INTEGUMENTARY

SYSTEM
Mrs Siwale M.C
Learning objectives
At the end of the lesson students should be able:
1. List terminologies used in integumentary system
2. Describe the skin; epidermis dermis and hypodermis
3. Describe accessory structures of the integumentary
4. To clinically the integumentary to to common
disorders
Introduction
◦ The skin/cutaneous membrane/integument covers external surface
of the body
◦ Composed of the skin, hair, oil and sweat glands, nails, and sensory
receptors
◦ Helps maintain a constant body temperature, protects the body, and
provides sensory information about the surrounding environment
◦ Largest organ of the body in; surface area and weight – adults skin
covers an area of about 2 square meters and weighs 4.5–5 kg about
16-20 % of total body weight
Introduction
Integumentary system is composed of
1. Skin
◦ Epidermis epithelial layer (ectodermal origin)
◦ Dermis mesodermal connective tissue
◦ Deep to dermis lies subcutaneous tissue with adipocytes;
subcutaneous tissue binds skin to underlying tissue(superficial
fascia)
2. Accessory structures
◦ Hair and hair follicle
◦ Skin glands
◦ Nails
Skin
Epidermis
◦ Composed of keratinized stratified squamous epithelium
◦ Contains 4 principal types of cells: keratinocytes, melanocytes, Langerhans
cells, and Merkel cells
◦ Keratinocytes make up about 90% of epidermal cells arranged in layers
◦ Keratinocytes produce protein keratin a tough, fibrous protein that helps
protect the skin and underlying tissues from heat, microbes, and chemical
◦ Keratinocytes also produce lamellar granules which release a water-
repellent sealant that decreases water entry and loss and inhibits the entry
of foreign materials
Epidermis
Epidermis
Melanocytes
◦ Make up about 8% of the epidermal cells
◦ Develops from ectoderm
◦ Produce the pigment melanin
◦ Have long, slender projections extend between
keratinocytes and transfer melanin granules to
them
◦ Melanin is a yellow-red or brown-black pigment
that contributes to skin color and absorbs
damaging ultraviolet (UV) light
◦ Once inside keratinocytes, melanin granules
cluster to form a protective veil over the nucleus,
on the side toward the skin surface, they shield the
nuclear DNA from damage by UV light
Epidermis
Langerhans cells
◦ Arise from red bone marrow and migrate to the
epidermis
◦ Participate in immune responses mounted against
microbes that invade the skin, and are easily
damaged by UV light
Merkel cells
◦ Least numerous of the epidermal cells
◦ Located in the deepest layer of the epidermis,
where they contact the flattened process of a
sensory neuron
◦ Merkel cells and their associated Merkel discs
detect touch sensations
Keratinocytes
◦Epidermis made up distinct layers of keratinocytes in various
stages of development
◦2 types of skin
1. Thin skin found in most regions epidermis has 4
strata/layers—stratum basale, stratum spinosum, stratum
granulosum, and a thin stratum corneum
2. Thick skin areas exposed to friction fingertips, palms, and
soles, the epidermis has 5 layers—stratum basale, stratum
spinosum, stratum granulosum, stratum lucidum, and a thick
stratum corneum
Epidermis
Stratum Basale/stratum germinativum
◦ Deepest layer
◦ Composed of a single row of cuboidal/columnar keratinocytes
◦ Some cells are stem cells that undergo cell division to continually produce new
keratinocytes
◦ Nuclei are large, and their cytoplasm contains many ribosomes, a small Golgi complex, a
few mitochondria, and some rough endoplasmic reticulum
◦ Cytoskeleton includes scattered intermediate filaments, called tonofilaments which are
composed of a protein that will form keratin in more superficial epidermal layers
◦ Tonofilaments attach to desmosomes, which bind cells to each other and to
hemidesmosomes, which bind the keratinocytes to the basement membrane positioned
between the epidermis and the dermis
◦ Melanocytes and Merkel cells with their associated Merkel discs are scattered among the
keratinocytes of the basal layer
Epidermis
Stratum Spinosum
◦ Superficial to stratum basale
◦ arranged in 8 - 10 layers of many-sided
keratinocytes fitting closely together
◦ Each spiny projection is a point where
bundles of tonofilaments are inserting into a
desmosome, tightly joining the cells to one
another provides both strength and flexibility
to the skin
◦ Langerhans cells and projections of
melanocytes are also present in this layer
Epidermis
Stratum Granulosum
◦ Consists of 3-5 layers of flattened keratinocytes
that are undergoing apoptosis
◦ Nuclei and other organelles begin to degenerate,
and tonofilaments become more apparent
◦ keratohyalin - darkly stained granules of a protein
which converts tonofilaments into keratin
◦ Lamellar granules membrane enclosed, which
