CPT 4: PHYSIOLOGY - DOC CARADO

INTEGUMENTARY SYSTEM ➔ If too cold:

➔ Integument as an organ, alternative name for skin ◆ Dermal blood vessels constrict
➔ Includes the skin & the skin derivatives hair, nails, & glands ◆ Prevents heat from escaping
➔ The largest system of the body ● Excretion
➔ 16% of body weight ➔ Small amounts of waste products are lost through
➔ 1.5 to 2m² in area perspiration
➔ Made up of two parts: Structures of Skin
◆ Cutaneous membrane ➔ Understanding how skin can function in these many ways starts
a. Epidermis– superficial epithelium w/ understanding the structure of 3 layers of skin
b. Dermis– underlying connective tissue w/ blood ➔ The Epidermis
supply ◆ Epithelial tissue
◆ Accessory structures ➔ Dermis
a. Hair ◆ Dense connective tissue proper – irregular
b. Nails ➔ Hypodermis
c. Exocrine glands ◆ Subcutaneous tissue– loose connective tissue proper &
Functions of Integumentary System adipose tissue
● Protection
➔ 1st line defense against
◆ Bacteria & viruses
➔ Protects underlying structures frim
◆ Ultraviolet (UV) radiation & dehydration
● Vitamin D production
➔ Needed for calcium absorption
● Sensation
➔ Sensory receptors
● Body temperature regulation
➔ If too hot:
◆ Dermal blood vessels dilate
◆ Vessels carry more blood to surface so heat can
escape

Inventor, Joanna Marie P. 1

CPT 4: PHYSIOLOGY - DOC CARADO
Epidermis Stratum Basale
➔ Vascular stratified squamous epithelium ➔ Attached to basement membrane by hemidesmosomes
◆ Nutrients & oxygen diffuse from capillaries in the dermis ➔ Forms strong bond between epidermis and dermis
➔ Cells of epidermis: ➔ Forms epidermal ridges (fingerprints)
◆ Keratinocytes ➔ Dermal papillae (tiny mounds)
➔ Contain large amount of keratin ◆ Increase the area of basement membrane
➔ Most abundant cells in epidermis ◆ Strengthen attachment between epidermis & dermis
➔ Think skin ➔ Has many basal cells or germinative cells
◆ Covers most of the body Stratum Spinosum
◆ Has 4 layers of keratinocytes ➔ “Spiny layer”
➔ Thick skin ➔ Produced by division of stratum basale
◆ Covers the palms of hands & soles of feet ➔ 8-10 layers of keratinocytes bound by desmosomes
◆ Has 5 layers of keratinocytes ➔ Cells shrink until cytoskeleton stick out (spiny)
➔ Structures of the Epidermis ➔ Continue to divide, increasing thickness of epithelium
◆ 5 strata of keratinocytes in thick skin ➔ Contains dendritic (Langerhans) cells, active in immune
◆ From basal lamina to free surface response
1. Stratum basale Stratum Granulosum
2. Stratum spinosum ➔ “Grainy layer”
3. Stratum granulosum ➔ Stops dividing, starts producing
4. Stratum lucidum ➔ Keratin
5. Stratum corneum ◆ Tough, fibrous protein
◆ Makes up hair & nails
➔ Keratohyalin
◆ Dense granules
◆ Cross-link keratin fibers
Stratum Lucidum
➔ “Clear layer”
➔ Found only in thick skin
➔ Covers stratum granulosum

Inventor, Joanna Marie P. 2

CPT 4: PHYSIOLOGY - DOC CARADO
Stratum Corneum ➔ Characteristics:
➔ “Horn layer” ◆ String, due to collagen fibers
➔ Exposed surface of skin ◆ Elastic, due to elastic fibers
➔ 15-30 layers of keratinized cells ◆ flexible
➔ Water resistant Hypodermis (Subcutaneous layer)
➔ Shed & replaced every 2 weeks ➔ Lies below integument
Dermis ➔ Stabilizes the skin
➔ Located between epidermis & subcutaneous layer ➔ Allows separate movement
➔ Anchors epidermal accessory structures (hair follicles, sweat ➔ Made of elastic areolar & adipose tissue
glands) ➔ Connected to the reticular layer of integument by connective
➔ 2 components: tissue fibers
1. Outer papillary layer ➔ Deposits of subcutaneous fat
2. Deep reticular layer) ➔ Distribution patterns determined by hormones
Papillary Layer ➔ Reduced by cosmetic liposuction (lipoplasty)
➔ Consists of areolar tissue Structure of Hair
➔ Contains smaller capillaries, lymphatics, & sensory neurons Hair Follicle
➔ Has dermal papillae projecting between epidermal ridges ➔ Organs that form the hairs
Reticular Layer ➔ Located deep in dermis
➔ Consists of dense irregular connective tissue ➔ Produces nonliving hairs
➔ Contains larger blood vessels, lymphatic vessels, & nerve fibers ➔ Wrapped in a dense connective tissue sheath
➔ Contains collagen & elastic fibers ➔ Base is surrounded by sensory nerves (root hair plexus)
➔ Contains connective tissue proper ◆ Control bacteria
Dermatitis Accessory Structures of Hair
➔ Inflammation of the papillary layer Arrector Pili
➔ Caused by: ➔ Involuntary smooth muscle
◆ Infection, radiation, mechanical irritation, or chemicals ➔ Causes hair to stand up
(e.g., poison ivy) ➔ Produces “goose bumps”
➔ Characterized by: Sebaceous Glands
◆ itch /pain ➔ Lubricate the hair

