‫كلية طب الفم و االسنان‬

Research of

Skin
GROUP 4

under supervision

DR/ Ahmed Yahia Sedeak

 ‫‪Group 4‬‬

‫‪ /1‬رهف ابو الدهب البدرى ‪221020262‬‬

‫‪231020173‬‬ ‫‪ /2‬روان صالح محمد‬
‫‪ /3‬روان محمد احمد عبده ‪231020518‬‬
‫‪231020498‬‬ ‫‪ /4‬رؤى خالد ربيع‬
‫‪231020144‬‬ ‫‪ /5‬ريهام فرج طهير‬
‫‪ /6‬ساره اشرف عبدالعظيم ‪231020484‬‬
‫‪ /7‬سعيد نصر عبدالرحيم ‪231020530‬‬
‫‪ /8‬سهيلة احمد معروف ‪231020218‬‬
‫‪231020001‬‬ ‫‪ /9‬شاهر اشرف سعيد‬
‫‪231020231‬‬ ‫‪ /10‬شمس الدين محمد‬
Introduction
Skin is the largest organ in the body and covers the body's entire external surface. It is made up
of three layers, the epidermis, dermis, and the hypodermis, all three of which vary significantly
in their anatomy and function. The skin's structure is made up of an intricate network which
serves as the body’s initial barrier against pathogens, UV light, and chemicals, and mechanical
injury. It also regulates temperature and the amount of water released into the environment. This
article discusses the relevant anatomical structures of the skin’s epidermal layer, its structure,
function, embryology, vascular supply, innervation, surgical considerations, and clinical
relevance.
Skin Thickness
The thickness of each layer of the skin varies depending on body region and categorized based
on the thickness of the epidermal and dermal layers. Hairless skin found in the palms of the
hands and soles of the feet is thickest because the epidermis contains an extra layer, the stratum
lucidum. The upper back is considered thickest based on the thickness of the dermis, but it is
considered “thin skin” histologically because the epidermal thickness lacks the stratum lucidum
layer and is thinner than hairless skin.
Layers of Epidermis
The layers of the epidermis include the stratum basale (the deepest portion of the epidermis),
stratum spinosum, stratum granulosum, stratum lucidum, and stratum corneum (the most
superficial portion of the epidermis).
Stratum basale, also known as stratum germinativum, is the deepest layer, separated from the
dermis by the basement membrane (basal lamina) and attached to the basement membrane by
hemidesmosomes. The cells found in this layer are cuboidal to columnar mitotically active stem
cells that are constantly producing keratinocytes. This layer also contains melanocytes.
Stratum spinosum, 8-10 cell layers, also known as the prickle cell layer contains irregular,
polyhedral cells with cytoplasmic processes, sometimes called “spines”, that extend outward and
contact neighboring cells by desmosomes. Dendritic cells can be found in this layer.
Stratum granulosum, 3-5 cell layers, contains diamond shaped cells with keratohyalin granules
and lamellar granules. Keratohyalin granules contain keratin precursors that eventually
aggregate, crosslink, and form bundles. The lamellar granules contain the glycolipids that get
secreted to the surface of the cells and function as a glue, keeping the cells stuck together.
Stratum lucidum, 2-3 cell layers, present in thicker skin found in the palms and soles, is a thin
clear layer consisting of eleidin which is a transformation product of keratohyalin.
Stratum corneum, 20-30 cell layers, is the uppermost layer, made up of keratin and horny
scales made up of dead keratinocytes, known as anucleate squamous cells. This is the layer
which varies most in thickness, especially in callused skin. Within this layer, the dead
keratinocytes secrete defensins which are part of our first immune defense.
Cells of the Epidermis
 Keratinocytes
  Melanocytes
 Langerhans’ cells
 Merkel’s cell
Keratinocytes
Keratinocytes are the predominant cell type of epidermis and originate in the basal layer,
produce keratin, and are responsible for the formation of the epidermal water barrier by making
and secreting lipids. Keratinocytes also regulate calcium absorption by the activation of
cholesterol precursors by UVB light to form vitamin D.
Melanocytes
Melanocytes are derived from neural crest cells and primarily produce melanin, which is
responsible for the pigment of the skin. They are found between cells of stratum basale and
produce melanin. UVB light stimulates melanin secretion which is protective against UV
radiation, acting as a built-in sunscreen. Melanin is produced during the conversion of tyrosine to
DOPA by the enzyme tyrosinase. Melanin then travels from cell to cell by a process that relies
on the long processes extending from the melanocytes to the neighboring epidermal cells.
Melanin granules from melanocytes are transferred via the long processes to the cytoplasm of
basal keratinocyte. Melanin transferred to neighboring keratinocytes by “pigment donation”;
involves phagocytosis of tips of melanocyte processes by keratinocytes.
Langerhans’ Cells
Langerhans cells, dendritic cells, are the skins first line defenders and play a significant role in
antigen presentation. These cells need special stains to visualize, primarily found in the stratum
spinosum. These cells are the mesenchymal origin, derived from CD34 positive stem cells of
bone marrow and are part of the mononuclear phagocytic system. They contain Birbeck
granules, tennis racket shaped cytoplasmic organelles. These cells express both MHC I and
MHC II molecules, uptake antigens in skin and transport to the lymph node.
Merkel Cells
Merkel cells are oval-shaped modified epidermal cells found in stratum basale, directly above the
basement membrane. These cells serve a sensory function as mechanoreceptors for light touch,
and are most populous in fingertips, though also found in the palms, soles, oral, and genital
mucosa. They are bound to adjoining keratinocytes by desmosomes and contain intermediate
keratin filaments and their membranes interact with free nerve endings in the skin.
Dermis
The dermis is connected to the epidermis at the level of the basement membrane and consists of
two layers, of connective tissue, the papillary and reticular layers which merge together without
clear demarcation. The papillary layer is the upper layer, thinner, composed of loose connective
tissue and contacts epidermis. The reticular layer is the deeper layer, thicker, less cellular, and
consists of dense connective tissue/ bundles of collagen fibers. The dermis houses the sweat
glands, hair, hair follicles, muscles, sensory neurons, and blood vessels.
Hypodermis
The hypodermis is deep to the dermis and is also called subcutaneous fascia. It is the deepest
layer of skin and contains adipose lobules along with some skin appendages like the hair
follicles, sensory neurons, and blood vessels.
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Structure and Function

