MEDSCI 111 - ANATOMY LECTURE
THE INTEGUMENTARY SYSTEM
Tortora | Week 4-5
SKIN
● aka cutaneous membrane
● Covers the external surface of the body
● Largest organ of the body (weight)
● Adult:
○ Area: 2 square meters (22 square feet)
○ Weight: 4.5-5 kg (10-11 lb) — 7% of total
body weight
○ Thickness: 1-2mm (0.04-0.08 in)
○ Eyelids — 0.5 mm (0.02 in)
○ Heels — 4.0 mm (0.16 in)
Two main parts
EPIDERMIS
● superficial thinner portion
● Composed of epithelial tissue
○ Keratinized stratified squamous
epithelium
● Avascular — if cut, no bleeding
4 principal types:
Keratinocytes (90%)
● Arranged in 4 or 5 layers
● Produce protein keratin.
● Keratin
○ tough, fibrous protein
○ helps protect the skin and underlying
tissue from abrasion, heat, microbes,
chemicals.
● Lamellar Granules
○ Release a water-repellent sealant,
decreases water entry and loss and
inhibits the entry of foreign materials.
Melanocytes (8%)
● Develop from ectoderm of developing embryo
● Produce pigment Melanin
○ Yellow-red or brown-black pigment
○ Contributes skin color
○ Absorb damaging UV light.
● Once inside keratinocytes, melanin granules cluster
and form a protective veil over the nucleus of the
skin surface. (Shields the nuclear DNA from UV
damage)
● It can still be susceptible to UV light damage
● Scattered among the keratinocytes of the basal
layer, together with tactile epithelial cells.
Intradermal macrophage (Langerhans cells)
● Arise from red bone marrow à then migrates to
the epidermis
● Small fraction of epidermal cells
● Help other cells of immune system recognize an
invading microbe and destroy it (Immune
response)
● Easily damaged by UV light
Tactile epithelial cells (Merkel cells)
● Least number of epidermal cells
● Located at the deepest layer of the epidermis
● Contact the flattened process of sensory neuron
(nerve cells) — tactile disc (merkel disc)
○ Detects sensation
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Layers of keratinocytes
Stratum Basale (stratum germinativum)
● Deepest layer of epidermis
● Composed of single row of cuboidal or columnar
keratinocytes
● Stem cell - undergoes cell division — new
keratinocytes
○ Large nuclei
○ Many ribosomes
○ Small golgi complex
○ Few mitochondria and rER
● Keratin intermediate filaments (tonofilaments)
○ Scattered intermediate filaments in the
cytoskeleton within keratinocytes
○ Forms tough proteins (superficial
epidermal layer)
○ Attached to desmosomes → binds cells of
stratum basale, adjacent stratum
spinosum, hemidesmosomes
keratinocytes bind to the basement
membrane (between epidermis and
dermis)
● Keratin protects the deeper layers from injury
● “Germ” = sprout — forming new cells
Stratum Spinosum
● Superficial to the stratum basale
● “spinos” – thornlike
● 8-10 layers of keratinocytes
● Flattened in more superficial layer
● Its keratinocytes are produced by the stem cell of
Stratum Basale
○ some retain its ability to divide
● produce – courser bundle of keratin in
intermediate filaments
● rounded and larger in living tissue → shrink and
pull apart when prepared for microscopic exam →
appears thorn like spines
● at each spinelike projection, bundles of keratin
intermediate filaments → insert into desmosomes
(tightly join the cells to another)
● Intraepidermal macrophage and projections of
melanocytes
Stratum Granulosum
● Middle of the epidermis
● consist of 3 to 5 layers of flattened keratinocytes –
undergoes apoptosis
○ Apoptosis: genetically programmed cell
death in which the nucleus fragments
before the cell die
● Degenerate as they move farther from dermal
blood vessels
● Keratohyalin: assembles keratin intermediate
filament into keratin (darkly staining granules)
● Lamellar-granules: membrane-enclosed, fused
with the plasma membrane → release a lipid-rich
secretion → deposited, spaces between stratum
granulosum, stratum lucidum, stratum corneum.
● Lipid secretion act as:
○ Water-repellent sealant
○ Retarding loss
○ Entry of water and entry of foreign
materials
● Marks as transition between the deeper,
metabolically active strata and the dead cells of
the more superficial strata.
