection from the sunlight

Parts of Hair
✓ Shaft – the visible but dead portion of hair projecting above
surface of the skin
✓ Root – enclosed in the follicle
✓ Hair bulb matrix – the growth zone; contains melanocytes
that give color to the hair
 HAIR

3 Layers of Hair in Cross Section

✓ Medulla – inner part
✓ Cortex – thick middle part
✓ Cuticle – covers cortex and forms
toyughened outer portion
LAYERS IN CROSS SECTION

✓ Medulla – inner part

✓ Cortex - thick middle part
✓ Cuticle – covers cortex and
forms tough outer portion
LANUGO – FINE, SILKY FETAL (IMMATURE)
HAIR
VELLUS – SHORT, FINE HAIRS

Fine vellus hairs grow all over the body except the palms
and soles.
DEFINITIVE HAIR

✓grows up to a certain length only, most dominant

type of hair . Eyelashes ,eyebrow,pubic and axillary
hair.
NAIL
✓Nail body – visible attached portion
✓Hyponychium – beneath free edge
✓Nail matrix – growth area of the nail,
proximal portion of nail bed
✓Lunula – white crescent shape
NAIL

✓ Free edge – distal

exposed portion
✓ Nail root – covered by
skin
✓ Eponychium – (cuticle)
covers the nail root
Skin Homeostatic Imbalances

✓ Infections
✓ Athletes foot
✓ Caused by fungal infection
✓ Boils and carbuncles
✓ Caused by bacterial infection
✓ Cold sores
✓ Caused by virus

SLIDE 4.23
ATHLETE’S FOOT
Tinea pedis
Itchy, red peeling condition of the skin between the toes
due to fungal infection
BOILS AND CARBUNCLES
Inflammation of hair follicles and sebaceous glands,
found on the dorsal neck

Typically caused by bacterial infection

( Staphylococcus aureus )
COLD SORES
 Fever blisters

 Small-fluid filled blisters that itch and sting, caused by

herpes simplex infection

 The virus localizes in a cutaneous nerves, where it

remains dormant until activated by emotional upset,
fever, or UVR

 Commonly occurs around the lips and in the oral

mucosa of the mouth
Athlete’s Foot
 Boils

Cold Sores
Skin Homeostatic Imbalances

• Infections and allergies

• Contact dermatitis
• Exposures cause allergic reaction
• Impetigo
• Caused by bacterial infection
• Psoriasis
• Cause is unknown
• Triggered by trauma, infection, stress
SLIDE 4.24
CONTACT DERMATITIS
Itching, redness, and swelling of the skin , progressing
to blisters

Caused by exposure of the skin to chemicals ( poison ivy

) that provoke allergic responses in sensitive individuals
IMPETIGO
Pink water-filled, raised lesions that develop a yellow
crust and eventually rupture

Caused by a highly contagious staphylococcal infection

Commonly affects elementary school-aged children

Commonly occurs around the mouth and nose

PSORIAIS
Chronic condition characterized by reddened epidermal
lesions covered with dry, silvery scales

Triggering Factors:
1. trauma
2. infection
3. hormonal changes
4. stress
 Psoriasis
Impetigo
Skin Homeostatic Imbalances

• Burns
• Tissue damage and cell death caused by
heat, electricity, UV radiation, or chemicals
• Associated dangers
• Dehydration
• Electrolyte imbalance
• Circulatory shock
SLIDE 4.25
Rules of Nines

✓ Way to determine the extent of burns

✓ Body is divided into 11 areas for quick
estimation
✓ Each area represents about 9%
✓ Pg. 108 textbook

SLIDE 4.26
Severity of Burns
First-degree burns
✓ Only epidermis is damaged
✓ Skin is red and swollen
Second degree burns
✓ Epidermis and upper dermis are
damaged
✓ Skin is red with blisters
Third-degree burns
✓ Destroys entire skin layer
✓ Burn is gray-white or black SLIDE 4.27
FIRST DEGREE BURNS
✓ Partial thickness burn

✓ Epidermis is damaged

✓ Generally heal in 2-3 days without any special attention

✓ The area becomes red and swollen ( sunburn )

SECOND DEGREE BURN
✓ Partial thickness burn

✓ Involves the dermis and upper region of the dermis

✓ Skin is red and painful and blisters appear

✓ Regeneration of the epithelium ( healing ) can still occur

because of sufficient number of epithelial cells still
present
THIRD DEGREE BURN
✓ Full thickness burn

