Integumentary

System
Skin , Hair and
Nails
Gerald S. Bernal, MD, FPCP, MSc

Copyright © 2020 Gerald S. Bernal, MD

 Learning Objectives
• Identify the components & function of the integumentary
system
• List the functions of the skin in general
• Identify and describe the layers of the skin
• Explain how fingerprints are created in humans
• Explain the role of melanin in protecting the skin
• Classify body membranes & their respective functions
• Enumerate and describe the skin appendages
• Conduct a basic physical assessment of the skin
• List common skin disorders and disease
• Classify & describe the degree of burns
• Describe the“rule of nines” in estimating the burned
surface area in the skin
 Learning Tasks
At the end of the session the student must be able to:
•Name the components and describe the function(s) of the
integumentary system
•Name and describe the layers of the skin
•Describe the layers of the epidermis & dermis
•Describe how our fingerprint is formed
•Describe the role of melanin in skin protection
•Enumerate & classify body membranes
•Name the different glands & describe their functions
•Use the guide in doing physical assessment of the skin
•Apply the proper terms in describing skin lesions and
abnormalities in skin
•Compare normal from abnormal findings on physical
assessment of skin, hair and nails
•Utilize the rule of 9’s in assessing degree of burns
 Integumentary System
 largest body system
 Consist of: skin (or integument) and its appendages
(hair, nails and certain glands)

Functions:
protection of inner body structures
sensory perception
regulation of body temperature
excretion of some body fluids
synthesis of vitamin D
 Integumentary System
Skin (cutaneous membrane)
Skin Skin derivatives
 Sweat glands
 Oil glands
 Hairs
 Nails

Slide 4.8
 Skin and Body Membranes
Skin:
largest body organ
weighs up to 5 kg, covers an area of 2 square meter
forms the boundary between the body’s interior and its
surrounding
contain sensory receptors

Function:
Protection
Sensory perception
Body temperature regulation (thermoregulation)
Excretion
Synthesis
Functions:
PROTECTION:
- protect deeper tissues against chemical and thermal
damage
- prevent invasion of skin from harmful microorganisms
- against UV rays of sun & dessication (drying)
- maintain integrity of body surface by migration & shedding
- repair surface wounds thru cell replacement mechanism

SENSORY PERCEPTION:
- sensory nerve fibers supply sensation to the skin

BODY TEMPERATURE REGULATION:

- nerves, blood vessels & eccrine glands within the skin’s
deeper layer (dermis) help control body temperature
(thermoregulation)
EXCRETION:
-sweat glands in the skin excrete sweat which contain
water, electrolytes, urea and lactic acid

SYNTHESIS:
- vitamin D ( needed for bone metabolism)
Skin Structure

Figure 4.4
Slide
Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings
4.13b
• Epidermis
- outermost layer
- thickness varies
- no blood vessels
- stratified squamous epithelium
- often keratinized (hardened by keratin)

• Layers/ Stratum:
S. corneum (horny layer): outermost layer; keratinized
S. lucidum (clear layer): blocks water penetration & water loss
- absent in thin skin (occurs only in thick skin)
S. granulosum (granular layer): responsible for keratin formation
- may be missing in some thin skin
S. Spinosum (spiny layer): helps in keratin formation; rich in RNA
S. Basale (basal layer): innermost; produce new cells
Layer of Epidermis

Slide
4.11a
• Dermis
- also called corium
- form the 2nd layer of skin
- elastic system: contain blood and
lymphatic vessels, nerves & epidermal
appendages

• 2 Layers/ Stratum:
1. Papillary layer
- contain projections called dermal papillae
- contain pain receptors and capillary loops
2. Reticular layer
- made of collagen which provide strength, structure &
elasticity to skin
- contain blood vessels, gland and nerve receptors
 Hypodermis or subcutaneous tissue
- layer of fat located deep to the dermis
 not part of the skin
 anchors skin to underlying organs
 composed mostly of adipose tissue filled with fats
 Function: insulation, shock absorption, storage of
energy reserves
 FINGERPRINT
S
• produced from fingerlike projections of
papillary layer of dermis which form ridges
on fingers
WHIRL