Stratum Lucidum
● Only in thick skin areas: fingertip, palms, soles
● 4 to 6 layers of flattened clear, dear keratinocytes
(large amount of keratin and thickened plasma
membrane)
● Provided additional level of toughness in thick
skins
→ Stratum Corneum
● Average 25 to 30 layers of flattened dead
keratinocytes
○ Range in thickness from few cells in thin
skin to 50 or more cell layers in thick skin
● Its cells are extremely thin, flat, plasma
membrane-enclosed packages of keratin (no
nucleus or any internal organelles
● Final product of differentiation process of the
keratinocytes.
● Cells are continuously shed and replaced by cells
from the deeper strata
○ Layers of dead cells help the strata to
protect deeper layers from injury and
microbial invasion.
● Callus
- Abnormal thickening of the stratum
corneum
- Due to constant exposure of skin to
friction – ↑ cell and keratin production
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KERATINIZATION
● Cells move from one epidermal layer to the next,
they accumulate more and more keratin.
● Undergo apoptosis
● Keratinized cells slough off and are replaced by
underlying cells that in turn become keratinized.
○ Slough off = 4 to 6 weeks (ave. epidermis
of 0.1mm or 0.004 in)
Growth of Epidermis
● Avascular epidermis receives nutrients and oxygen
from dermis.
● Stratum basale – closest to dermis, received most
of the nutrients and oxygen.
○ Metabolically active and continuously
undergoes cell division to produce new
keratinocytes.
○ As new keratinocytes get pushed further
up by cell division, strata above the
stratum basale receive fewer nutrients
and cells become less active and die.
● Epidermal growth factor (EGF) – hormonelike
proteins, regulate keratinization.
● Dandruff – due to excessive number of keratinized
cells shed from the skin of the scalp
DERMIS
● 2nd deeper part of the skin, thicker connective
tissue
○ Dense irregular connective tissue
containing collagen and elastic fibers
○ Great tensile strength
● Stretch and recoil easily
● Thicker than epidermis (varies from region to
region)
● ↑ thickness on palms and soles
● Cells present:
○ Fibroblast
○ Some macrophage
○ Few adipocytes
○ Blood vessels, nerves, glands, and hair
follicles
● Vascular — if cut, bleeding is present
● Essential to survival of the epidermis
Dermis can be divided into:
Papillary region
● 1/5 of the thickness of the total layer
● Contains thin collagen and fine elastic fibers
● Greatly increased by dermal papillae, small, nipple
shaped structures that project into the
undersurface of the epidermis
● Dermal papillae contain:
○ Capillary loops
○ Corpuscles of touch or Meissner
corpuscles – nerve endings that are
sensitive to touch
○ Free nerve endings – initiates signals that
give rise to sensations of warmth,
coolness, pain, tickling, and itching.
○ Dendrites
Reticular region
● attached to the subcutaneous layer
○ bundle of thick collagen fibers
○ scattered fibroblast
○ various wandering cells
○ adipose tissue (on the deep part) with
coarse elastic fibers
● Collagen fibers - arranged in a netlike manner, and
have more regular arrangement than those in the
papillary region
○ large collagen fibers, helps the skin resist
stretching
● blood vessels, nerves, hair follicle, sebaceous (oil)
glands, and sudoriferous glands occupy the spaces
between fibers.
● Collagen + elastic fibers =
○ Extensibility - ability to stretch
○ Elasticity - ability to return to original
shape after stretching
Epidermal ridges
- Series of ridges and grooves on the surface of the
palms, fingers, soles, and toes.
- Straight lines or as a pattern of loops and whorls
- Downward projections of the epidermis into the
dermis between the derma, papillae of papillary
region
- Produce during 3rd month of fetal
- Create a strong bond between epidermis and
dermis regions of high mechanical stress
- Increase surface area = increase number of
corpuscles of touch and thus increases tactile
sensitivity.