✓ Destroys the entire thickness of the skin

✓ Burned area appears blanched ( gray white ) or blackened

✓ Painless because the nerve endings in the area are destroyed

✓ Regeneration ( healing ) is no longer possible

✓ Skin grafting must be done to cover the underlying exposed

tissue ( due to absence of regeneration )
CRITICAL BURNS:
1. over 25% TBSA has 2nd degree burns
2. over 10% TBSA has 3rd degree burn
3. 3rd degree burns of the face, hands or feet
Facial burns are dangerous because of the possibility of the
burned respiratory passageways to swell and cause suffocation
Joint burns are troublesome because scar tissue formation can
severely limit joint mobility
COMPLICATIONS OF BURNS
1. circulator shock
2. renal failure
3. infection
4. depression of the immune system
CIRCULATORY SHOCK
✓ Due to extravassation of fluids containing proteins and
electrolytes from the burned surface – dehydration &
electrolyte imbalance – decrease volume – circulatory
shock
RENAL FAILURE
✓ Due to extravassation of fluids containing proteins
electrolytes from the burned surface – dehydration &
electrolyte imbalance – renal failure
INFECTION
✓ L eading cause of death after burns
✓ Burned skin is sterile for about 24 hours
✓ After 24 hours, bacteria and fungi easily invade areas
where the skin has been destroyed and multiply rapidly
in the nutrient rich environment of dead tissues
DEPRESSION OF IMMUNE SYSTEM
✓ Occurs in severe burn cases
Skin Cancer
Cancer – abnormal cell mass
✓ Two types
✓ Benign
✓ Does not spread (encapsulated)
✓ Malignant
✓ Metastasized (moves) to other parts of
the body
✓ Skin cancer is the most common type of
cancer
Skin Cancer Types
✓ Basal cell carcinoma
✓ Least malignant
✓ Most common type
✓ Arises from statum basale
✓ Squamous cell carcinoma
✓ Arises from stratum spinosum
✓ Metastasizes to lymph nodes
✓ Early removal allows a good chance of
cure
Basal Cell Squamous Cell
Carcinoma Carcinoma
SQUAMOUS CELL CARCINOMA
✓ Arises from the cells of the stratum spinosum
✓ Scaly reddened papule ( small rounded elevation ) that
gradually forms a shallow ulcer with a firm, raised
border

Common sites:
1. scalp
2. ears
3. dorsum of the hands
4. lower lip
BASAL CELL CARCINOMA
✓ Most common and least malignant cancer

✓ Alteration of the cells of stratum basale – inablity to

distinguish the boundary between the dermis and epidermis –
invasion of the cancer cells in the dermis and subcutaneous
tissues

✓ Most commonly occurs on exposed areas of the skin

✓ Appears as shiny dome-shaped nodules that later developed

a central ulcer with pearly beaded edge

✓ Slow growing and metastasis seldom occurs before it is

noticed
✓ Grows rapidly and metastasizes to adjacent lymph
nodes if not removed
✓ Believed to be sun-induced

Good prognosticating factors:

1. early detection
2. early removal through surgery
3. early chemotherapy
Skin Cancer Types
Malignant melanoma
✓ Most deadly of skin cancers
✓ Cancer of melanocytes
✓ Metastasizes rapidly to lymph and blood
vessels
✓ Detection uses ABCD rule
MALIGNANT MELANOMA
✓ Cancer of melanocytes
✓ Accounts for 5% of skin cancers
✓ Occurs spontaneously in pigmented areas but some
develop from pigmented moles
✓ Usually appears as a spreading brown to black patch
that metastasize rapidly to surrounding lymph and blood
vessels
✓ 50% chances of survival with early detectio
Malignant Melanoma
ABCD Rule
A = Asymmetry
✓ Two sides of pigmented mole do not
match
B = Border irregularity
✓ Borders of mole are not smooth
C = Color
✓ Different colors in pigmented area
D = Diameter
✓ Spot is larger then 6 mm in diameter
DEVELOPMENTAL ASPECTS OF SKIN AND
BODY MEMBRANES
✓ Lanugo
✓ down type of hair covering the soon-to born infant during 5th -
6th months of fetal development ( shed by birth )

✓ Vermix caseosa
✓ accumulations of small white spots in the sebaceous glands on
the baby’s nose and forehead
✓ normally disappear by the 3rd week after birth
SKIN DEVELOPMENT
✓ Fetal
✓ ( + ) lanugo

✓ Neonatal
✓ vermis caseosa and millia
✓ very thin and blood vessels can easily be seen through it

✓ Infancy
✓ thicker and moist, and more deposition of subcutaneous fats

✓ Adolescence
✓ skin and hair become oilier due to activation of sebaceous
glands, causing acne
✓ acne subsides in early adulthood
✓ Adulthood – 20-30
✓ skin reaches its optimal appearance

✓ Geriatric Period :
✓ 1. reduction of subcutaneous fats
✓ 2. dry skin
✓ 3. thinning of the skin
✓ 4. decrease skin elasticity
✓ 5. baldness
✓ 6. ( + ) vellus hair
REDUCTION OF SUBCUTANEOUS FATS
✓ Causes cold intolerance
DRY SKIN
✓ Due to decrease oil production and reduction of collagen
fibers

✓ Causes itchiness and discomfort

THINNING OF THE SKIN
✓ Increases the risk for bruising and other types of
injuries
DECREASE SKIN ELASTICITY
✓ Along with the loss of subcutaneous fat causes eyebags
and sagging of jowls
BALDNESS
✓ Alopecia
✓ Occurs in 5th decade of life
✓ Due to reduced number of degeneration of hair follicles
✓ “ male pattern baldness “ = obvious balding / hair loss
with aging
VELLUS HAIRS
✓ Very tiny and colorless hairs ion the bald area due to
degeneration of the hair follicles
PREMATURE GRAYING OF HAIR
Causes :
1. emotional crisis ( problems )
2. anxiety
3. protein deficient diets
4. chemotherapy
5. radiation
6. excessive vitamin A
7. fungal diseases ( ringworm )
These conditions are not genetically determined
END GAME