CH 5 Integumentary System

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CH 5 Integumentary System
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SKIN

• The integumentary system includes the skin and
  its accessory organs
• Another term for the skin is the cutaneous
  membrane.

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Facts about the SKIN

• Skin is waterproof
• The outer surface of the skin is made of dead
  cells. House dust is mainly skin flakes!
• If you laid out all your skin on a flat surface,
  it would have an area of about 2 square meters
  (22 square feet). Skin weighs about 2.5 kilograms
  (12-15 of body weight) - the largest organ in
  the body.
• What hurts if you pull it, but doesn't hurt if
  you cut it?
• Your hair, of course!
• Skin is elastic - it springs back into shape when
  stretched.

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Skin Facts Continued.

• Some medicines (eg oestrogen, nicotine) can pass
  through the skin, but others cannot (eg
  insulin). Why is that? Because only fat-soluble
  substances can enter the skin, not water-soluble
  ones.
• Your hair stands on end and you develop goose
  bumps because there are tiny muscles attached to
  the hair follicles and they contract when you are
  frightened or cold.

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The Skin and its Tissues

• Skin functions
• Protective covering (primary function) barrier
  to the entry of microbes, viruses, and UV
  exposure
• Aids in regulating body temperature
• Slows water loss
• Houses sensory receptors
• Synthesizes various chemicals (vitamin D and
  melanin)
• Excretes waste
• The skin is composed of an epidermis, dermis, and
  subcutaneous layer (hypodermis).

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THE SKIN
Epidermis
Dermis
Subcutaneous (Hypodermis)
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The EPIDERMIS

• 4-5 layers of 4 different types of cells.
• The deepest layer of the epidermis contains cells
  undergoing cell division (mitosis) to produce new
  cells.
• About 90 of the epidermis are keratinocytes.
• Epidermal cells become keratinocytes when they
  undergo keratinization. During this process,
  they mature and are pushed toward the surface
  while producing keratin (takes about 2-4 weeks).
  What does keratin do?
• Gives tissue a waterproof quality
• Melanocytes produce the skin pigment melanin.
  Melanin is a brown/black pigment that covers the
  nucleus to protect the DNA from UV radiation-
  which can cause mutation. The more that cells
  are exposed to UV radiation, the more melanin is
  produced. A sun tan is a sign of injury!!

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Epidermis Continued.

• Langerhans cells- Arise from red bone marrow and
  move to the epidermis where they participate in
  immune responses.
• Merkel cells- Found in the deepest layer of the
  epidermis where they contact the flattened part
  of a sensory nerve cell and function in the
  sensation of touch.

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Layers of the Epidermis- from the bottom to top

1. Stratum Basale- Here is where cell division takes
   place, producing new skin cells and pushing older
   cells toward the surface. This layer contains
   pre-keratinocytes, melanocytes, Langerhans cells
   and Merkel cells. This layer is attached to a
   layer of fibers called the basement membrane.
2. Stratum Spinosum- Contains spiny keratinocytes
   that are not yet mature enough to produce
   keratin.
3. Stratum Granulosum- Contains keratin producing
   keratinocytes.
4. Stratum Lucidum- Clear, flat, dead cells found
   only in the thick skin of palms and soles.
5. Stratum Corneum- Thickest layer- 30 layers of
   flat, dead keratinocytes.

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LAYERS OF EPIDERMIS
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Quick Review

1. Another name for skin is the ______________
   membrane.
2. What are 5 functions of skin?
3. What are the 3 layers of skin?
4. What are the 4 types of cells found in the
   epidermis?
5. What are the 5 layers of the epidermis?
6. Which layer contains functioning keratinocytes?
7. Which layer is attached to the basement membrane?
   