- Sweat glands opens on the tops of the epidermal
ridges as sweat pores, the sweat and ridges form
— fingerprint or footprint
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 - part genetically determined and is unique for
each individual
- Basis of identification
- Dermatoglyphics - study of pattern of epidermal
ridges
Hemoglobin
Carotene
The Structural Basis of Skin Color
● 3 pigments:
o Melanin
o Hemoglobin
o Carotene
Melanin
● Skin’s color varies form pale yellow to reddish
brown to black
● 2 forms:
o Pheomelanin: Yellow to red
o Eumelanin: brown to black; hair
● Melanocytes
o Melanin-producing cells
o Epidermis of the penis, nipples of the
breast, areolae, face and limbs, mucous
membranes
o Differences in skin color are due to the
amount of pigment produced and transfer
to keratinocytes
o Freckles: patches of melanin in genetically
predisposed people; reddish/ brown
o Age (Liver) spots: darker than freckles;
light brown to black; build up overtime
due to exposure to sunlight Tattooing
o Nevus/ Mole: round, flat or raised area;
benign localized overgrowth of
melanocytes
o Synthesize melanin tyrosine with the aid
of tyrosinase; occurs in melanosome
● Exposure to UV light increases enzymatic activity
of melanosomes 🡪 increased melanin production Body Piercing
● Protective function
o Absorbs UV radiation
o Prevents DNA damage in epidermal cells
o Neutralizes free radicals that form in the
skin following damage by UV radiation
CLINICAL CONNECTION
Albinism
- Inherited inability of an individual to produce
melanin
- Have melanocytes that are unable to synthesize
tyrosinase
- Problems with vision
- Tendency of skin to burn easily on overexposure to
sunlight
Vitiligo
- Partial or complete loss of melanocytes from
patches of skin produces irregular white spots
- May be related to immune system malfunction in
which antibodies attack melanocytes
● Red color
● Oxygen carrying pigment of RBCs
● Yellow orange pigment
● Precursor of Vit A
● Stored in the stratum corneum and fatty areas of
the dermis and subcutaneous layer in response to
excessive dietary intake
Clinical Connection: Skin Color as Diagnostic Clue
Cyanotic
- Skin, mucous membranes and nail beds appear
bluish when blood is not picking up adequate
amount of O2 from the lungs
Jaundice
- Yellowish appearance (skin, whites of the eyes) 🡪
liver disease
- Buildup of bilirubin
Erythema
- Redness of the skin
- Caused by engorgement of capillaries in the dermis
with blood due to skin injury, exposure to heat,
infection or allergic rxns
Pallor
- Paleness of skin
- Shock and anemia
● Permanent coloration of the skin in which a foreign
pigment is deposited with a needle into the dermis
● Originanted in Egypt (bet 4000 and 2000 BC)
● Can be removed by lasers (concentrated beams of
light)
● Insertion of jewelry through an artificial opening
● Potential complications: infections, allergic rxns,
anatomical damage
● May interfere with medical procedures
(resuscitation, airway management procedures,
catheterizations, radiograph)
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ACCESSORY STRUCTURES OF THE SKIN
HAIR (Pili)
● Present on most skin surfaces except the palms,
palmar surface of the fingers, soles, plantar surface
of the feet
● Most heavily distributed across the scalp, Hair growth
eyebrows, axillae and external genitalia Growth stage
● For protection
Anatomy of a Hair
● Shaft: superficial portion; projects above the
surface of the skin
● Root: portion of the hair deep to the shaft that Regression stage
penetrates into the dermis
Shaft & Root
- 3 concentric layers:
Resting stage
o Medulla (inner)
▪ 2 or 3 rows of irregularly shaped cells
that contain large amounts of pigment
granules & the presence of air bubbles
in white hair
▪ Lacking in thinner hair
o Cortex (middle)
▪ Major part of the shaft
▪ Elongated cells
o Cuticle of the hair (outermost)
▪ Single layer of thin, flat cells; heavily
keratinized
▪ Arranged like shingles on the side of
the house; their free edges pointing
toward the end of the hair
● Hair follicle: surrounds the root; made up of an
external and internal root sheath (epithelial root
sheath)
● External Root Sheath: downward continuation of
the epidermis
● Internal Root Sheath: produced by the matrix;
forms a cellular tubular sheath of epithelium
between the external root sheath and the hair
● Dermal Root sheath: dense dermis surrounding
