CHAPTER FIVE

The Integumentary System

Introduction. Skin is the most accessible but often least appreciated organ system.
A. The skin, or simply integument, accounts for approximately 16% of your total body weight.
B. 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.
C. Skin is composed of two major components:
1. Cutaneous membrane:
a. The epidermis consists of stratified squamous.
b. The dermis consists of a papillary layer of areolar tissue and a reticular layer of dense
irregular connective tissue.
2. Accessory Structures:
a. Nerve fibers and corpuscles
b. Hair follicles, hair shafts, and arrector pili muscles
c. Oil glands and sweat glands
d. Arteries, veins, and lymph vessels forming the cutaneous network
D. 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

A. Epidermis. The epidermis is composed of layers with various functions.
1. The epidermis is dominated by keratinocytes, the body’s most abundant epithelial cells.
Keratin is an intracellular fibrous protein that gives hair, nails, and skin their hardness and
water-resistant properties. These cells form several layers called strata.
a. 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).
b. 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 0.5 mm).
c. Note that the terms “thick” and “thin” refer to the relative thickness of the epidermis,
not the integument as a whole.
2. Stratum Basale “basement” layer
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.
3. Stratum Spinosum “spiny” layer
a. Consists of approximately 8 – 10 layers of keratinocytes bound together by
desmosomes and microfilaments of pre-keratin. The cells look like miniature
pincushions in stained histological sections due to their desmosomes.
 b. The keratinocytes in the stratum spinosum begin the synthesis of keratin and release a
water-repelling glycolipid that helps prevent water loss from the body, making the skin
relatively waterproof.
c. Large numbers of dendritic cells or Langerhans 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.
4. Stratum Granulosum “grainy” layer
a. Consists of 3 – 5 cell layers where the keratinocytes appearance begins to change.
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.
Keratin is an intracellular fibrous protein that gives hair, nails, and skin their hardness
and water-resistant properties.
d. Beyond this layer, there is no nutrient availability.
5. Stratum Lucidum “clear” layer
a. In the thick skin of the palms and soles, a stratum lucidum separates the stratum
corneum from deeper layers.
b. By the time they reach the stratum lucidum, the cells are dead and undergoing
dehydration.
c. The cells of this layer are flattened, densely packed, largely devoid of organelles, and
filled with the proteins: keratin and eleidin - a clear protein rich in lipids, derived from
keratohyalin, which gives these cells their transparent (i.e., lucid) appearance and
provides a barrier to water.
6. Stratum Corneum
a. Outermost layer consisting of 15 – 30 layers of keratinized cells that accounts for up to
three-quarters of the epidermal thickness.
b. Keratinization (also called cornification hence the name) is the formation of protective,
superficial layers of cells filled with keratin.
c. The dead cells in each layer of the stratum corneum remain tightly interconnected by
desmosomes.
d. It takes 7 to 10 days for a cell to move from the stratum basale to the stratum corneum.
The entire layer of dead cells is replaced during a period of about 4 weeks. Cosmetic
procedures, such as microdermabrasion, help remove some of the dry, upper layer and
aim to keep the skin looking “fresh” and healthy.
e. Glycolipids in this layer provide a waterproofing quality to the epidermis.
7. A finger-like projection, or fold, known as the dermal papilla (plural = dermal papillae) is found
in the superficial portion of the dermis. Dermal papillae increase the strength of the connection
between the epidermis and dermis; the greater the folding, the stronger the connections made
8. The friction ridge pattern of epidermal tissue 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. Fingerprint patterns are caused from the combination of epidermal ridges
and supporting dermal papilla on areas of thick skin.
9. 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.
B. Dermis - supports the epidermis, and the hypodermis connects the dermis to the rest of the body. 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 elastin 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.
C. Hypodermis separates the skin from deeper structures. It is not strictly a part of the skin, although the
border between the hypodermis and dermis can be difficult to distinguish.
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:
a. insulation
b. cushioning
c. 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”).
D. Pigmentation. Factors influencing skin color include epidermal pigmentation and dermal circulation.
1. The color of one’s skin is genetically programmed. However, increased pigmentation, or
tanning, can result in response to ultraviolet radiation.
2. Skin color is influenced by the presence of pigments in the epidermis including melanin,
carotene, and hemoglobin:
a. Melanin - a brown, yellowish-brown, or black pigment produced by melanocytes.
i. 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.
ii. 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.
iii. 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.
iv. 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.
b. Carotene - an orange-yellow pigment that normally accumulates in epidermal cells from
diets rich in this plant-based pigment. 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.
i. When bound to oxygen, hemoglobin is bright red, giving capillaries in the dermis
a reddish tint that is most apparent in light-skinned individuals.
ii. 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.
iii. 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 serves a variety of functions, including protection, sensory input, thermoregulation, and