release a lipid-rich secretion which fills the spaces
between cells of the stratum granulosum, stratum
lucidum, and stratum corneum
◦ Lipidrich secretion acts as a water-repellent sealant,
retarding loss and entry of water and entry of
foreign materials
Epidermis
Stratum Lucidum
◦ Present only in thick skin
◦ consists of 3 to 5 layers of flattened clear, dead
keratinocytes that contain large amounts of keratin
and thickened
◦ plasma membranes
Stratum Corneum
◦ consists on average of 25 to 30 layers of flattened
dead keratinocytes
◦ cells are continuously shed and replaced by cells
from the deeper strata
◦ cells contains mostly keratin
◦ Between cells are lipids from lamellar granules that
help make this layer an effective water-repellent
barrier
Epidermis
◦ Normal transit time from basal cell to formed keratin is 50 to 60 days
◦ Mechanisms that regulate this remarkable growth are not well understood, but
hormone-like proteins such as epidermal growth factor (EGF) play a role
◦ Excessive amount of keratinized cells shed from the skin of the scalp is called
dandruff
Psoriasis
◦ Common skin condition, in part manifesting as epidermal hyperplasia with
acclerated maturation to as short as 7 days
◦ Insufficient time for full development of tonofibrils and keratohyaline
◦ Clinically, the skin has a surface of opaque, flakey, white scale overlying thickened
red epidermis
The dermis
◦ Composed of a strong connective tissue containing collagen and
elastic fibers
◦ Woven network of fibers with great tensile strength
◦ Has the ability to stretch and recoil easily
◦ Cells include predominantly fibroblasts, macrophages, and a few
adipocytes near its boundary with the subcutaneous layer
◦ Blood vessels, nerves, glands, and hair follicles (epithelial invaginations
of the epidermis) are embedded in the dermal layer
◦ Based on its tissue structure, dermis can be divided into a superficial
papillary region and a deeper reticular region
Dermis
Papillary region
◦ makes up about 1/5 of the thickness of total layer
◦ Consists of areolar connective tissue containing thin collagen and fine
elastic fibers
◦ surface area is greatly increased by dermal papillae small, fingerlike
structures that project into the undersurface of the epidermis
◦ Some of these nipple-shaped structures contain capillary loops
◦ Some dermal papillae contain tactile receptors called Meissner
corpuscles/corpuscles of touch, nerve endings that are sensitive to touch, and
free nerve endings, dendrites that lack any apparent structural
specialization
Dermis
Reticular region
◦ Attached to the subcutaneous layer
◦ Consists of dense irregular connective tissue containing fibroblasts, bundles of
collagen, and some coarse elastic fibers
◦ Collagen fibers in the reticular region interlace in a netlike manner
◦ Few adipose cells, hair follicles, nerves, sebaceous (oil) glands, and sudoriferous
(sweat) glands occupy the spaces between fibers
◦ Extensibility of skin can be readily seen around joints and in pregnancy and
obesity
◦ Extreme stretching may produce small tears in the dermis, causing striae/stretch
marks, visible as red or silvery white streaks on the skin surface
The skin
◦Dermis-epidermis Junction; projections
dermal papillae interdigitate with
invaginations of epidermal ridges to strengthen
adhesions
◦Dermal-epidermal interdigitations (thick skin)
occur as ridges (palms and sore) called
dermatolyphs, finger print
Sensory Receptors
◦ Skin functions as an extensive receiver for various stimuli from the environment
◦ Unencapsulated receptors include the following:
1. Merkel cells, each associated with expanded nerve endings function as tonic receptors for sustained light
touch and for sensing an object’s texture
2. Free nerve endings in the papillary dermis and extending into lower epidermal layers, which respond
primarily to high and low temperatures, pain, and itching, but also function as tactile receptors
3. Root hair plexuses, a web of sensory fibers surrounding the bases of hair follicles in the reticular dermis
that detects movements of the hairs
Encapsulated receptors are all phasic
mechanoreceptors, responding rapidly to stimuli on
the skin
◦ Meissner corpuscles are elliptical structures, 30-
75μm by 50-150 μm, consisting of sensory axons
winding among flattened Schwann cells arranged
perpendicular to epidermis in dermal papillae
initiate impulses when light touch/low-frequency
stimuli against skin temporarily deform their shape
numerous in the fingertips, palms, and soles but
decline slowly in number during aging after puberty
◦ Lamellated corpuscles are specialized for sensing
coarse touch, pressure (sustained touch), and
vibrations, with distortion of the capsule amplifying
a mechanical stimulus to the axonal core where an
impulse is initiated.