the hair
● Bulb: onion-shaped structure; base of each hair
follicle
● Papilla of the hair: contains areolar CT and many
blood vessels that nourish the growing hair follicle
● Hair matrix: arise form stratum basale; responsible Types of Hairs
for growth of existing hairs
● Arrector pili: pulls the hair shafts perpendicular to
the skin surface due to physiologic or emotional
stress (goosebumps)
● Hair root plexus: dendrites of neurons surrounding
each hair follicle; sensitive to touch; generate
nerve impulses
CLINICAL CONNECTION: Hair Removal
Depilatory
- A substance that removes hair
- Dissolves protein in the hair shaft, turning it into a
gelatinous mass that can be wiped away Hair Color
- Hair root is not affected 🡪 regrowth occurs
Electrolysis
- Electric current is used to destroy the hair matrix
Laser treatments
● Cells of the hair matrix divide
● As new cells are added, existing cells are pushed
upward and the hair grows
● For 2 to 6 yrs
● 85% of scalp hair
● Cells of the hair matrix stop dividing
● Hair follicle atrophies 🡪 hair stops growing
● For 2 to 3 wks
● For 3 mos
CLINICAL CONNECTION: Chemotherapy and Hair Loss
Chemotherapy
- Treatment of disease (cancer) by means of chemical
substances or drugs
Chemotherapeutic agents
- Interrupt the life cycle of rapidly dividing cancer cells
- Also affect other rapidly dividing cells (hair matrix
cells)
Hirsutism
- Excessive body hair in areas that are usually not
hairy
- Excess androgens
Androgenic alopecia/ Male-pattern baldness
- Androgens inhibit hair growth
Minoxidil (Rogaine)
- 1st drug approved for enhancing scalp hair growth
- Causes vasodilation 🡪 increase circulation;
- direct stimulation of hair follicle cells to pass into
growth stage follicles;
- inhibition of androgens
- does not help people who are already bald
Alopecia
- partial/ complete lack of hair
- may result from genetic factors, aging, endocrine
disorders, chemotherapy, skin dse
● hair follicles develop 12 weeks after fertilization
● Lanugo
o Very fine, nonpigmented, downy hairs
produced usually by the 5th month of
development
o Replaced by terminal hairs, long coarse,
heavily pigmented hairs
o Vellus hairs (peach fuzz) will replace the
lanugo of the rest of the body; short fine,
pale hairs that are barely visible to the
naked eye
● Due to the amount & type of melanin in its
keratinized cells
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 ● Gray hair: due to progressive decline in melanin
production
● White hair: lack of melanin & accumulation of air
bubble in the shaft
● Hair coloring: process that adds or removes
pigment.
o Temporary hair dyes coat the surface of a
hair shaft; wash out within 2 or 3
shampoos
o Semipermanent dyes penetrate the hair
shaft moderately; fade and wash out of
hair after about 5 to 10 shampoos.
o Permanent hair dyes penetrate deeply
into the hair shaft; don’t wash out but are
eventually lost as the hair grows out
SKIN GLANDS
Sebaceous Glands (Oil glands)
● simple, branched acinar (rounded) glands
● Sebum: oily substance secreted; a mixture of
triglycerides, cholesterol, proteins, and inorganic
salts
o coats the surface of hairs; helps keep
them from drying and becoming brittle
o prevents excessive evaporation of water
from the skin, keeps the skin soft and
pliable, and inhibits the growth of some
CLINICAL CONNECTION: Acne
Acne
- An inflammation of sebaceous glands that usually
begins at puberty, when the sebaceous glands are
stimulated by androgens
Cystic acne
- The infection may cause a cyst or sac of connective
tissue cells to form, which can destroy and displace
epidermal cells
Treatment
- gently washing the affected areas once or twice
daily with a mild soap
- topical antibiotics (clindamycin and erythromycin)
- topical drugs such as benzoyl peroxide or tretinoin
- oral antibiotics (tetracycline, minocycline,
erythromycin, and isotretinoin)
Sudoriferous Glands (Sweat glands)
● these glands release sweat, or perspiration, into
hair follicles or onto the skin surface through pores
● 2 main types (based on structure & type of
secretion)
o Eccrine sweat glands
▪ simple, coiled tubular glands that
are much more common than
apocrine sweat glands
▪ Sweat consists of water & small
amounts of ions (Na, Cl)
▪ Function: (Thermoregulatory
sweating) to help regulate body
temperature through evaporation
▪ Insensible perspiration: Sweat that
