BASIC SCIENCE OF DERMATOVENEREOLOGY

Dr. Chairiyah Tanjung, SpKK

Departement of Dermato-venereology
University of North Sumatera
RSUP H.Adam Malik Medan

BASIC SCIENCE OF DERMATOVENEREOLOGY

Skin:
The outermost layer, most complex
structure
A reflection of healthy man
15% of body weight; area of 1,5-1,75
m2
Thickness: 0,5mm-6mm

Basic science
1.
2.
3.
4.
5.
6.

Structure of the skin

Function of the skin
Structure of genitalia
Microbiology of the skin
Histopathology of the skin
Morphology and how to make
diagnosis
7. Basic science of dermatoimmunology

Structure of the Skin

1. Epidermis
1.1.
1.2.
1.3.
1.4.
1.5.

Basal layer
Malphigian layer (spinous layer)
Granular layer
Lucidal layer
Stratum corneum

2. Dermis
2.1. Papillary dermis
2.2. Reticular dermis

3.

Sub cutis

Diagramatic cross section of the skin

and panniculus

Epidermis
1. Basal layer

Columnar shape cell, pallisade

Mitotically active, differentiate, the cells
change in form while move upward
Melanocyte cell (+) melanosome
melanin
keratinocyte

dermis

2. Malphigian layer (spinous layer)

The thickest layer: 6-8 layers; poligonal shape

Glycogen >> ; intercelular bridge (+)
Langerhans cell (+)

3. Granular layer

2-3 flatten cell layers

Cytoplasm: keratohyalin granules,
basophilic, nucleus (+)
Function:
Apoptosis
Impermeable water barrier

4. Lucidal layer

Flatten cells, nucleus (-)

Cytoplasm: protein eleidin
Clearly seen in hands and soles

5. Stratum corneum

20-25 flatten cell layers, cornified,

nucleus(-)
Cytoplasm: keratinous
Desquamation (+)

Merkel cells

Found between basal keratinocyte, in

hairy/glaborous skin
Intracytoplasmic neurosecretory like
granules (+)

The dermis
Thicker than epidermis
Composition: collagen fibers, elastic fibers,
fibrous protein, cellular elements, hair
follicles, vascular tissue
Papillary dermis:
Close to epidermis
Collagen fiber & elastic fiber in small bundles
Vascular and nerve ending (+)

Reticulary dermis
Close to sub cutis
Collagen fiber & elastic fiber in big bundles

Function: elasticity of the skin

age elasticity

SUB CUTIS
Lobule of fat cells separated by fibrous septa
Vary in thickness.
Function heat insulator, mechanical barier,
energy reserve.
The cutaneus vascularization :
1. Sub papillary plexus.
2. Deeper plexus.
Associate with the vascular plexus are the
dermal lymphatics.

 EPIDERMAL APPENDAGES (THE

ADNEXA).
1. Sweat glands:
Eccrine glands.
Apocrine glands.
2. Sebaceous glands.
3. Hair.
4. Nails.

Eccrine glands

Apocrine glands

Size, form

Small, spiral

Bigger

Location

All over the body,

palms, soles, axilla,
forehead

Axilla, areola,
anogenital region, lids
(gland of Moll),
ceruminous glands

Secret

Watery

Juicy

Orifice

Skin surface

Infundibular hair
follicle

Influencing factors

Cholinergic
innervations, fear,
emotional

Adrenergic
innervation,
catecholamines

Function

thermoregulation

Unknown; probably
body odor

SEBACEOUS GLANDS.
Throughout all skin sites except the palms and
soles.
Holocrine, release products into the upper portion
of the hair canal.
Sebum: triglyceride, free fatty acid, squalene, wax
ester, cholesterol.
Influence by androgen.
Sebum production: baby , children,
adolescence.

HAIR.
All over the skin, except the palms and soles,
dorsal phalanges, distal phalanges, labium minus,
lips.
Hair types :
Lanugo hair fetus, baby.
Velus hair <1 cm, forehead.
Indeterminate hair about 1 cm.
Terminal hair >1 cm.
Androgen hormon axillary hair, pubic hair, beard.
Hair composition :carbon 50,60%, hydrogen6,36%,
nitrogen 17,14%, sulphur 5.0%, oksigen 20,80%.

THE HAIR CYCLE.

The rate of hair growth is dependent upon
mitotic activity of bulb matrix.
1. Anagen (growth stage)
2-6 years : 0,3mm/day.
85%-90% human scalp hair follicle are in
anagen.
2. Catagen (degenerative stage).
2 weeks.
Matrix activity(-), club hair (+).
<1%.
3. Telogen (resting phase).
Several months.
The club hair within the foreshortened follicle
until a new anagen follicle develops.

THE NAIL.
Consist of horny product.
Grows 1mm / week; fingernails
growth>toenails growth.
Functions:

Esthetics.
Protecting the distal phalanges.
Enhancing tactile discrimination.
The capacity to pick up small objects.
Used for scratching and grooming.

THE FUNCTION OF THE

SKIN:
1.Protection.
2.Absorbtion.
3.Excretion.
4.Perception.
5.Thermoregulatory.
6.Pigmentation.
7.Photosynthesis of vit D.
8.Keratinization.
Another function: - skin immunologic
- socio-sexual

1. Skin as protection organ

1.1Physical protection:

- stratum corneum.
- keratinization.
- elastic and collagen fibers
- fat tissue.
1.2 Chemical protection: - impermeability of stratum
corneum
- acidity of the skin.
1.3 Photo protection:
- melanocyte.
- thickness of stratum
corneum.
- urocanic acid.
1.4 Microorganism protection
- acidity of the skin
- desquamation

2.