◦ Pacinian corpuscles are also found in the
connective tissue of organs located deep in the
body, including the wall of the rectum and
urinary bladder, where they also produce the
sensation of pressure when the surrounding
tissue is distorted
◦ Krause end bulbs are simpler encapsulated, ovoid
structures, with extremely thin, collagenous
capsules penetrated by a sensory fiber found
primarily in the skin of the penis and clitoris
where they sense low frequency vibrations
◦ Ruffini corpuscles have collagenous, fusiform
capsules anchored firmly to the surrounding
connective tissue, with sensory axons stimulated
by stretch (tension) or twisting (torque) in the
skin
Functions of the skin
◦ Protection
◦ Cushions and insulates and is waterproof
◦ Protects from chemicals, heat, cold, bacteria
◦ Screens UV
◦ Synthesizes vitamin D with UV
◦ Regulates body heat
◦ Prevents unnecessary water loss
◦ Sensory reception (nerve endings)
◦ Sexual signaling
Epidermis
Hypodermis
◦ Hypodermis below the skin
◦ Subcutaneous below the skin
◦ Also called superficial fascia
◦ Fatty tissue; stores fat and anchors skin (areolar tissue and adipose cells)
◦ Different patterns of accumulation
(male/female)
Skin color
◦ Three skin pigments
◦ Melanin: the most important
◦ Carotene: from carrots and yellow vegies
◦ Hemoglobin: the pink of light skin
◦ Melanin in granules passes from melanocytes (same number in all races) to keratinocytes in stratum
basale
◦ Digested by lysosomes
◦ Variations in color
◦ Protection from UV light vs vitamin D?
Skin appendages
◦1st develop in the 2nd trimester of intrauterine
development as simple down growths of the surface
epithelium (epidermis) into the developing
subepithelial layers of mesoderm which will eventually
become dermis and subcutis
◦include hair follicles, sebaceous glands, eccrine
glands, apocrine glands and nails (fingers and toes)
Skin appendages
Hair
◦ produced in follicles in association with sebaceous glands and a smooth muscle
bundle (arrector pili); called pilosebaceous follicles or units
◦ Hairs are long, thin, cylindrical shafts composed of keratin
◦ Hair shafts have a surface cuticle composed of a single layer of flattened keratin
scales which covers a cortex of keratin forming the bulk of the hair
◦ Large hairs may have a central medulla
◦ growth is cyclical, with 3 phases:
1. Anagen long phase of active growth
2. Catagen short phase of involution
3. Telogen short inactive involuted phase
Hair
◦ Growth cycle of hairs varies from site to site
◦ Scalp hair follicles have an anagen growth phase of more than 2 years
and a short telogen resting phase of a few months’ scalp hair can
grow to a great length
◦ Pubic hair, coarse trunk hair, eyelashes and eyebrows have a short
growth phase (anagen) and a relatively long resting phase (telogen),
thereby limiting hair length
◦ body hair is fine and soft and is known as vellus
◦ coarse hair of the scalp is known as terminal hair.
Hair
◦ hair follicle is a tubular structure formed of specialized peri-follicular
connective tissue and epithelium
◦ Base is formed by the hair bulb, enclosing the hair papilla
◦ epithelial cells around the hair papilla proliferate to form the layers of
the follicle hair bulb, all the layers start as an indistinguishable
proliferative cell mass known as the hair matrix
◦ As they grow, they are pushed towards the skin surface from the hair
bulb, and 5 epithelial layers form inner 3 epithelial layers undergo
keratinisation to form the hair shaft (the hair)
◦ outer 2 layers form an internal and external sheath
◦ innermost layer cells undergo keratinisation to form medulla the core
of the hair shaft
◦ medullary layer may not be distinguishable, especially in fine hairs
◦ medulla is surrounded by a broad, highly keratinised layer, the cortex
which forms the bulk of the hair shaft
◦ third cell surface layer keratinises to form a hard, thin cuticle on the
surface of the hair, consisting of overlapping keratin plates, an
arrangement which is said to prevent matting of the hair
Hair
◦ outer 4th layer constitutes the internal root sheath
IRS, cells become only lightly keratinised and lock
with the developing cuticle, keeping the developing
hair as a solid unit as it matures
◦ after keratinisation, this layer fractures and
fragments, leaving the hair shaft free in the follicle