evaporates from the skin before it is
perceived as moisture
▪ Sensible perspiration: Sweat that is
excreted in larger amounts and is
seen as moisture on the skin
▪ Emotional sweating/ Cold sweat:
release sweat in response to an
emotional stress such as fear or
embarrassment
▪ start to function soon after birth
o Apocrine sweat glands
▪ simple, coiled tubular glands but
have larger ducts and lumens
▪ secretion is via exocytosis
▪ apocrine sweat appears milky or
yellowish in color
▪ also active in emotional sweating
but not in thermoregulatory
sweating
Ceruminous Glands
● Modified sweat glands in the external ear
● produce a waxy lubricating secretion
● Cerumen/ earwax: combined secretion of the
ceruminous and sebaceous glands is a yellowish
material
o provides a sticky barrier that impedes the
entrance of foreign bodies and insects
o waterproofs the canal and prevents
bacteria and fungi from entering cells
CLINICAL CONNECTION: Impacted Cerumen
Impacted Cerumen
- some people produce abnormally large amount of
cerumen in the external auditory canal
- soundwaves may be prevented from reaching the
eardrum
Treatment
- periodic ear irrigation with enzymes
- removal of wax with blunt instrument by trained
medical person
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NAILS

● Plates of tightly packed, hard, dead, keratinized

epi- dermal cells that form a clear, solid covering
over the dorsal surfaces of the distal portions of
the digits.

Functions
● They protect the distal end of the digits.
● They provide support and counterpressure to the
palmar surface of the fingers to enhance touch
perception and manipulation. FUNCTIONS OF THE SKIN
● They allow us to grasp and manipulate small 1. Thermoregulation
objects, and they can be used to scratch and ● Homeostatic regulation of body
groom the body in various ways. temperature
● In a high environmental temperature or
Each nail consists of: when heat is produced by exercise, sweat
Nail body (Plate) production from eccrine glands increases
- Visible portion of the nail and blood vessels in the dermis dilate.
- Appears pink because of blood flowing through the Evaporation of the sweat and increased
capillaries in the underlying dermis blood flow through the dermis helps
Free edge lower body temperature.
- Part of the nail body that may extend past the ● In a low environmental temperature,
distal end of the digit production of sweat is decreased and
- White because there are no underlying capillaries blood vessels constrict; reducing heat loss
Nail root from the body.
- Portion of the nail that is buried in a fold of skin 2. Blood reservoir
Lunula ● Dermis houses an extensive network of
- Whitish, crescent-shaped area of the proximal end blood vessels that carry 8–10% of the
of the nail body total blood flow in a resting adult.
Hyponychium 3. Protection
- Secures the nail to the fingertip Keratin
Nail bed ● Protects underlying tissues from
- Skin below the nail plate that extends from the microbes, abrasion, heat, and chemicals,
lunula to the hyponychium and the tightly interlocked keratinocytes
- The epidermis of the nail bed lacks a stratum resist inva- sion by microbes
granulosum.
Eponychium (cuticle) Lipids
- Narrow band of epidermis that extends from and ● Inhibit evaporation of water from the skin
adheres to the margin (lateral border) of the nail surface
wall. ● Guard against dehydration
Nail matrix Sebum
- Portion of the epithelium proximal to the nail root ● Keeps skin and hairs from drying out and
contains bactericidal chemicals
(substances that kill bacteria)
Acidic pH of perspiration
● Retards the growth of some microbes
Melanin
● Helps shield against the damaging effects
of ultra- violet light
Intraepidermal macrophages
● Alert the immune system to the presence
of potentially harmful microbial invaders
by recognizing and processing them
TYPES OF SKIN Macrophages
Two major types of skin: ● Phagocytize bacteria and viruses that
● Thin (hairy) skin manage to bypass the intraepidermal
● Thick (hairless) skin macrophages of the epidermis
4. Cutaneous sensations
● A wide variety of nerve endings and
receptors are distributed throughout the
skin, including the tactile discs of the

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 epidermis, the corpuscles of touch in the
dermis, and hair root plexuses around
each hair follicle.