• arise from interaction between individual’s

genes & developmental environment in the
uterus
• genes determine general characteristics of
ARCH
fingerprint patterns
• Classification: whirl, arch, loop
 Body Membranes
Membrane:
- thin sheet of material forming a barrier or lining

Function of body membranes

 Cover (or line)
 Protect body surfaces
 Lubricate
 Classification of Body Membranes
Body Membranes
2 major groups
Epithelia Connective
l Tissue
membrane membrane
Synovial Membranes

Cutaneous Mucous Serous

Membranes Membranes Membranes joint spaces

open closed
skin body cavities
body cavities
 Epithelial Membrane
 CUTANEOUS MEMBRANE
 made up of skin
 exposed to air = dry membrane
 provide outermost protective
boundary to the body

 MUCOUS MEMBRANE
 cover all body cavities that open to
exterior surface
 adapted for absorption / secretion
 respiratory, digestive, urinary,
reproductive
SEROUS MEMBRANE
cover body cavities that are closed to the
exterior of the body
 occur in pairs, producing 2 layers
- Parietal layer: forms outer wall
- Visceral layer: forms inner wall

Specific name depends on location:

Peritoneum – abdominal cavity
Pleura – around lungs
Pericardium – around heart
 Connective Tissue Membrane
 SYNOVIAL MEMBRANE
 no epithelial cells
 lines fibrous capsules
surrounding joints
providing smooth surface
 synovial fluid- lubricant
 What determines skin color
 Melanin
 Yellow, brown or black pigments
 Carotene
 Orange-yellow pigment from some vegetables
 Hemoglobin
 Red coloring from blood cells in dermis capillaries
 Oxygen content determines the extent of red
coloring
Melanin
 pigment produced by melanocytes
 melanocytes - mostly found in stratum basale
 color - yellow to brown to black
 helps filter UV light/radiation
 amount of melanin produced depends on:
- genetic
- sunlight exposure = stimulate melanin production
 Appendages

 Sebaceous (oil) glands

- (+) all over skin except palms & soles
 produce oil (sebum)
- lubricant: makes skin soft & moist; hair- soft
- kills bacteria
 most have ducts that empty into hair follicles
 activated at puberty w/c makes skin oilier
 testosterone increases the activity of sebaceous
glands during puberty
• SWEAT GLANDS (sudoriferous gland)
- widely distributed in skin
Two types
1. Eccrine sweat gland - ducts opens skin surface
- efficient in heat regulation
-nerve endings cause glands to secrete sweat when
external or body temperature is high
- acidic pH (4-6) of sweat inhibit bacterial growth

2. Apocrine sweat gland - ducts empty into hair follicles

- largely confined in axilla & genital area
- begins to function during puberty under androgen
- precise function (?)
- activated by nerve fibers during pain,stress, sexual
foreplay
 Sweat glands (sudoriferous gland)
2. Apocrine - ducts empty into hair follicles
- largely confined in axilla & genital area
- function begins during puberty under
influence of androgen
- precise function (?)
- activated by nerve fibers during pain,
stress, sexual foreplay

Slide 4.16
Composition & Function of sweat:
 Composition
 Mostly water
 Some metabolic waste
 Fatty acids and proteins (apocrine only)

 Function
 Helps dissipate excess heat
 Excretes waste products
 Acidic nature inhibits bacteria growth

 Odor is from associated bacteria

 Appendages of the Skin
 HAIR
 produced by hair bulb
 consists of hard keratinized epithelial cells
 melanocytes provide pigment for hair color

 NAILS
 scale-like modifications of the epidermis
 heavily keratinized
 stratum basale extends beneath the nail bed
is responsible for growth of nail
 Colorless – due to lack of pigment
 Hair follicle
 Dermal and epidermal
sheath surround hair root
 Arrector pilli
 Smooth muscle
 Sebaceous gland
 Sweat gland
Nail Structures
 Free edge Figure 4.9

 Body
 Root of nail
 Eponychium –
proximal nail
fold that
projects onto
the nail body

