2.

1 The integument composed of skin and its appendages, sweat glands, sebaceous glands, hair,
and nails, is the largest organ, constituting 16% of the body weight. Skin is a complex organ that
protects its host from its environment, at the same time allowing interaction with its
environment. It is much more than a static, impenetrable shield against external insults. Rather,
skin is a dynamic, complex, integrated arrangement of cells, tissues, and matrix elements that
mediates a diverse array of functions
Skin consists of three layers: an outer epidermis connective tissue layer, the dermis and a deeper
hypodermis. The epidermis is composed of stratified squamous keratinized epithelium. Lying
directly below and interdigitating with the epidermis is the dermis, composed of dense, irregular
collagenous connective tissue.

EPIDERMIS Functions as a mechanical and antimicrobial barrier, protects against water loss
and provides immunological protection, thickness varies from 0.04 mm (eyelid skin) to 1.5 mm
(palmoplantar skin) and is 0.07 to 0.12 mm in thickness over most of the body. Keratinocytes,
which form the largest population of cells, are arranged in five recognizable layers; the
remaining three cell types (Langerhans cells, Merkel cells, and melanocytes) are interspersed
among keratinocytes in specific locations. Because keratinocytes are being continually sloughed
from the surface of the epidermis, this cell population must continually be renewed. Renewal is
accomplished through mitotic activity of the keratinocytes in the basal layers of the epidermis
and as the new cells are forming, the cells above continue to be pushed toward the surface.
Along their way to the surface, the cells differentiate and begin to accumulate keratin filaments
in their cytoplasm.
 Eventually, as they near the surface, the cells die and are sloughed off, a process that
takes 20 to 30 days. Because of the cytomorphosis of keratinocytes during their migration from
the basal layer of the epidermis to its surface, five morphologically distinct zones of the
epidermis can be identified. From the inner to the outer layer, these are the (1) stratum basale
(germinativum), (2) stratum spinosum, (3) stratum granulosum, (4) stratum lucidum, and
(5) stratum corneum. Skin is classified as thick or thin according to the thickness of the
epidermis. However, these two types also are distinguished by the presence or absence of certain
epidermal layers and the presence or absence of hair.

DERMIS The region of the skin lying directly beneath the epidermis, called the dermis is
divided into two layers: the superficial, loosely woven papillary layer and the deeper, much
denser reticular layer. The dermis is composed of dense, irregular collagenous connective tissue,
containing mostly type I collagen fibers and networks of elastic fibers, which support the
epidermis and bind the skin to the underlying hypodermis (superficial fascia). Ranges from 0.2
mm thick in the eyelids to about 4 mm thick in the palms and soles. It is composed mainly of
collagen but also contains elastic and reticular fibers, the usual cells of fibrous connective tissue
and blood vessels, sweat glands, sebaceous glands, hair follicles, and nail roots.
The superficial papillary layer of the dermis is uneven where it interdigitates with the epidermis,
forming the dermal ridges (papillae) It is composed of a loose connective tissue whose thin type
III collagen fibers and elastic fibers are arranged in loose networks. The interface between the
papillary layer and reticular layer of the dermis is indistinguishable. Characteristically, the
reticular layer is composed of dense, irregular collagenous connective tissue, displaying thick
type I collagen fibers, which are closely packed into large bundles lying mostly parallel to the
skin surface. Sweat glands, sebaceous glands, and hair follicles, all derived from the epidermis,
invade the dermis and hypodermis during embryogenesis, and remain there permanently.
Groups of smooth muscle cells are located in the deeper regions of the reticular layer at
particular sites (e.g. scrotum); contractions of these muscle groups wrinkle the skin in these
regions. Other smooth muscle fibers, called arrector pili muscles, are inserted into the hair
follicles; contractions of these muscles erect the hairs when the body is cold or suddenly exposed
to a cold environment, giving the skin “goose bumps.” Additionally, a particular group of
striated muscles located in the face, parts of the anterior neck, and scalp (muscles of facial
expression) originate in the superficial fascia and insert into the dermis.