5. Excretion and Abrasion
● About 400 mL of water evaporates
through the skin daily.
● A sedentary person loses an additional
200 mL per day as sweat; a physically
active person loses much more
● Sweat is the vehicle for excretion of small
amounts of salts, carbon dioxide,
ammonia and urea.
● Absorption of water-soluble substances
through the skin is negligible, but certain
lipid-soluble materials penetrate the skin;
including fat-soluble vitamins (A, D, E, and
K), certain drugs, and oxygen and carbon
dioxide
6. Synthesis of Vitamin D
● Ultraviolet rays in sunlight is required for
the activation of a precursor molecule in
the skin
● Enzymes in the liver and kidneys then
modify the activated molecule, producing
calcitriol (the most active form of vitamin
D).
● Calcitriol is a hormone that aids in the
absorption of calcium in the
gastrointestinal tract into the blood.
MAINTAINING HOMEOSTASIS: SKIN WOUND HEALING
EPIDERMAL WOUND HEALING
● In response to injury, basal cells surrounding the
wound break contact with the basement
membrane.
● Cells then enlarge and migrate across the wound
as a sheet until advancing cells from the opposite
side of the wound meet.
● When cells encounter one another, they stop
migrating due to a response called contact
inhibition.
● Migration of the epidermal cells stops completely
when each is finally in contact with other
epidermal cells on all sides.
DEEP WOUND HEALING
● Injury that extends to the dermis and
subcutaneous layer.
● Healing is more complex because multiple layers
must be repaired.
● Healed tissue loses some of its normal function
because scar tissue is formed
Four Phases:
1. INFLAMMATORY PHASE
● Blood clot forms in the wound and loosely
unites the wound edges
● Involves inflammation, a vascular and
cellular response that helps eliminate
microbes, foreign material, and dying
tissue in preparation for repair
● Vasodilation and increased permeability
of blood vessels enhance delivery of cells
including phagocytic white blood cells
called neutrophils; monocytes, which
develop into macrophages that
phagocytize microbes; and mesenchymal
cells, which develop into fibroblasts.
2. MIGRATORY PHASE
● Clot becomes a scab, and epithelial cells
migrate beneath the scab to bridge the
wound.
● Fibroblasts migrate along fibrin threads
and begin synthesizing scar tissue
● Damaged blood vessels begin to regrow
● Granulation tissue fill the wound
3. PROLIFERATIVE PHASE
● Extensive growth of epithelial cells
beneath the scab
● Deposition by fibroblasts of collagen
fibers in random patterns
● Continued growth of blood vessels
4. MATURATION PHASE
● Scab sloughs off once the epidermis has
been restored to normal thickness
● Collagen fibers become more organized
● Fibroblasts decrease in number
● Blood vessels are restored to normal
DEVELOPMENT OF THE INTEGUMENTARY SYSTEM
● Epidermis is derived from the ectoderm
● At about 4 weeks after fertilization, the epidermis
consists of only a single layer of ectodermal cells
● At the beginning of the seventh week the single
layer, called the basal layer, divides and forms a
superficial protected layer of flattened cells called
the periderm
● The peridermal cells are continuously sloughed off,
and by the fifth month of development secretions
from sebaceous glands mix with them and hairs to
form a fatty substance called vernix caseosa
(covers and protects the skin of the fetus from
constant exposure to the amniotic fluid and
facilitates birth of the fetus)
● By about 11 weeks, the basal layer forms an
intermediate layer of cells. Proliferation of the
basal cells eventually forms all layers of the
epidermis, and epidermal ridges form along with
the epidermal layers.
● The mesenchymal cells differentiate into
fibroblasts and begin to form collagen and elastic
fibers by 11 weeks. Epidermal ridges form, parts of
the superficial dermis project into the epidermis
and develop into the dermal papillae, which
contain capillary loops, corpuscles of touch, and
free nerve endings
● At about 12 weeks, hair follicles develop as
downgrowths (hair buds) of the basal layer of the
epidermis into the deeper dermis
● As the hair buds penetrate deeper into the dermis,
their distal ends become club- shaped and are
called hair bulbs. Invaginations of the hair bulbs,
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 called papillae of the hair, fill with mesoderm in
which blood vessels and nerve endings develop
● Cells in the center of a hair bulb develop into the
matrix, which forms the hair, and the peripheral
cells of the hair bulb form the epithelial root
sheath; mesenchyme in the surrounding dermis
develops into the dermal root sheath and arrector
pili muscle
● At about four months, most sebaceous (oil) glands
develop as outgrowths from the sides of hair
follicles and remain connected to the follicles
● By the fifth month, the hair follicles produce
lanugo (delicate fetal hair). It is produced first on
the head and then on other parts of the body, and
is usually shed prior to birth.