communication.
2. Hair follicles are a complex structure composed of epithelial cells and connective tissues of the
epidermis penetrating the dermis. The hair follicle has three regions (the internal root sheath,
the external root sheath, and glassy membrane).
3. 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.
4. 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.
5. Parts of a Hair:
a. Hair shaft the part of the hair not anchored to the follicle, and much of this is exposed
at the skin’s surface.
b. Hair root lies below the surface of the skin and is anchored into the follicle.
c. Hair matrix consists of superficial cells of the hair bulb. These germinative cells in the
hair matrix produce the hair.
d. The hair bulb surrounds the hair papilla, which is made of connective tissue and
contains blood capillaries and nerve endings from the dermis. These nerve endings give
hair the ability to detect touch, sense air movement, and other disturbances.
e. Medulla, or core, consists of cells at the center of the hair matrix filled with soft keratin.
f. Cortex an intermediate layer of cells deep to the cuticle. Contains thick layers of hard
keratin, which give hairs their stiffness.
g. Cuticle forms the surface of the hair. Composed of hard keratin.
6. The wall of the hair follicle is made of three concentric layers of cells.
a. The cells of the internal root sheath surround the root of the growing hair and extend
just up to the hair shaft. They are derived from the basal cells of the hair matrix.
 b. The external root sheath, which is an extension of the epidermis, encloses the hair root.
It is made of basal cells at the base of the hair root and tends to be more keratinous in
the upper regions.
c. The glassy membrane is a thick, clear connective tissue sheath covering the hair root,
connecting it to the tissue of the dermis.
7. Hair Growth occurs in three phases:
a. The first is the anagen phase (2 to 7 years), during which cells divide rapidly at the root
of the hair, pushing the hair shaft up and out.
b. The catagen phase (2 to 3 weeks) marks a transition from the hair follicle’s active
growth.
c. Telogen phase (2 to 4 months), the hair follicle is at rest and no new growth occurs. At
the end of this phase, another anagen phase begins. The basal cells in the hair matrix
then produce a new hair follicle, which pushes the old hair out as the growth cycle
repeats itself.
8. Hair Color. 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 - formed on the nail bed and protects the tips of our fingers and toes as they
are the farthest extremities and the parts of the body that experience the maximum
mechanical stress. The nail body forms a back-support for picking up small objects with
the fingers and can also be decorated with nail polish. The nail body is composed of
densely packed dead keratinocytes. The epidermis in this part of the body has evolved a
specialized structure upon which nails can form. The nail body forms at the nail root.
b. 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. The nail root has a matrix of proliferating cells from the stratum basale
that enables the nail to grow continuously.
c. The lateral nail fold overlaps the nail on the sides, helping to anchor the nail body. The
nail fold that meets the proximal end of the nail body forms the nail cuticle or
eponychium.
d. Eponychium (aka cuticle) - a portion of stratum corneum of the nail root that extends
over the exposed nail.
e. Lunula - a pale crescent shaped area near the root where the dermal blood vessels are
obscured; may not be present in all nails.
f. Hyponychium - the area beneath the free edge of the nail composed of a thickened
stratum corneum.
C. Sweat Glands
1. Sweat glands aka sudoriferous glands. Distributed all over the surface of the body except the
nipple, parts of the external genitalia, and the lips. Sweat glands develop from epidermal
 projections into the dermis and are classified as merocrine glands. The secretions are excreted
by exocytosis through a duct without affecting the cells of the gland.
a. Eccrine sweat glands are very numerous in the palms, soles of the feet and forehead.
i. Eccrine gland secretions, commonly called
ii. Sweat is hypotonic and composed mostly of water, with some salt, antibodies,
traces of metabolic waste, and dermicidin, an antimicrobial peptide.
iii. Normal pH of sweat is between 4 and 6.
iv. Once released, the sweat travels via a duct to the surface of the skin where it
opens into a funnel-shaped pore.
v. Eccrine glands are a primary component of thermoregulation in humans and
thus help to maintain homeostasis.
b. Apocrine sweat glands* are largely confined to the axillary and anogenital areas.
i. Larger than eccrine sweat glands, lie deeper in the dermis, and release their
secretions into hair follicles.
ii. The secretions produced are similar to sweat but they also contain fatty
substances and proteins make the sweat thicker and subject to bacterial
decomposition and subsequent smell.
iii. Apocrine glands begin functioning at puberty.
iv. The release of this sweat is under both nervous and hormonal control and plays
a role in the poorly understood human pheromone response.
v. Most commercial antiperspirants use an aluminum-based compound as their
primary active ingredient to stop sweat. When the antiperspirant enters the
sweat gland duct, the aluminum-based compounds precipitate due to a change
in pH and form a physical block in the duct, which prevents sweat from coming
out of the pore.
vi. Mammary glands are modified apocrine sweat glands that secrete milk. (Discuss
in Ch 27)
2. Sebaceous glands - oil glands
b. 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.
c. 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.
d. These glands are the holocrine type, the cells fill up with oil then bust.
e. Sebum is secreted into a hair follicle, or occasionally a pore, or follicle, on the skin
surface.
f. Sebum softens and lubricates hair and surrounding skin and also has anti-bacterial
properties.

