Physiology and pathophysiology of the Skin and related parts

Physiology the Skin

1. Protection
What is the skin?

The skin is the body’s largest organ, made of water, protein, fats and minerals. Your skin protects your
body from germs and regulates body temperature. Nerves in the skin help you feel sensations like hot
and cold.

Your skin, along with your hair, nails, oil glands and sweat glands, is part of the integumentary (in-TEG-
you-MEINT-a-ree) system. “Integumentary” means a body’s outer covering.

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ANATOMY

What are the layers of the skin?

Three layers of tissue make up the skin:

 Epidermis, the top layer.

 Dermis, the middle layer.
 Hypodermis, the bottom or fatty layer.

What does the epidermis (top layer of skin) do?

Your epidermis is the top layer of the skin that you can see and touch. Keratin, a protein inside skin cells,
makes up the skin cells and, along with other proteins, sticks together to form this layer. The epidermis:

Acts as a protective barrier: The epidermis keeps bacteria and germs from entering your body and
bloodstream and causing infections. It also protects against rain, sun and other elements.

Makes new skin: The epidermis continually makes new skin cells. These new cells replace the
approximately 40,000 old skin cells that your body sheds every day. You have new skin every 30 days.

Protects your body: Langerhans cells in the epidermis are part of the body’s immune system. They help
fight off germs and infections.
Provides skin color: The epidermis contains melanin, the pigment that gives skin its color. The amount of
melanin you have determines the color of your skin, hair and eyes. People who make more melanin
have darker skin and may tan more quickly.

What does the dermis (middle layer of skin) do?

The dermis makes up 90% of skin’s thickness. This middle layer of skin:

 Has collagen and elastin: Collagen is a protein that makes skin cells strong and resilient. Another
protein found in the dermis, elastin, keeps skin flexible. It also helps stretched skin regain its
shape.
 Grows hair: The roots of hair follicles attach to the dermis.
 Keeps you in touch: Nerves in the dermis tell you when something is too hot to touch, itchy or
super soft. These nerve receptors also help you feel pain.
 Makes oil: Oil glands in the dermis help keep the skin soft and smooth. Oil also prevents your
skin from absorbing too much water when you swim or get caught in a rainstorm.
 Produces sweat: Sweat glands in the dermis release sweat through skin pores. Sweat helps
regulate your body temperature.
 Supplies blood: Blood vessels in the dermis provide nutrients to the epidermis, keeping the skin
layers healthy.

What does the hypodermis (bottom layer of skin) do?

The bottom layer of skin, or hypodermis, is the fatty layer. The hypodermis:
 Cushions muscles and bones: Fat in the hypodermis protects muscles and bones from injuries
when you fall or are in an accident.
 Has connective tissue: This tissue connects layers of skin to muscles and bones.
 Helps the nerves and blood vessels: Nerves and blood vessels in the dermis (middle layer) get
larger in the hypodermis. These nerves and blood vessels branch out to connect the hypodermis
to the rest of the body.
 Regulates body temperature: Fat in the hypodermis keeps you from getting too cold or hot.

What else makes up the skin?

One inch of your skin has approximately 19 million skin cells and 60,000 melanocytes (cells that make
melanin or skin pigment). It also contains 1,000 nerve endings and 20 blood vessels

2. Sensation
An important function of the skin dermis is to detect the different sensations of heat, cold, pressure,
contact and pain. Sensation is detected through the nerve endings in the dermis which are easily
affected by wounds. This sensation in the skin plays a role in helping to protect us from burn wounds.

3. Thermoregulation
The skin's immense blood supply helps regulate temperature: dilated vessels allow for heat loss, while
constricted vessels retain heat. The skin regulates body temperature with its blood supply. The skin
assists in homeostasis. Humidity affects thermoregulation by limiting sweat evaporation and th us heat
loss.

4. Excretion
The skin plays a role in excretion through the production of sweat by sweat glands. Sweating eliminates
excess water and salts, as well as a small amount of urea , a byproduct of protein catabolism.