● Most sudoriferous (sweat) glands are derived from
downgrowths (buds) of the stratum basale of the
epidermis into the dermis. As the buds penetrate
into the dermis, the proximal portion forms the
duct of the sweat gland and the distal portion coils
and forms the secretory portion of the gland.
Sweat glands appear at about five months on the
palms and soles and a little later in other regions.
● Nails are developed at about 10 weeks. Initially
they consist of a thick layer of epithelium called
the primary nail field. The nail itself is keratinized
epithelium and grows distally from its base. It is
not until the ninth month that the nails actually
reach the tips of the digits.
AGING AND THE INTEGUMENTARY SYSTEM
● Most of the age-related changes begin at about
age 40 and occur in the proteins in the dermis.
● COLLAGEN FIBERS in the dermis begin to decrease
in number, stiffen, break apart, and disorganize
into a shapeless, matted tangle.
● ELASTIC FIBERS lose some of their elasticity,
thicken into clumps, and fray, an effect that is
greatly accelerated in the skin of smokers.
● FIBROBLASTS, which produce both collagen and
elastic fibers, decrease in number.
● As a result, the skin forms the characteristic
crevices and furrows known as wrinkles.
● The pronounced effects of skin aging do not
become noticeable until people reach their late
40s.
● Intraepidermal macrophages dwindle in number
and become less-efficient phagocytes, thus
decreasing the skin’s immune responsiveness.
● Moreover, decreased size of sebaceous glands
leads to dry and broken skin that is more
susceptible to infection.
● Production of sweat diminishes, which probably
contributes to the increased incidence of heat
stroke in the elderly.
● There is a decrease in the number of functioning
melanocytes, resulting in gray hair and atypical
skin pigmentation.
● Hair loss increases with aging as hair follicles stop
producing hairs.
○ About 25% of males begin to show signs
of hair loss by age 30 and about ⅔ have
significant hair loss by age 60.
○ Both males and females develop pattern
baldness.
● An increase in the size of some melanocytes
produces pigmented blotching (age spots).
○ Walls of blood vessels in the dermis be-
come thicker and less permeable, and
subcutaneous adipose tissue is lost.
● Aged skin (especially the dermis) is thinner than
young skin, and the migration of cells from the
basal layer to the epidermal surface slows
considerably.
● With the onset of old age, skin heals poorly and
becomes more susceptible to pathological
conditions such as skin cancer and pressure sores.
● Rosacea (ro-ZAˉ- she ̄-a rosy) is a skin condition
that affects mostly light-skinned adults between
the ages of 30 and 60.
● It is characterized by redness, tiny pimples, and
noticeable blood vessels, usually in the central
area of the face.
● Growth of nails and hair slows during the second
and third decades of life. The nails also may
become more brittle with age, often due to
dehydration or repeated use of chemicals (cuticle
remover or nail polish).
● Several cosmetic anti-aging treatments are
available to diminish the effects of aging or
sun-damaged skin. These include the following:
● Topical products that bleach the skin to
tone down blotches and blemishes
(hydroquinone) or decrease fine wrinkles
and roughness (retinoic acid).
● Microdermabrasion (m ̄ı-kroˉ-DER-ma-bra
̄-zhun; mikros- small; -derm- skin;
-abrasio to wear away), the use of tiny
crystals under pressure to remove and
vacuum the skin’s surface cells to improve
skin texture and reduce blemishes.
● Chemical peel, the application of a mild
acid (such as glycolic acid) to the skin to
remove surface cells to improve skin
texture and reduce blemishes.
● Laser resurfacing, the use of a laser to
clear up blood vessels near the skin
surface, even out blotches and blemishes,
and decrease fine wrinkles. An example is
the IPL Photofacial®.