Slide 4.22
 Physical Assessment of skin
 Note for the following when assessing the skin :
 appearance: rashes, eruption, scars,moles,
tattoos, hair pattern
 color: look at the nailbeds, lips, eyes
normal: pink color
abnormal: pale, cyanotic (blue-gray), flushed
(red), jaundice (yellow)
 temperature: warm (N),cold, hot
 texture: moist (N),dry, papery thin, leathery
 DERMATOLOGIC DESCRIPTIONS OF SKIN
LESIONS
• Atrophy – thinning of skin surface with associated loss of
normal markings
• Bulla- superficial, well-circumscribed, raised fluid-filled lesion
greater than 1cm in diameter
• Burrow- subcutaneous linear tract made by a parasite
• Crust- slightly raised lesion w/ irregular border & variable
color resulting from dried blood, serum or other exudate
• Ecchymosis- flat, nonblanching, red-purple-blue lesion that
result from escape (extravasation) of red blood cells into skin
• Erosion- depressed lesion resulting from loss of epidermis
due to rupture of vesicle or bullae
• Excoriation- linear, superficial lesion which may be covered
with dried blood
 DERMATOLOGIC DESCRIPTIONS OF SKIN
LESIONS
• Lichenification- thickening of skin with an increase in skin
markings resulting from chronic irritation or rubbing
• Maculae- circumscribed nonpalpable discoloration of skin < 1
cm
• Nodule- solid, palpable circumscribed lesion > 1cm but < 2
cm
• Papule- solid elevated lesion <1 cm diameter
• Patch- nonpalpable skin discoloration with irregular border >
cm
• Petechiae- flat, pinpoint nonblanching red-purple lesion
caused by hemorrhage into the skin
• Plaque- solid, flat, elevated lesion >1 cm diameter
• Purpura- flat, nonblanching, red-purple lesion caused by
hemorrhage into the skin
• Pustule- vesicle that is filed with purulent fluid
 DERMATOLOGIC DESCRIPTIONS OF SKIN
LESIONS
• Scales- partial separation of the superficial layer of skin
• Scar- replacement of normal skin with fibrous tissue, often
resulting from injury
• Telangiectasia- dilatation of capillaries resulting in red,
irregular, clustered lines that branch
• Tumor- solid, palpable circumscribed lesion >2 cm in
diameter
• Ulcer- depressed lesion resulting from loss of epidermis and
part of dermis
• Vesicle- superficial, well-circumscribed raised, fluid-filled
lesion
<1 cm diameter
• Wheal- slightly raised, red, irregular lesions that are transient
and secondary to edema of skin
 BURNS
 Burns
 Tissue damage and cell death caused by heat,
electricity, UV radiation, or chemicals
 Associated dangers – dehydration, electrolyte
imbalance, circulatory shock

• Rules of Nines
 Way to determine the extent of burns
 Body is divided into 11 areas – each area
represents about 9%
 Severity of Burns
 First-degree burns
 damage: epidermis
 Skin: red and swollen

 Second degree burns

 damage: epidermis &
upper dermis
 Skin: red with blisters

 Third-degree burns
 damage: entire skin layer
 Skin: gray-white or black
 Critical Burns
 Burns are considered critical if:
 Over 25% of body has second degree burns
 Over 10% of the body has third degree burns
 There are third degree burns of the face,
hands, or feet

Slide 4.28
Skin Cancer
 Cancer – abnormal cell mass

Two types
1. Benign
- does not spread (encapsulated)

2. Malignant
- metastasized (moves) to other parts of
the body

Slide 4.29
 Skin Cancer Types
 Basal cell carcinoma
 least malignant
 most common type
 arises from Stratum basale

Squamous cell carcinoma

 Arises from stratum spinosum
 metastasizes to lymph nodes
 early removal allows a good chance of cure
Skin Cancer Types

 Malignant melanoma
 Most deadly of skin cancers
 cancer of melanocytes
 metastasizes rapidly to lymph and blood
vessels
 detection uses ABCD rule
 ABCD Rule
 A = Asymmetry
 two sides of pigmented mole do not match

 B = Border irregularity
 borders of mole are not smooth

 C = Color
 different colors in pigmented area

 D = Diameter
 spot is larger then 6 mm in diameter