SKIN:

Basic Structure and

Function
 General Functions of the Skin
 Barrier Function
 Immunologic barrier
 Temperature Regulation
 Protection from Radiation
 Nerve Sensation
 Cutaneous wound/injury repair
 Layers of the Skin
 Skin is has 3 layers:
• Epidermis – composed of keratinocytes
• Dermis – principal component is collagen,
fibroblasts, elastic fibers
• Subcutaneous fat – also called panniculus or
hypodermis
 Epidermis

Dermis

Subcutaneous Fat
 Zones of the Epidermis
Stratum corneum
(Horny layer)

Stratum granulosum
(granular layer)

Stratum spinosum
(Malpighian or prickle
layer)
Stratum
germinativum
(basal layer)

* Stratum Lucidum – above the granular layer; present on palms & soles 5
 Basic Cell Types of Epidermis
1. Keratinocytes or squamous cells
 principal cells of the epidermis; ectodermal origin
 produces keratin: forms the surface coat of stratum corneum and
structural protein of hair & nails

2. Melanocytes
 staggered along the basal layer at around one in every 10
keratinocytes
 pigment-producing cells
 Basic Cell Types of Epidermis
3. Langerhans Cells
• Scattered among keratinocytes of the stratum spinosum
• Characterized ultrastructurally by a folded nucleus and
distinct intracytoplasmic organelles called Birbeck granules.
• Hyaluronic acid plays a critical role in their maturation and
migration
4. Merkel cell
found in the basal layer of palms and soles, oral and genital
mucosa, nail bed and follicular infundibula
w/ association w/ neurites, act as slow-adapting touch receptors
 Dermoepidermal junction

 Junction of the epidermis and dermis is formed by the basement

membrane zone or dermoepidermal junction
 A porous semipermeable filter w/c permits exchange of cells
and fluid b/w the epidermis and dermis
 Serves as a structural support for the epidermis
 Helps to regulate growth, adhesion and movement of
keratinocytes and fibroblasts as well as apoptosis
 Dermis
 contains the blood, lymphatic vessels and nerves
which supply the skin, as well as sweat glands,
sebaceous glands and hair follicles.

 Principal component is COLLAGEN ( a major

structural protein for the body found in tendons,
ligaments, lining of bones; 70% of dry weight of skin)
 Subcutaneous Tissue (Fat)
 The fat layer which separates the dermis from deeper
underlying structures such as fascia and muscles

 Insulates the body

 Important site of hormone conversions like
androstenedione to estrone
 Skin Adnexa

 Eccrine Sweat Glands

 Pilosebaceous Units:
1. Apocrine (Sweat) glands
2. Hair Follicle
3. Sebaceous (oil) glands
4. An arrector pili muscle
( when contracted, you get goosebumps)
 Nails
 Assist in grasping small objects
and in protecting the fingertip
from trauma
 Grow an ave. of 0.1mm/day; 4-
6mos to replace a complete nail
plate; toenails- 12-18mos
 Abnormalities may serve as impt
clues to cutaneous and systemic
disease
Cutaneous Signs and Diagnosis
 Original lesions are the primary lesions.
 Primary lesions may continue to develop or be modified by
regression, trauma, or other extraneous factors, producing
secondary lesions.
Primary Lesions
 Macule
 Papule
 Patch
 Plaque
Secondary Lesions
 Vesicle  Excoriation
 Bulla  Erosion
 Pustule  Crust
 Nodule  Scale
 Tumor  Lichenification
 Wheal  Ulcer
 Comedone
Macule Patch

Papule Plaque
Nodule Wheal

Vesicle Bulla
Comedone Pustule

Erosion Ulcer
 Scale Crust

Lichenification Fissure
Configuration of Lesions
Surface contours
 History Taking
7 Key Points
 Onset
 Characteristic lesion
 Pattern of distribution
 Associated symptoms
 Aggravating/ provocative factors
 Alleviating factors
 Previous treatments and response
 Physical Examination
 Conducted in a well-lit room; natural sunlight is ideal
 Patient should be completely undress and viewing from a
distance at first and then look at the primary lesions
closely.
 Wood’s light - commonly used in diseases w/
abnormalities of melanin pigmentation such as vitiligo
and melasma
 Magnifying lens – helpful aid to diagnosis because subtle
changes in the skin become more apparent when enlarged
 Physical Examination
 Dermoscopy – use of a dermatoscope ( a magnifier w/ a
non-polarised light source)
 Diascopy – a technique in which a glass slide or clear plastic
spoon is pressed on vascular lesions to blanch them and
verify that their redness is caused by vasodilatation and to
unmask their underlying color.
 Photography - helps to record the baseline appearance of a
lesion or rash
 Side-room and office tests
Potassium hydroxide preparations
 aid in diagnosis of fungal infections
 the scale from the edge of a scaling lesion is vigorously scraped
on to a glass slide with a No. 15 scalpel blade
 a drop or two of the KOH solution is run under the cover slip
 after 5–10 min the mount is examined under a microscope with
the condenser lens lowered to increase contrast
 Side-room and office tests
 Cytology (Tzanck Smear)
 aid the diagnosis of viral infections
 herpes simplex, zoster, bullous diseases
such as pemphigus
 a blister roof is removed and the cells
from the base of the blister are scraped
off with a No. 10 or 15 surgical blade.
 cells are smeared on to a microscope
slide, air-dried and fixed with methanol.
 stained with Giemsa, toluidine blue or
Wright’s stain.
 Side-room and office tests
 Patch Test
 involves applying a chemical to the skin and then watching for
dermatitis to develop 48–96 h later
 test materials are applied to the back under aluminium discs or
patches
 detects type IV delayed hypersensitivity reactions