The skin has many functions. It serves as a barrier to water, invasion by microorganisms,
mechanical and chemical trauma, and damage from UV light. The epidermal water barrier
established by the cell envelop, a layer of insoluble proteins on the inner surface of the plasma
membrane. It is formed by cross-linking of small proline-rich proteins and larger proteins like
cystatin, desmoplakin, filaggrin and contributes to strong mechanics of barrier. And the lipid
envelope, a lipid/hydrophobic layer attached to the outer surface of the plasma membrane. As
keratinocytes in stratum spinosum produce keratohyalin granules, they also produce lamellar
bodies (containing a mixture of glycosphingolipids, phospholipids, and ceramides) assembled
within Golgi. Lamellar bodies’ contents are then secreted by exocytosis into extracellular spaces
between the stratum granulosum and corneum. Skin is the first site of immunological defense by
the action of the Langerhans cells in the epidermis which are dendritic epidermal T lymphocytes
and part of the adaptive immune system. The skin preserves the bodies homeostasis by
regulating temperature and water loss, while also serving both endocrine and
exocrine functions. The endocrine functions include the production of vitamin D in the
keratinocytes which are responsible for converting 7-dehydrocholesterol in the epidermis to
vitamin D, with the assistance of UV light from the sun. The keratinocytes express the vitamin D
receptor (VDR) and also contain the enzymes needed to convert vitamin D to its active form of
1, 25 dihydroxy vitamin D. The significance of the VDR is that stimulation of it plays a role in
the proliferation of the stratum basale and differentiation of keratinocytes as they move upwards
in the epidermis. The exocrine functions of the skin are by way of the sweat and sebaceous
glands. Another important role of the skin is a sensation to touch, heat, cold, and pain by the
actions of the nociceptors. The general appearance, turgor, and other qualities also give insight
into the general health of the body.