8. Which layer is the thickest?

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The DERMIS

• Composed of 2 layers papillary layer and
  reticular layer.
• Papillary layer contains a thin arrangement of
  collagen fibers and supplies nutrients to select
  layers of the epidermis and regulates temperature
  (by increasing and reducing blood supply to the
  epidermis). The fingerlike projections of this
  layer are called dermal papillae. These cause
  ridges in the epidermis and are what produce
  fingerprints.
• Inside the dermal papillae are blood vessels and
  nerve endings. The nerve endings are called
  corpuscles of touch or Meissner corpuscles.
  These are sensitive to touch. What type of
  epidermal cell is closely associated with these?
  
• Merkel Cells!

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Dermis continued..

• Reticular layer- The reticular layer contains
  thicker collagen fibers than the papillary
  dermis. It strengthens the skin, provides
  structure and provides elasticity. It also
  supports other components of the skin, such as
  hair follicles, nerves, oil glands, muscles, and
  sweat glands.

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HAIR

• Also called pili- Each strand is dead,
  keratinized cells that consist of a shaft (above
  the skin) and a root (below the skin).
• Surrounding the root is a hair follicle which
  includes an external root sheath, internal root
  sheath, and connective tissue sheath
• The base of the follicle is the matrix- where new
  hair cells are formed from cell division
• Surrounding the follicle base is/are
• blood vessels- provide nourishment to the hair
• arrector pili muscle-contracts and causes the
  hair to stand up (goose bumps)
• hair root plexus (nerve endings)

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HAIR
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Sebaceous Glands

• Sebaceous glands usually are associated with hair
  follicles
• Secrete sebum, which keeps hair from drying out
• If plugged and infecteda pimple develops

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Sweat (Sudoriferous) Glands

• Each sweat gland consists of a coiled tube (duct)
• 2 Types (Apocrine and Eccrine)
• Apocrine glands respond to emotional stress
  larger and occur in armpits (axillary regions)
  and groin areasthese produce a solution that
  bacteria act on to produce body odor
• Eccrine glands respond to elevated body
  temperature
• Sweat is primarily water, but also contains salts
  and wastes

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The SUBCUTANEOUS Layer (Hypodermis)

• Adipose (fat) tissue helps conserve body heat
• Contains blood vessels that branch into the
  dermis
• The layer where you receive shots and
  vaccinations

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Nails

• Nails are produced by epidermal cells originating
  at the nail matrix that undergo keratinization
• HOW SWEET ARE
• THOSE NAILS??

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SKIN CANCER
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Skin Cancer Facts

• Most skin tumors are benign (non-cancerous) ex.
  Warts, calluses, moles
• Skin cancers metastasize, which means that they
  invade other tissues. If they enter the
  bloodstream and/or lymph system, they can travel
  anywhere and lodge themselves in other locations.
• The cause of skin cancer is not known, but
  overexposure to ultraviolet (UV) radiation is the
  main risk factor. The DNA in a cell can become
  mutated, and consequently, it divides out of
  control.

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Basal Cell Carcinoma

• Least malignant and most common skin cancer
• Most often appears on the exposed areas of the
  face
• Appears as a shiny dome-shaped nodule that later
  develops a central ulcer with a pearly beaded
  edge
• Full cure in 99 that are removed surgically
• Cells of the stratum basale no longer form
  keratin and do not honor the boundary between
  dermis and epidermis

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Basal Cell Carcinoma
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Squamous Cell Carcinoma

• Arises from the cells of the stratum spinosum
• Occurs most often on the scalp, ears, hands, and
  lower lip
• Appears as a scaly, reddened elevation that
  gradually forms a shallow ulcer with a firm,
  raised border
• It grows rapidly and metastasizes to adjacent
  lymph nodes if not removed
• Chance for complete cure is good if caught early
  and removed surgically or by radiation therapy

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Squamous Cell Carcinoma
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Malignant Melanoma

• Cancer of the melanocytes
• 5 of all skin cancers
• Is often deadly and chance of survival is
  50...early detection helps.
• Can begin anywhere there is pigmentation, some
  develop from pigmented moles.
• Usually appears as a spreading brown to black
  patch that metastasizes rapidly to surrounding
  lymph nodes and blood vessels.
• Use the ABCDE Rule to recognize it

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Malignant Melanoma
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The ABCDE rule is a convenient guide to the usual
signs of melanoma.