5.3 Functions of the integument system

A. Protection.
1. The skin protects the rest of the body from the basic elements of nature such as wind, water,
and UV sunlight.
2. It acts as a protective barrier against water loss, due to the presence of layers of keratin and
glycolipids in the stratum corneum.
3. It also is the first line of defense against abrasive activity due to contact with grit, microbes, or
harmful chemicals.
 4. Sweat excreted from sweat glands deters microbes from over-colonizing the skin surface by
generating dermicidin, which has antibiotic properties.
B. Sensory Function: The integument contains many sensory receptors:
1. Free nerve endings - numerous encapsulated nerve endings for pain and temperature
detection
2. Merkel cells - extend from the dermis into the stratum basale of the epidermis responsible for
stimulating sensory nerves that the brain perceives as touch. These cells are especially
abundant on the surfaces of the hands and feet.
3. Meissner’s corpuscles (tactile corpuscle) - receptors located in the dermal papillae; responsible
for the detection of light touch.
4. Pacinian corpuscles (lamellated corpuscle) - receptors located in the reticular layer of the
dermis; responsible for detection of vibration and deep pressure.
C. Thermoregulation: your skin can help regulate your body temperature via vasodilation and
vasoconstriction as well as through evaporation of sweat.
D. Vitamin D synthesis:
1. 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.
2. Although cholecalciferol can be obtained from the diet, few foods contain it. In fact, most
foods that contain cholecalciferol have been “fortified” with it.
3. The liver then converts cholecalciferol into an intermediary product used by the kidneys to
synthesize the hormone calcitriol.
4. Calcitriol is required for stimulating normal absorption of calcium and phosphorus in the small
intestine.
5. An inadequate supply of calcitriol leads to impaired bone growth and maintenance such as
typical of rickets.
6. In addition to its essential role in bone health, vitamin D is essential for general immunity
against bacterial, viral, and fungal infections. Recent studies are also finding a link between
insufficient vitamin D and cancer.