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 ● Dermal fillers, injections of human
collagen (Cosmoderm®), hyaluronic acid
(Restylane® and Juvaderm®), calcium
hydroxyl- apatite (Radiesse®), or polylactic
acid (Sculptra®) that plumps up the skin to
smooth out wrinkles and fill in fur- rows,
such as those around the nose and mouth
and between the eyebrows.
● Fat transplantation - fat from one part of
the body is injected into another location
such as around the eyes.
● Botulinum toxin or Botox®, a diluted
version of a toxin that is injected into the
skin to paralyze skeletal muscles that
cause the skin to wrinkle.
● Radio frequency non surgical facelift, the
use of radio frequency emissions to
tighten the deeper layers of the skin of
the jowls, neck, and sagging eyebrows
and eyelids.
● Facelift, browlift, or neck lift, invasive
surgery in which loose skin and fat are
removed surgically and the underlying
connective tissue and muscle are
tightened
Contributions of The Integumentary System to the
Homeostasis of All Other Body Systems
SKELETAL SYSTEM
● Skin helps activate vitamin D, needed for proper
absorption of dietary calcium and phosphorus to
build and maintain bones
MUSCULAR SYSTEM
● Skin helps provide calcium ions, needed for
muscle contraction
NERVOUS SYSTEM
● Nerve endings in skin and subcutaneous tissue
provide input to brain for touch, pressure, thermal,
and pain sensations
CARDIOVASCULAR SYSTEM
● Local chemical changes in dermis cause widening
and narrowing of skin blood vessels, which help
adjust blood flow to skin
LYMPHATIC SYSTEM and IMMUNITY
● Skin is “first line of defense” in immunity,
providing mechanical barriers and chemical
secretions that discourage penetration and growth
of microbes Intraepidermal macrophages in
epidermis participate in immune responses by
recognizing and processing foreign antigens.
● Macrophages in dermis phagocytize microbes that
penetrate skin surface
RESPIRATORY SYSTEM
● Hairs in nose filter dust particles from inhaled air
● Stimulation of pain nerve endings in skin may alter
breathing rate
DIGESTIVE SYSTEM
● Skin helps activate vitamin D to the hormone
calcitriol, which promotes absorption of dietary
calcium and phosphorus in small intestine
URINARY SYSTEM
● Kidney cells receive partially activated vitamin D
hormone from skin and convert it to calcitriol.
● Some waste products are excreted from body in
sweat, contributing to excretion by urinary system
REPRODUCTIVE SYSTEMS
● Nerve endings in skin and subcutaneous tissue
respond to erotic stimuli, thereby contributing to
sexual pleasure
● Suckling of a baby stimulates nerve endings in skin,
leading to milk ejection Mammary glands
(modified sweat glands) produce milk
● Skin stretches during pregnancy as fetus enlarges
CLINICAL APPLICATION
BURNS
● tissue damage caused by excessive heat,
electricity, radio- activity, or corrosive chemicals
that denature (break down) proteins in the skin.
● Destroys some of the skin’s important
contributions to homeostasis—protection against
microbial invasion and dehydration, and
thermoregulation.
● Graded according to their severity:
○ First-degree burn involves only the
epidermis. It is characterized by mild pain
and erythema (redness) but NO BLISTERS.
■ Skin functions remain intact.
■ Healing of a first-degree burn will
occur in 3 to 6 days
○ Second-degree burn destroys the
epidermis and part of the dermis
■ Some skin functions are lost. In a
second-degree burn, redness,
BLISTER FORMATION, edema,
and pain result.
■ Associated structures, such as
hair follicles, seba- ceous glands,
and sweat glands, usually are not
injured. If there is no infection,
second-degree burns heal
without skin grafting in about 3
to 4 weeks, but scarring may
result. First- and second-degree
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 burns are collectively referred to
as partial-thickness burns.
○ Third-degree burn or full-thickness burn
destroys the epidermis, dermis, and
subcutaneous layer.
■ MOST SKIN FUNCTIONS ARE
LOST.
■ Such burns vary in appearance
from marble-white to mahogany
colored to charred, dry wounds.
■ There is marked edema, and the
burned region is numb because
sensory nerve endings have been
destroyed.
■ Regeneration occurs slowly, and
much granulation tissue

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