• A is for ASYMMETRY One-half of a mole or
  birthmark does not match the other.
• B is for BORDER The edges are irregular, ragged,
  notched, or blurred.
• C is for COLOR The color is not the same all
  over, but may have differing shades of brown or
  black, sometimes with patches of red, white, or
  blue.
• D is for DIAMETER The area is larger than 6
  millimeters (about ¼ inch -- the size of a pencil
  eraser)
• E is for EVOLVING If the growth changes at all

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IMPORTANT NOTE One blistering sunburn in
childhood or adolescence more than doubles a
person's chances of developing melanoma later in
life. A person's risk for melanoma also doubles
if he or she has had five or more sunburns at any
age.
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BURNS
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Burns

• Serious threat to skin
• 2 Life Threatening Problems associated with
  Burns
• Body Fluid Loss-. Dehydration and electrolyte
  imbalance follow and can lead to shutdown of
  kidneys and circulatory shock
• Infection- The leading cause of death in burn
  victims. Burned skin is sterile for about 24 hrs.
  The bacteria and fungi easily invade areas where
  the skin is destroyed and feed off of the dead
  tissues. The patients immune system becomes
  overwhelmed and suppressed after severe burn
  injury.

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Rule of Nines

• The rule of nines assesses the percentage of a
  persons body that is burned and is used to help
  guide treatment decisions.
• This divides the body into regions and states the
  surface area of the body for each region. See
  next slide.

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Rule of Nines
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Severity of Burns

• First Degree Only the epidermis is damaged.
  Not usually serious and can heal in 2-3 days.
• Ex. Mild sunburn

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First Degree Burns

• First-degree burns involve minimal tissue damage
  and they involve upper layers of the epidermis
  (skin surface). These burns cause pain, redness
  and swelling.

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First Degree Burns
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Second-Degree Burns

• Epidermis and upper region of dermis is damaged.
  
• Usually no permanent scars.

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Third-Degree Burns

• Third-degree burns affect the epidermis, dermis
  and hypodermis, causing charring of skin or a
  translucent white color, with coagulated vessels
  visible just below the skin surface. These burn
  areas may be numb because nerves are destroyed.
  Regeneration is not possible and skin grafting
  must be performed.

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Third-Degree Burns

• Third-degree burns affect the epidermis, dermis
  and hypodermis, causing charring of skin or a
  translucent white color, with coagulated vessels
  visible just below the skin surface. These burn
  areas may be numb because nerves are destroyed.
  Regeneration is not possible and skin grafting
  must be performed.

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Fourth-Degree Burns

• Fourth degree burns damage all layers of the skin
  as well as the muscles, ligaments and tendons
  below the skin. These burns often result in
  death. If the patient survives, then skin
  grafting will be necessary.

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Fifth-Degree Burns

• Fifth degree burns are when all tissue is burned
  up to the bone. Sometimes there is even bone
  damage. There are virtually no chances of
  surviving such burns. In the case of a miracle
  survival, amputation of the affected area will be
  necessary.

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SEVERITY OF BURNS

1. Minor burns treated at home First or
   second-degree burns covering less than 15 of an
   adult's body or less than 10 of a child's body,
   or a third-degree burn on less than 2 BSA..
2. Moderate burns treated at a hospital These are
   defined as First or second-degree burns covering
   15-25 of an adult's body or 10-20 of a
   child's body, or a third-degree burn on 2-10
   BSA.

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• Critical, or major, burns should be treated in a
  specialized burn unit of a hospital. These are
  defined as First or second-degree burns covering
  more than 25 of an adult's body or more than 20
  of a child's body, or a third-degree burn on more
  than 10 BSA. In addition, burns involving the
  hands, feet, face, eyes, ears, or genitals are
  considered critical.

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For the following scenarios, indicate the body
surface area that is burned and rate the burn
as minor, moderate or critical.