5.4 Diseases, disorders and injuries of the immune system

A. Diseases.
1. Skin Cancer. Overexposure to UV radiation damages DNA, which can lead to the formation of
cancerous lesions. In general, cancers result from an accumulation of DNA mutations. These
mutations can result in cell populations that do not die when they should and uncontrolled cell
proliferation that leads to tumors. Although many tumors are benign (harmless), some produce
cells that can mobilize and establish tumors in other organs of the body; this process is referred
to as metastasis. Cancers are characterized by their ability to metastasize.
2. ABCDE rule:
a. Asymmetry - the two sides are not symmetrical
b. Borders - the edges are irregular in shape
c. Color - the color is varied shades of brown or black
d. Diameter - it is larger than 6 mm (0.24 in)
e. Evolving - its shape has changed
3. Basal cell carcinoma is the most common form of skin cancer. This is a cancer that originates in
keratinocytes of the stratum basale. Although UV rays are the main culprit, exposure to other
agents, such as radiation and arsenic, can also lead to this type of cancer. Like most cancers,
basal cell carcinomas respond best to treatment when caught early. Treatment options include
surgery, freezing (cryosurgery), and topical ointments.
 4. Squamous cell carcinoma originates in keratinocytes of the stratum spinosum layer. Presents as
lesions commonly found on the scalp, ears, and hands It is the second most common skin
cancer. it is more aggressive than basal cell carcinoma. If not removed, these carcinomas can
metastasize. Surgery and radiation are used to cure squamous cell carcinoma.
5. 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. Typically, a melanoma develops from a mole. It is the most fatal
of all skin cancers, as it is highly metastatic and can be difficult to detect before it has spread to
other organs. 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%.
6. Some specialists cite the following additional signs for the most serious form, nodular
melanoma:
a. Elevated – it is raised on the skin surface
b. Firm – it feels hard to the touch
c. Growing – it is getting larger
B. Disorders.
1. Albinism is a genetic disorder that affects (completely or partially) the coloring of skin, hair, and
eyes. The defect is primarily due to the inability of melanocytes to produce melanin. Individuals
with albinism tend to appear white or very pale due to the lack of melanin in their skin and hair.
Individuals with albinism tend to need more protection from UV radiation, as they are more
prone to sunburns and skin cancer. They also tend to be more sensitive to light and have vision
problems due to the lack of pigmentation on the retinal wall.
2. Vitiligo - the melanocytes in certain areas lose their ability to produce melanin, possibly due to
an autoimmune reaction. This leads to a loss of color in patches.
3. Eczema is an inflammatory condition and occurs in individuals of all ages. It 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.
4. Acne involves the clogging of pores, which can lead to infection and inflammation, and is often
seen in adolescents. It occurs from an over productive, blocked sebaceous gland.
5. Other disorders, not discussed here, include seborrheic dermatitis (on the scalp), psoriasis, cold
sores, impetigo, scabies, hives, and warts.
C. Injuries
1. Healing an injury. Skin injuries set off a healing process that occurs in several overlapping
stages. The first step to repairing damaged skin is the formation of a blood clot that helps stop
the flow of blood and scabs over with time. Many different types of cells are involved in wound
repair, especially if the surface area that needs repair is extensive. Before the basal stem cells
of the stratum basale can recreate the epidermis, fibroblasts mobilize and divide rapidly to
repair the damaged tissue by collagen deposition, forming granulation tissue. Blood capillaries
follow the fibroblasts and help increase blood circulation and oxygen supply to the area.
Immune cells, such as macrophages, roam the area and engulf any foreign matter to reduce
the chance of infection.
2. Burns results when the skin is damaged by intense heat, radiation, electricity, or chemicals.
a. First degree burns effect only the epidermis. Although the skin may be painful and
swollen, these burns typically heal on their own within a few days. Ex: mild sunburn
b. Second degree burns go deeper and effect both epidermis and dermis. These burns
result in swelling and a painful blistering of the skin. It is important to keep the burn site
 clean and sterile to prevent infection. If this is done, the burn will heal within several
weeks.
c. Third degree burn extends through the epidermis and dermis to damage underlying
tissue and nerve endings. These are serious burns that may appear white, red, or black;
they require medical attention and will heal slowly without it.
d. Fourth degree burn includes damage to all of the above as well as muscle and bone.
Third and fourth-degree burns are usually not as painful because the nerve endings
themselves are damaged. Full thickness burns can NOT be repaired by the body and
require a skin graft.
3. Scars are collagen-rich skin formed after the process of wound healing that differs from normal
skin. Fibroblasts generate scar tissue in the form of collagen, and the bulk of repair is due to
the basket-weave pattern generated by collagen fibers and does not result in regeneration of
the typical cellular structure of skin. Instead, the tissue is fibrous in nature and does not allow
for the regeneration of accessory structures, such as hair follicles, sweat glands, or sebaceous
glands. Keloids are raised or hypertrophic scars resulting from an overproduction of scar tissue,
because the process of collagen formation does not stop when the wound is healed. Scars that
result from acne and chickenpox have a sunken appearance and are called atrophic scars.
4. Bedsores happen in areas exposed to prolong pressure resulting in loss of blood flow and
necrosis of the tissues.
5. Stretch Marks result from the skin is stretched beyond its normal capacity due to pressure
caused by rapid growth typically during puberty and pregnancy.
6. Calluses and Corns form from areas of constant abrasion or mechanical stress. This occurs
because the basal stem cells in the stratum basale are triggered to divide more often to
increase the thickness of the skin at the point of abrasion to protect the rest of the body from
further damage. Corns are a specialized form of callus that result from an elliptical-type
motion.
D. Age-related changes alter the appearance of structure of the integument.
1. 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.
2. Sebaceous gland secretions decrease with age and the skin becomes dry and often scaly.
3. 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.
4. The metabolic activity in the skin decreases as well. Synthesis of calcitriol (vitamin D 3)
decreases leading to muscle weakness and brittle bones.
5. 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.
6. 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.
7. Merocrine sweat glands become less active and with impaired perspiration processes, older
people cannot lose heat at fast as younger people. Thus, the elder are at greater risk of
overheating in warm environments.
8. 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
lessen their ability to lose body heat, which can cause their body temperature to soar
dangerously high.
9. 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.
10. Hair follicles stop functioning or produce thinner, finer hairs. With decreased melanocyte
activity, these hairs are gray or white.