Embryology
The epidermis is derived from ectodermal tissue. The dermis and hypodermis are derived from
mesodermal tissue from somites. The mesoderm is also responsible for the formation of
Langerhans cells. Neural crest cells, responsible for specialized sensory nerve endings and
melanocyte formation migrate into the epidermis during epidermal development.

Blood Supply and Lymphatics

Blood vessels and lymphatic vessels are found in the dermal layer of the skin. Blood supply to
the skin is an arrangement of two plexuses, the first lies between the papillary and reticular
layers of the dermis and the second lie between the dermis and subcutaneous tissues. Supply to
the epidermis is by way of the superficial arteriovenous plexus (subepidermal/papillary plexus).
These vessels are important for temperature regulation. The mechanism by which the body
regulates temperature through the skin is very effective and works by increased blood flow to the
skin, transferring heat from the body to the environment. The changes in blood flow are
controlled by the autonomic nervous system, sympathetic stimulation resulting in
vasoconstriction (heat retention) and while vasodilation results in heat loss. Vasodilation of the
blood vessels is the response to increased body temperature and is the result of inhibition of the
sympathetic centers in the posterior hypothalamus whereas decreased body temperature will
cause vasoconstriction of skin blood vessels.

Nerves
Nerves of the skin include both somatic and autonomic nerves. The somatic sensory system is
responsible for pain (nociceptors), temperature, light touch, discriminative touch, vibration,
pressure, and proprioception medicated primarily by specialized cutaneous receptors/end organs
including Merkel disks, Pacinian corpuscles, Meissner’s corpuscles, and Ruffini corpuscles. The
autonomic innervation is responsible for the control of the tone of the vasculature, pilomotor
stimulation at the hair root, and sweating. The free nerve endings extend into the epidermis and
sense pain, heat, and cold. They are most numerous in the stratum granulosum layer and
surround most hair follicles. Merkel disks sense light touch and reach the stratum basale layer.
The other nerve endings are found in the deeper portions of the skin and include the Pacinian
corpuscle which senses deep pressure, Meissner’s corpuscle which senses low-frequency
stimulation at the level of the dermal papillae, and Ruffini corpuscles which sense pressure.

Muscles
The arrector pili muscles are bundles of smooth muscle fibers that attach to the connective tissue
sheath of hair follicles. When the muscles contract, they pull the hair follicle outward resulting in
the hair erecting up but also compresses the sebaceous glands, resulting in the secretion of their
contents. Hair does not exit perpendicularly, but instead at an angle. This erection of hair also
produces goosebumps, the bumpy appearance of the skin.

Physiologic Variants
Skin is continuously shedding and desquamating and varies slightly depending on the body
region. There are more layers of cells in thicker hairless skin with an additional layer, known as
the stratum lucidum. Overall, the process of cell division, desquamation, and shedding go as
follows:
1. Cell division occurs in stratum basale/germinativum. One cell remains, another cell is
pushed toward the surface. Basal cells begin synthesis of tonofilaments (composed of
keratin) which are grouped into bundles (tonofibrils).
2. Cells are pushed into stratum spinosum. In the upper part of the spinous layer, cells begin
to produce keratohyalin granules having intermediate-associated proteins, filaggrin, and
trichohyalin; helps aggregate keratin filaments and conversion of granular cells to
cornified cells, i.e. keratinization. Cells also produce lamellar bodies.
3. Cells are pushed into stratum granulosum and become flattened and diamond shaped. The
cells accumulate keratohyalin granules mixed between tonofibrils.
4.
Cells continue to stratum corneum where they flatten and lose organelles and nuclei. The
keratohyalin granules turn tonofibrils into a homogenous keratin matrix.
 5. Finally, cornified cells reach the surface and are desquamated via a break-down of
desmosomes. Proteinase activity of KLK (kallikrein-related serine peptidase) is triggered
by lowered pH near the surface.

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