1. A child suffers 1st degree burns at a family
   bonfire. His anterior right arm is affected.
2. An adult woman suffered 3rd degree burns using a
   chicken fryer. Her left foot and posterior left
   leg were affected.

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Regulation of Body Temperature

• Regulation of body temperature is vital because
  heat affects the rates of metabolic reactions
• Normal body temperature of deeper body parts is
  about 37 C (98.6 F)
• Heat Production and loss
• When body temperature rises above normal, dermal
  blood vessels dilate and sweat glands secrete
  sweat
• In hot weather, 4 liters per hour can be lostso
  drink your fluids!!!
• If body temperature drops below normal, dermal
  blood vessels constrict and sweat glands become
  inactive
• During excessive heat loss, skeletal muscles are
  stimulated to contract involuntarily (shivering)

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Some actions involved in Body Temperature Regulati
on
Body Heat is lost to surroundings
Nervous System Signals dermal Blood vessels to
dilate and sweat glands to secrete
Body Temp. Rises Above Normal
Body Temp returns to normal
Normal Body Temperature 37 C or 98.6 F
Body Temp drops below normal
Body Temp rises towards normal
Nervous System signals dermal blood vessels to
constrict and sweat glands remain inactive
Body heat is generated by muscle contractions
If body temp continues to drop, Nervous system
signals muscles to Contract involuntarily
(shivering)
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Some actions involved in Body Temperature Regulati
on
Body Heat is lost to surroundings
Nervous System Signals dermal Blood vessels to
dilate and sweat glands to secrete
Body Temp. Rises Above Normal
Body Temp returns to normal
Normal Body Temperature 37 C or 98.6 F
Body Temp drops below normal
Nervous System signals dermal blood vessels to
constrict and sweat glands remain inactive
Body Temp rises towards normal
Body heat is generated by muscle contractions
If body temp continues to drop, Nervous system
signals muscles to Contract involuntarily
(shivering)
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SKIN DISORDERS
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ACNE
Acne is a common skin condition in which the
sebaceous glands become clogged. This causes a
pimple and inflamed infected abscesses, or
collections of pus. The symptoms of this
condition may include blackheads, whiteheads,
pimples, pustules, and cysts. Acne is caused by
a hormonal change in the body. It is usually
inherited.
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Allergic Contact Dermatitis A bumpy patch of
itchy, flaky, red skin. It occurs when someone
has a reaction after coming into contact with
something that irritates his/her skin. Symptoms
are redness, itchy skin, crackling skin,
blisters, spreading patch, and oozing. Causes
are repeated contact, soaps, fabric softeners,
perfumes, cosmetics, nickel, deodorants, plants
such as poison ivy, oak, or sumac.
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Alopecia
Alopecia is a medical name for baldness or hair
loss. Symptoms hair loss. Causes
Male-Patterned Baldness, which is the most
common, inflammation of the scalp, medications,
chemotherapy, radiation treatment of the head,
infections such as syphilis, trauma to the hair
or scalp, low iron, low thyroid hormone levels,
lupus, and cancer
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Athletes Foot
Athletes Foot is a fungal infection that affects
the top layer of skin on the foot. Symptoms
Itching, itchy red rash between toes or
underneath the arch of the foot, small blisters,
which contain pus, skin may look inflamed, dry,
and scaly. Causes fungus
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Boil/ Carbuncle
Boil/Carbuncle is an abscess which is a
collection of pus in soft tissues of the skin
caused by bacterial infections and usually
involves a hair follicle. Symptoms tender red
swollen skin , with an overlying pus head or a
very tender soft lump in which the pus may not be
visible.
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Cold Sore
Cold Sores are blisters inside the mouth or on
the lips. Causes a virus called Herpes Simplex
Virus Type I. Symptoms tiny blisters, swelling
and redness, fever, not feeling well, feeling
tired, hard to eat, and sore throat. Spread from
person to person easily, able to spread to other
parts of the body, may become infected with
bacteria