5. Absorption

Absorption refers to the movement of substances from the outside world, through the skin and into our
bodies. We can absorb certain vitamins, drugs (think about a hydrocortisone cream), gases (oxygen and
carbon dioxide), as well as many other substances through our skin.
6. Vitamin D synthesis

The skin is responsible for producing vitamin D. During exposure to sunlight, ultraviolet radiation
penetrates into the epidermis and photolyzes provitamin D3 to previtamin D3. Previtamin D3 can either
isomerize to vitamin D3 or be photolyzed to lymisterol and tachysterol.

Receptors of the Skin

1. Mechanoreceptors
These receptors detect mechanical stimuli such as touch, pressure, vibration, and stretch.There are four
primary tactile mechanoreceptors in human skin: Merkel's disks, Meissner's corpuscles, Ruffini endings,
and Pacinian corpuscle; two are located toward the surface of the skin and two are located deeper. A
fifth type of mechanoreceptor, Krause end bulbs, are found only in specialized regions.

2.Thermoreceptors
Thermoreceptors can include: Krause end bulbs, which detect cold and are defined by capsules; Ruffini
endings, which detect warmth and are defined by enlarged dendritic endings; and warm and cold
receptors present on free nerve endings which can detect a range of temperature.

3. Nociceptors
Nociceptors are sensory receptors that detect signals from damaged tissue or the threat of damage and
indirectly also respond to chemicals released from the damaged tissue. Nociceptors are free (bare)
nerve endings found in the skin, muscle, joints, bone and viscera.

4. Proprioceptors
Receptors involved in proprioception are located in skin, muscles, and joints. Information about limb
position and movement is not generated by individual receptors, but by populations of afferents.
Afferent signals generated during a movement are processed to code for endpoint position of a limb.

Pathophysiology of the Skin

1. Inflammation

Inflammatory conditions like dermatitis or eczema can occur due to an immune response triggered by
irritants or allergens.Chronic skin inflammation has many causes. Among the most frequent chronic
inflammatory skin diseases are atopic dermatitis, psoriasis, urticaria, lichen planus, and hidradenitis
suppurativa, driven by a complex interplay of genetics and environmental factors.

2. Infections
Bacterial, viral, or fungal infections can affect the skin and lead to conditions like cellulitis, herpes
simplex virus infections (cold sores), or ringworm.Most common conditions that can predispose an
individual to bacterial skin infections involve cases when the integrity of the skin barrier is breached;
therefore, trauma such as abrasion, excoriation, laceration, or ulceration may result in vulnerable skin.

3. Allergic reactions

Allergies can cause various skin conditions like hives (urticaria) or contact dermatitis when the immune
system reacts abnormally to certain substances. There are 4 stages of allergy :

Type I: reaction mediated by IgE antibodies.

Type II: cytotoxic reaction mediated by IgG or IgM antibodies.

Type III: reaction mediated by immune complexes.

Type IV: delayed reaction mediated by cellular response.

4. Autoimmune disorders
Conditions like psoriasis or systemic lupus erythematosus (SLE) involve the immune system mistakenly
attacking the skin, leading to chronic inflammation and skin lesions.In general, autoimmune disease
results from an interplay between a genetic predisposition and environmental factors. Genetic
predisposition to autoimmunity is complex and can involve multiple genes that regulate the function of
immune cell populations.

5. Skin cancer

Uncontrolled growth of abnormal cells in the skin can lead to different types of skin cancer, such as basal
cell carcinoma, squamous cell carcinoma, or melanoma. Three main types of skin cancer are basal cell
carcinoma (the most common), squamous cell carcinoma (the second most common), and the least
common but most deadly, melanoma. Risk factors for skin cancer include exposure to UV radiation, a
history of sunburns, fair skin, and a weakened immune system.

6. Genetic disorders
Genetic mutations can result in inherited skin disorders like epidermolysis bullosa or ichthyosis, which
affect the structure and function of the skin. Deletion or loss of part of a gene, one or many genes, part
of a chromosome, one or more chromosomes, one or more of mitochondrial genes, or even a whole
genome. Duplication/rearrangement of the genetic material. Deficient/defective transcription of mRNA.

 Understanding the physiology and pathophysiology of the skin is crucial for diagnosing and
treating various dermatological conditions.
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1 Soliyana Mulugeta RU 1630/14

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