HYPODERMIS Beneath the skin is a layer called the hypodermis, subcutaneous tissue, or
superficial fascia. The boundary between the dermis and hypodermis is indistinct, but the
hypodermis generally has more areolar and adipose tissue. When adipose tissue dominates, the
hypodermis is called the subcutaneous fat (panniculus adiposus). The hypodermis binds the skin
to the underlying tissues, pads the body, serves as an energy reservoir, and provides thermal
insulation. Infants and elderly people are more sensitive to cold than others because they have
less fat in this layer. Obesity is due mainly to the accumulation of subcutaneous fat. The
subcutaneous fat is about 8% thicker in women than in men and differs in distribution between
the sexes. Drugs are introduced into the hypodermis by injection because the subcutaneous tissue
is highly vascular and absorbs them quickly.
Besides providing a cover for the underlying soft tissues, skin performs many additional
functions, including
(1) Protection
The skin bears the brunt of most physical injuries to the body, but it resists and recovers
from trauma better than other organs do. The toughness of keratin and strength of the epidermal
desmosomes make the skin a barrier that is not easily breached. Few infectious organisms can
penetrate the skin on their own. Those that do either rely on accidental breaks in the skin or have
life cycles that involve vectors animals such as mosquitoes, fleas, lice, and ticks, with mouthparts
strong enough to puncture the skin. The epidermal surface is populated by bacteria, fungi, and
other pathogens poised for any opportunity to get inside. Even vigorous scrubbing in a hot
shower does not rid the skin of bacteria. They are, however, discouraged from multiplying on the
skin by its relatively dry, unfavorable habitat. The sebum (oil of the skin) contains bactericidal
substances, and sweat forms a film called the acid mantle (pH 4–6) that is unfavorable to
microbial growth.
Even when a pathogen breaches the epidermis, it faces an army of dermal macrophages
and leukocytes that can quickly migrate to the site of infection and mount a defense. The skin is
also important as a barrier to water. It prevents the body from absorbing excess water when you
are swimming or bathing, but even more importantly, it prevents the body from losing excess
water. This function becomes especially evident when skin is lost; in patients who have suffered
extensive burns, fluid replacement is one of the most critical needs for survival. The skin is also
a barrier to solar radiation, including ultraviolet (UV) rays. Most UV rays are filtered out by
atmospheric ozone, but even the small fraction that reaches us is enough to cause sunburns and
skin cancer. Scientists fear that we could see a catastrophic increase in skin cancer because of the
loss of atmospheric ozone. Ozone is destroyed by chemicals called chlorofluorocarbons (CFCs),
used in air conditioners, refrigerators, spray cans, and other sources. Although the skin is
impermeable to most chemicals, there are exceptions. The blood receives 1% to 2% of its oxygen
by diffusion through the skin, and it gives
(2) Regulation of body temperature
The nervous, endocrine, muscular, and integumentary systems are involved in regulating
body temperature. The dermis contains naked nerve endings called thermoreceptors, some of
which respond when the skin temperature rises above normal and others when it falls below
normal. They transmit signals to a region called the hypothalamusin the base of the brain. To
warm the body, the hypothalamus sends signals that constrict the cutaneous arteries, reducing
blood flow near the body surface and retaining heat deeper in the body. To cool the body,
hypothalamic signaling is inhibited and the cutaneous arteries are allowed to dilate. This
increases blood flow through the skin and allows more heat to radiate away from the body. If this
is inadequate to restore normal temperature, the hypothalamus also stimulates sweating. When
sweat evaporates, it carries heat away from the body.
(3) Reception of continual sensations from the environment
The skin is our most extensive sense organ. It is equipped with a variety of nerve endings
that react to heat, cold, touch, texture, pressure, vibration, and tissue injury. These sensory
receptors are especially abundant on the face, palms, fingers, soles, nipples, and genitals. There
are relatively few on the back and in skin overlying joints such as the knees and elbows. Some
receptors are naked dendrites that penetrate into the epidermis. Most, however, are limited to the
dermis and hypodermis
(4) Excretion

The Sweat Glands are responsible for producing what is known as sweat or perspiration
which cools down the body and gets rid of any excess salt in the body. Sweat or Perspiration, it
is composed mainly of water but it also has various salts and organic compounds. It also contains
some amount of urea and other waste products. When it comes to classification of Sweat Glands,
there are two main types of sweat glands which are the Eccrine Glands and the Apocrine Glands.
Eccrine Glands: The Eccrine Glands are distributed all over the body but are found mostly in the
palm of the hands, soles of the feet, and the forehead. These glands discharge the secretions
directly to the surface of the skin. Their main function is regulating the temperature of the body
and excretion of waste products from the body. For regulating the temperature, the Sweat or
Perspiration that comes out to the surface of the body cools the body from the outside heat. It
also helps in elimination of excess salt and other electrolytes in the body.

Apocrine Glands: These glands are found in the armpits. These glands are larger than the
Eccrine Glands. These glands produce a secretion which is viscous and cloudy in nature. This
secretion when it comes to the surface of the body gets mixed with the bacteria in the atmosphere
and produces a foul odor for which we use deodorants in the armpits. Apocrine Glands discharge
their secretions in the canals of hair follicles. These glands start function only after a person has
attained puberty.

(5) The synthesis of vitamin D.