Inventor, Joanna Marie P. 3

CPT 4: PHYSIOLOGY - DOC CARADO
Regions of the Hair ➔ Contract to stand hair perpendicular to skin surface
Hair root
➔ Lower part of hair Nails
➔ Attached to the integument ➔ Protect fingers & toes
Hair shaft ➔ Made of dead cells packed w/ keratin
➔ Upper part of the hair ➔ Metabolic disorders can change nail structure
➔ Not attached to the integument Nail production
Hair Shaft Structure ➔ Occurs in deep epidermal fold near the bone called the nail
Medulla root
➔ Core, dead cells contain soft keratin & air to provide flexible Structure of Nail
Cortex Nail body
➔ Middle layer, dead cells contain hard keratin to provide ➔ Visible portion of nail
stiffness ➔ Cover the nail bed
Cuticle Lunula
➔ outermost , overlapping dead keratinized cells form shiny ➔ Pale crescent at the base
surface of nail
Hair Function Sides of nails
Head: ➔ Lie in lateral nail grooves
➔ UV protection ➔ Surrounded by lateral nail
➔ Cushion from trauma folds
➔ Insulation
Nostrils, Ear canals, Eyelashes:
➔ Prevent entry of foreign material
Body hair:
➔ Sensory detection
Root hair plexus:
➔ Sensory nerves at base of hair follicle that detect slight
movement of hair
Arrector pili muscle:
➔ Attached to every hair follicle

Inventor, Joanna Marie P. 4

CPT 4: PHYSIOLOGY - DOC CARADO
Integumentary System ○ Stratified squamous keratinized epithelium
Integumentary - covering; covers outside of the body Epidermis: cells
Consists of: ● Keratinocytes:
● Hair ○ Produce keratin for strength
● Nails ● Melanocytes:
● Glands ○ Contribute to skin color
➔ Largest organ ● Langerhans’ cells:
➔ Continuous m/m at orifices ○ Part of immune system
➔ 7% of body weight ● Merkel’s cells:
➔ Surface area: 1.5 to 2 sq. meters ○ Detect light touch & pressure
➔ Thickness: 0.5 to 3 mm Appendages
➔ Consists of: Hair
◆ Epidermis ➔ Except palms, soles, lips, nipples, parts of external genitalia &
◆ Dermis distal segments of fingers & toes
Dermis: papillary layer Glands
● Loose ct w/ collagen & elastic fibers ➔ Sebaceous
● Peg-like projections – ➔ Sudoriferous (sweat)
○ dermal papillae- fit into reciprocal depressions on ➔ Ceruminous
undersurface of epidermis ➔ Mammary
● Dermal papillae contain capillary loops & free nerve endings Nail
Dermis: reticular layer Sweat Glands
● Main layer Sweat - blood filtrate
● Elastin & collagen produce: ● 99% water w/ some salts
○ Several strength ● Contains traces of metabolic waste
○ Cleavage lines Types:
○ Stretch marks- striae ● Eccrine glands
● Epidermis ○ Most numerous - produce true sweat
○ Avascular ● Apocrine glands
○ 5 layers ○ Confined to axillary, anal, & genital areas
○ Produces special kind of sweat

Inventor, Joanna Marie P. 5

CPT 4: PHYSIOLOGY - DOC CARADO
Sebaceous Glands Functions of Skin
● Over entire body except palms & soles ● Protection
● Simple alveolar glands ● Sensation
● Secrete sebum - oily substance ● Metabolism
● Holocrine secretion - entire cell breaks up to form secretion ○ Temperature regulation
● Functions– softens & lubricates hair & skin ○ Vitamin d production
Nail ○ Excretion
● Scale-like modification of epidermis on distal, dorsal surface of ○ Regulation of pH
fingers & toes ○ Absorption
● Parts: free edge, body root, nail folds, eponychium, lunula ○ Secretion
Cleavage lines (Lines of Langer) ○ Storage
● Elastin & collagen fibers oriented in directions Skin color in clinical conditions
● Important in surgery ● Pale – anemia
● When incision parallel to lines ● Yellow – jaundice
○ Less gaping ● Blue – cyanosis
○ Faster healing Skin grafts
○ Less scar tissue ● Split thickness grafts – epidermis & tips of dermal papillae is
Skin Color used
Determined by 3 factors: ● Full thickness graft – both epidermis & dermis is used
1. Pigments Rules of Nines
● Melanin ● Estimates severity of burns
● Carotene ● Burns are critical if:
● Albinism: deficiency/absence of pigment ○ Over 25% second degree burns
2. Blood circulating through skin ○ Over 10% third degree burns
● Imparts reddish hue– Hb & Oxy Hb (hemoglobin & oxy ○ Third degree burns on face, hands or feet
hemoglobin)
● Cyanosis– blue color caused by decrease in blood
oxygen
3. Thickness of stratum corneum

Inventor, Joanna Marie P. 6

CPT 4: PHYSIOLOGY - DOC CARADO
First-Degree burns
- superficial burns that only affect the skin surface
Second-Degree burns
- burns that affect the outermost & second skin layer
- Partial thickness burn
- Burns epidermis & dermis
- Blisters forming is the key to diagnosis
- Mottled, swelling, wet & painful
- 3-4 weeks to heal
- Cause excessive exposure to sun, radiation, hot or boiling
liquids, or fire
Third-Degree burns - burns that killed the skin all the way to the fatty
tissue

Inventor, Joanna Marie P. 7