Absorbtion function
skin permeability

skin

respiration
Influenced by many factors absorbtion (+)
epiderm
intercellularal cell

gland orifice

3. Excretion function
Sebaceous gland sebum
oily of the skin
protection excessive
evaporation
Skin gland metabolic residue : NaCl, urea,
uric acid,
ammonia
Product of sebaceous gland
acidity of the
+
skin
Product of sweat gland

4. Perception function
Kind of
perception

Sensory
receptor

Location

Touch

Meissners
Dermal
corpuscle
papillae
Merkel Ranvier Epidermis

Pressure

Pacinian
corpuscle

Deep dermis,
sub cutaneous
tissue

Heat

Ruffinis ends

Dermis, sub
cutaneous

Cold
Pain

Krause
Free nerve

Dermis
Papillary

5. Thermoregulatory Function
By
eccrine gland
skin circulation
constriction of blood vessels
6. Pigmentation
Skin colour depends on:
~
~
~
~
~

thickness of the skin

carotens
melanin
oxyhemoglobin
deoxygenated hemoglobin

Tyrosinase

Tyrosine
+
+

Dopaquinone

2 S Cysteinyldopa
or
5 S Cysteinyldopa

Leucodopachrome
Dopachrome

Benzothiazine intermediate
carboxylic acid

or
Pheomelanine
Quinone
Eumelanin

5,6 dihydroxyndole 2

5,6 dihydroxyndole

7. Photosynthesis of vitamin D
sunlight (295-300
nm)
7 dehydrocholesterol
vitamin D
8. Keratinization
14 21 days
Skin protection againts infection by
physiologic mechanism

Structure of genitalia

Male genitalia

Female
genitalia

Lymphatic system of male / female

genitalia
1.Horizontal tract of superficial lymph nodes
and deep lymph nodes
2.Pelvic lymph nodes and lymph nodes along
abdominal aortic

Organ
Penis
- Superficial
- deep
Srotum
Spongy uretra
Membranous & prostatic
urethra
Prostate and seminal vesicles
Testis, epididymal duct

Lymph nodes
Superficial medial inguinal
nodes
Superficial medial inguinal
nodes
Deep medial inguinal nodes
Superficial medial inguinal
nodes
Superficial medial inguinal
nodes
Deep inguinal nodes
Vesicle lateral nodes
internal iliac nodes
Sacral, external iliac nodes,
internal iliac nodes, anorectal
nodes
External iliac nodes

organ

Lymph nodes

Labium majus

Superficial medial inguinal nodes,

external iliac nodes
Superficial medial inguinal nodes,
deep inguinal nodes, external iliac
nodes
Anterior vesicle nodes
Superficial medial inguinal nodes,
deep inguinal nodes, external iliac
nodes
Superficial medial inguinal nodes,
deep inguinal nodes, interiliac
nodes, gliteal inferior nodes
Nodes along abdominal aortic
Nodes along abdominal aortic
Nodes along abdominal aortic,
superficial inguinal

Labium minus
Bartholin s gland
Clitoris
Urethra
Ovary
Fundus of uterus
Body of uterus

Microbiology of the skin

Keratinization fat, nitrogen, mineral etc
microorganism consuming colonization(+)
pathogen
Microorganism
opportunistic pathogen
non pathogen
Carrier
: pathogen microorganism (+),
clinical sign (-)
Virulensi : depends on microorganism strain

Pathogenesis of bacterial infection

towards the skin depends on :
1.Characteristic of pathogenic :
invasive potensial
toxigen properties of the organism
2.Portal of entry :
Vascular wall : hemorrhage, thrombosis,
infarction
Cellular reaction systemic spread
distant lesion
3.Defense mechanism/ hospes immunity

Defense mechanism/hospes immunity

1. Natural: - skin structure: - desquamation
- acid mantle theory
- dessication
- chemical protection:
-unsaturated fatty acid
- bacterial interference o.t. skin
- normal bacterial o.t. skin
2. Immunoglobulin & delayed type hypersensitivity
- IgM in the sweat (-)
- IgA, IgG, IgD, in the serum <<<
- Skin disease in immunodeficiency person (+)

Normal cutaneus flora

Comes from
Pathogenicity

Transient
skin flora

Resident
skin flora

Out of skin

Skin

Pathogen, non Non pathogen

pathogen

Multiplicating

(-)

(+)

Eradication
from the skin

easy

hard

Normal flora in the orifice of the body

microorgani
sm

External
acoustic
meatus

Nasal
vestibule

urethr
a

vulva

Micrococci

(+)

(+)

(+)

(+)

Diphteroid

(+)

(+)

(+)

(+)

Staphylococc
us

(+)

Streptococcus

(+)

Mycobacteriu
m smegmatis

umbilic
al

(+)

Enterococci

(+)

Coliform

(+)

Staphylococc
us aureus

(+)

Streptococcus
Pyogenus

(+)

Histopathology of the skin

Histophatology
diagnosis

defenitive diagnosis
helpful in making

biopsy fixation processing

-punch
-scalpel

coloring
Histopathology
examination

 Histopathologic alteration :
Epidermis : hyperkeratosis, hypergranulosis,
akantosis, hyperplasia, hypoplasia,
atrophy, spongiosis, baloon
degeneration, etc.
Dermis :
papillomatosis, sclerosis,
fibrosis, etc.
Sub kutis : inflamation, degenerative
process,
tissue necrosis,
vasculitis.

Kulit Normal

Hiperkeratosis

Parakeratosis

Hipergranulosis

Akantosis

Celah suprabasal

Eksositosis, Spongiosis

Eksositosis

Spongiosis

Degenerasi balon

Pemanjangan rete ridge

Papilomatosis

Good Luck!