Vitamin D is important in regulating blood calcium and phosphate levels and maintaining
the health of the skeleton. Vitamin D synthesis begins in the epidermal keratinocytes, under the
influence of UV rays in sunshine.
(6) Social Functions
The integumentary system plays an important role in the social relations of all vertebrate
animals by enabling them to identify members of their own species and distinguish the sexes.
Some mammals recognize each other by the color and distribution of hair. Animals may also
accept or reject one another’s company and choose mates based on the appearance of the
integument, which may indicate an animal’s state of health. Thus, it is not surprising that animals
allocate a lot of time to grooming.

Growth and Repair Cycles of The Skin

Usually, wound healing and tissue repair are the dynamic biological process, consisting
of a complex interaction of cellular and biochemical events. The process of wound healing
differs little from one kind of tissue to another, and is generally independent of the type of injury.
Although different elements of the wound healing process proceed in a continuous and integrated
manner, it is still convenient to divide the whole process into three overlapping phases, e.g.
inflammatory phase, proliferative phase and maturation phase, and several natural components
for descriptive purpose. Traditionally, the treatment of skin wounds consist local wound care,
surgery, skin grafting, debridement and vascular reconstruction. Recent investigators have shown
that growth factors play a key role in the natural mechanism of skin wound healing. These
growth factors attract inflammatory cells into the wound, stimulate cellular proliferation and
enhance neovascularization and epithelial migration. These properties have aroused a great deal
of interest in trying to prove efficacy in enhancing all forms of tissue repair. The topical
application of growth factors has been reported to promote wound healing in partial‐thickness
burns, skin‐graft donor sites and other wounds.
Some of genetically engineered drugs have been produced and used in the fields of skin
wound repair and regeneration and the successful clinical results have achieved. These
genetically engineered drugs include the recombinant human epidermal growth factor (rhEGF),
recombinant bovine basic fibroblast growth factor (rbFGF) and platelet derived growth factor
(PDGF), etc. The basic research found that these growth factors are involved in tissue
development in embryo and repair in adult after injury. After application in local wound, it is
found that the wound healing velocity can be accelerated and wound‐healing quality improved
with their powerful mitogenic and non‐mitogenic effects. The clinical trial indicated that all of
superficial second‐degree burns, deep second‐burns, donor sites and chronic skin ulcers treated
with recombinant bovine basic fibroblast growth factor or recombinant human epidermal growth
factor had an accelerated rate of granulation tissue formation and epidermal regeneration as
compared with that in the controls.
When tissue is damaged, platelets adhere to exposed matrix via integrins that bind to
collagen and laminin. Blood coagulation produces thrombin, which promotes platelet
aggregation and granule release. The platelet granules generate an infl ammatory response.
White blood cells are attracted by selectins and bind to integrins on endothelial cells, leading to
their extravasation through the blood vessel walls. Cytokines released by the white blood cells
and platelets up-regulate integrins on macrophages, which migrate to the area of injury, and on fi
broblasts and epithelial cells, which mediate wound healing and scar formation. Plasmin aids
healing by removing excess fibrin. This aids the migration of keratinocytes into the wound to
restore the epithelium under the scab. Collagensynthesis is up regulated, producing the scar.
Wounds gain 20% of their ultimate strength in 3 weeks and later gain more strength, but they
never reach more than about 70% of the strength of normal skin.

2.2 Some Disorders of the Integumentary System

Acne Inflammation of the sebaceous glands,especially beginning at puberty; follicle becomes
blocked with keratinocytes and sebum and develops into a blackhead (comedo) composed of
these and bacteria; continued inflammation of follicle results in pus production and appearance
of pimples.
Dermatitis  Any inflammation of the skin,typically marked by itching and redness; often
contact dermatitis, caused by exposure to toxins such as poison ivy.
Eczema  Itchy,red,“weeping”skin lesions caused by an allergy,usually beginning before age 5;
may progress to thickened,leathery,darkly pigmented patches of skin.
Psoriasis  Recurring,reddened plaques covered with silvery scale; sometimes disfiguring;
possibly caused by an autoimmune response; runs in families.
Rosacea  A red rashlike area,often in the area of the nose and cheeks,marked by fine networks
of dilated blood vessels; worsened by drinks,alcohol,and spicy food.
Seborrheic  Recurring patches of scaly white or yellowish inflammation often on the
head,face,chest,and back; called cradle cap (yellow,crusty scalp lesion) in infants. Cause
unknown,but correlated with genetic and climatic factors dermatitis.
Tinea  Any fungal infection of the skin; common in moist areas such as the axilla,groin,and
foot (athlete’s foot). Misnamed ringworm because of the circular,wormlike growth pattern
sometimes exhibited.