lumen, forming a space into which sebum is
secreted around the maturing hair
◦ outermost layer, the external root sheath ERS, is
the external epithelial layer and merges with
epidermis at the sebaceous glands there is a thick,
specialised basement membrane known as the
glassy membrane and a surrounding specialised
perifollicular connective tissue sheath CT
Nail
◦ dorsal skin surface of the tip of each finger and toe forms a highly specialized appendage
◦ consists of a dense keratinised plate called the nail plate which rests on a stratified squamous epithelium
called the nail bed
◦ Proximal end of the nail, the nail root and the underlying nail bed extend deep into the dermis to lie in close
apposition to the distal interphalangeal joint
◦ dermis beneath the nail plate is firmly attached to the periosteum of the distal phalanx
◦ Nail growth occurs by proliferation and differentiation of the epithelium underlying the nail root (known as
the nail matrix). The nail plate slides distally over the rest of the nail bed, which does not actively contribute
to nail growth
◦ on the surface, the distal part of the nail matrix is marked by the white crescent-shaped lunula at the base of
the nail
◦ skin overlying the root of the nail is known as the nail fold and its highly keratinised free edge is known as
the eponychium
◦ skin beneath the free end of the nail is known as the hyponychium
Sebaceous (oil) glands
◦ Entire body except palms and soles
◦ Produce sebum by holocrine secretion
◦ Oils and lubricates
Sweat glands
◦ Entire skin surface
except nipples and part
of external genitalia
◦ Prevent overheating
◦ 500 cc to 12 l/day! (is
mostly water)
◦ Humans most efficient
(only mammals have)
◦ Produced in response to
stress as well as heat
Types of sweat glands
◦ Eccrine or merocrine
◦ Most numerous
◦ True sweat: 99% water, some salts, traces of waste
◦ Open through pores
◦ Apocrine
◦ Axillary, anal and genital areas only
◦ Ducts open into hair follices
◦ The organic molecules in it decompose with time - odor
◦ Modified apocrine glands
◦ Ceruminous – secrete earwax
◦ Mammary – secrete milk
Blood supply to the skin
Disorders of the integumentary system
◦ Burns
◦ Threat to life
◦ Catastrophic loss of body fluids
◦ Dehydration and fatal circulatory shock
◦ Infection
◦ Types
◦ First degree – epidermis: redness (e.g. sunburn)
◦ Second degree – epidermis and upper dermis: blister
◦ Third degree - full thickness
◦ Infections
◦ Skin cancer
Blood supply and innervation of skin
◦ Skin is highly vascular important in temperature regulation.
◦ subcutaneous arteries form a network in the subcutaneous tissue, and from this is derived a subpapillary
plexus in the dermis.
◦ Capillary loops in the dermal papillae arise from the sub-papillary plexus, and from these loops the avascular
epidermis is bathed in tissue fluid.
◦ A sub-papillary plexus of venules gives the skin its pink colour: the vessels become dilated when the skin is
heated, and thereby make it look red.
◦ Most birthmarks consist of dilated capillaries (hemangioma).
Burns
First-degree
(epidermis only; redness)

Second-degree
(epidermis and dermis,
with blistering)

Third-degree
(full thickness, destroying
epidermis, dermis, often part of
hypodermis)
Estimate by “rule of 9’s”

Critical burns
◦ Over 10% of the
body has third-
degree burns
◦ 25 % of the body
has second-degree
burns
◦ Third-degree burns
on face, hands, or
feet
Tumors of the skin
◦ Benign, e.g. warts
◦ Cancer – associated with UV exposure (also skin aging)
◦ Aktinic keratosis - premalignant
◦ Basal cell - cells of stratum basale
◦ Squamous cell - keratinocytes
◦ Melanoma – melanocytes: most dangerous; recognition
Assignment
◦ Read on skin repair; cutaneous wound healing
References
TortosaG. and DerricksonB. (2011). Principles of Anatomy and Physiology. 13thed. [Link]-10:
0470565101 | ISBN-13: 978-0470565100
Thibodeau G. A & Patton K.T. (2007). Anatomy and [Link] Elsevier. Toronto
Williams, P.L,. Gray, H. Bannister H.L., Dyson M. & Warwick R.M. (2007). Gray’sAnatomy.38 Edition.
Churchill Livingstone. ISBN-13: 9780443025884
MescherA. L. (2013). Junqueira'sBasic Histology: Text & Atlas. McGraw-Hill Medical. 13 Edition. Toronto.
ISBN-10: 0071630201 ISBN-13: 9780071630207
Anderson J. E. (1983). Grant’s Atlas of [Link] Wilkins. ISBN 10: 0683002112/ ISBN 13:
9780683002119