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Warts
Warts are non-cancerous skin growths caused by a
viral infection in the top layer of the skin.
Viruses that cause warts are called human
papillomavirus (HPV). Warts are usually
skin-colored and feel rough to the touch, but
they can be dark, flat and smooth. The appearance
of a wart depends on where it is growing.
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Eczema
Eczema is a non-contagious skin condition that
causes patches of dry, scaly, extremely itchy
skin. Symptoms dry patches of skin, red
extremely itchy skin, rash, blisters, itching,
constant dry, scaly skin. Causes related to
history hypersensitivity or reaction in the body,
people who have asthma or hay fever are more
likely to get eczema. Stress, dry climate, high
temperature, soaps, chlorine, and other
irritating substances. Foods such as peanut
butter, milk, or eggs.
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Fungal Nail Infection
A fungal nail infection is a condition in which a
fungus or yeast causes a nail to become
misshapen, discolored, and thick. Symptoms
unattractive nails, itching, peeling, skin
dryness, and small blisters. Causes fungal
infection, bacterial buildup
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Impetigo
Impetigo is a contagious bacterial infection on
the surface of the skin. Symptoms honey
colored crusts, mild sores, pus filled blisters,
blisters containing clear yellow or slightly
cloudy fluid. Causes scratches, cuts, or prior
existing skin diseases such as eczema put a
person at risk.
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Keloid
Keloids are patches of excessive scar tissue that
may form following a skin injury. Symptoms
thick, smooth humped-up pink scar tissue larger
that the original site of injury, occasional
itching or tenderness. Causes cosmetics,
piercings
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Pediculosis
Pediculosis (lice) are small gray bugs.
Symptoms itchy scalp, inflammation, bacterial
infection, swollen lymph nodes, nits. Causes
sharing hats, combs or headphones, wearing dirty
clothing for weeks.
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Psoriasis
Psoriasis is an inherited disease that causes an
increase in skin cells on the outer layer of the
skin. Cause unknown, but allergies are thought
to play a role. Symptoms red bumps or patches
under dead skin, reddened areas that itch or are
tender, itching, scaling and red patches in the
scalp, crumbling or abnormal fingernails or
toenails, thickening, cracking, and blistering of
the palms or soles of the feet.
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Rosacea
Rosacea is a chronic inflammation that occurs on
the face. Symptoms redness of the face,
overproduction of sebum, inflamed acne like
bumps, mild swelling of the skin on the cheeks
and nose, thickening of the oil glands in skin of
the nose, swelling of tiny blood vessels on the
face. Cause unknown
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Scabies
Scabies is a skin infestation caused by a scabies
mite. Symptoms itchy bumps in characteristic
locations such as between fingers, or on the
wrists, or on the genitals. Other symptoms
include generalized itching and tiny burrow lines
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Varicella (Chickenpox)
Varicella is a disease caused by the
varicella-zoster virus (ZVZ). Symptoms
blistery, itchy rash, usually on all body
surfaces, fever, difficulty waking, trouble
walking, stiff neck, breathing difficulty,
vomiting, red tender skin, a child who looks or
acts sick, scabs that become soft and drain a
yellow pus (Chickenpox). We have a vaccine now
that prevents this disease.
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Shingles
Shingles is a painful rash of blisters that
develops due to the virus that causes chickenpox.
Symptoms sensations, pain, numbness, tingling,
itching, groups of blisters. Causes
reactivation of the chickenpox virus, weakness of
the immune system
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What is the skin disorder?

1. skin infestation caused by a mite
2. increase in skin cells on the outer layer of the
   skin
3. baldness or hair loss
4. small gray bugs
5. caused by HPV- Human Papilloma Virus
6. reactivation of the chicken pox virus
7. redness of the face, overproduction of sebum,
   inflamed acne like bumps
8. caused by Herpes Simplex Virus Type 1
9. fungal infection that affects the top layer of
   skin
10. patches of excessive scar tissue