DERMATOLOGY

EMERITA C. MENDOZA, R.N., M.D.

 The Integumentary System
• The integumentary
system is composed
of the:
– Skin
– Appendages

• Largest organ of the

body
 Functions of the
Integumentary system
• Gives shape to the body
• Protects the body from injury
• Serves as a barrier to infection
• Sensory reception
• Thermoregulation
• Maintenance of water balance
 The SKIN: 3 divisions
• 1 – Epidermis
• 2 – Dermis
• 3 – Hypodermis
or Subcutaneous
Tissue
• The epidermis is the
external covering of the
body, whereas the dermis
& subcutaneous tissue
lie immediately beneath
the epidermis.
 The EPIDERMIS
• Composed mainly of 4 layers:
> stratum corneum: outermost
> stratum granulosum: lucidum in thick
skin
> stratum spinosum
> stratum basale

• Nerves: found in the epidermis, which

function for pain and temperature sensation

• Blood vessels: Avascular

 Epidermis:
1st layer = stratum basale or germinativum
 Epidermis: 1st layer
• stratum basale/ stratum germinativum
• mitotically active basal layer
• protein keratin
• source of new epidermal cells, which
gradually move upward
• epidermis is renewed every 15-30 days
• presence of melanocytes and Merckel cells

• Psoriasis results from the increased proliferation of

cells from this layer, resulting in a thicker epidermis
with continuous rapid turnover.
 Epidermis: 2 layer nd

• stratum spinosum
• mitotically-active
• bound together by spiny-looking desmosomal
junctions
• Spines are desmosomes that promote
adhesion of epidermal stress
• Langerhans cells present
 Epidermis: 3 layerrd

• stratum granulosum
• acts as the impermeable epidermal
sealant
 Epidermis: 4 layer th

• stratum corneum
• OUTERMOST layer
• most superficial
• flat, squamous
keratinocytes
• cornified (keratinized)
cells
• oldest keratinocytes
 Epidermis: stratum lucidum
• stratum lucidum
• transitional zone
• flat, pale-staining keratinocytes
• anucleated cells
• found only in thick skin
Epidermal Cell Types (4)
• 1 – Keratinocytes

• 2 – Melanocytes

• 3 – Langerhans

• 4 - Merckel
Keratinocytes

• most numerous
(85%)
• secrete keratin
• provides the barrier
function of the
epidermis
 Melanocytes

• found in the dermis

and basal layer of
the epidermis
• produce melanin
• protect from UV
 Langerhans cells
• members of the immune system, and
functioning as antigen-presenting cells.
Found in stratum spinosum.

Merckel cells
• found in the basal layer and appear
associated with sensory nerve fibers,
functioning as mechanoreceptors.
 The DERMIS
• layer beneath or internal to the epidermis
• thicker than the epidermis
• loose connective tissue, mainly collagen
and elastic and reticular fibers
• blood vessels
• nerves
 Functions
• Provides pliability, elasticity, and tensile strength
• Binds water
• Aids in thermal regulation
• Increased receptors for sensory stimuli
 Subcutaneous Tissue
• Consists mostly of adipose tissue
• Contains larger blood vessels and nerves
• May contain the base of hair follicles and
sweat glands
• Functions: caloric reserve, heat insulator,
shock absorber
 Skin Appendages
• Sweat glands
• Sebaceous glands
• Hair
• Nails
Sweat glands – 2 types
• Eccrine: < 0.5mm
diameter
• found anywhere
except penis
• secretion contains
protein,
NaCl, urea, NH3,
uric acid
• Function in
thermoregulation
Sweat glands – 2 types
• Apocrine: 3-5mm in
diameter
• Modified sweat gland
• found in the axillary,
areolar, anal regions

• open up into hair follicles

• secrete odor-producing
discharges called
“pheromones”
• functional at puberty
 Sebaceous or Oil glands
• secrete sebum
• anywhere except on the palms
and soles
• lubricate hair follicles & skin
surface and prevent
dessication
• functional at puberty
• accumulation & obstruction of
sebum  whitehead
(comedo) & blackhead (dead
cells with melanin)
• rupture of sebaceous gland
duct + sebum + bacteria  red
papules (pimples) and
pustules (lesions with pus)
 Hair
• arises from hair
follicles which are
epidermal
invaginations

• Associated arrector pili

muscle causes
“goosebumps”
Nails
• like hair, are modified
stratum corneum
• keratin of nails is harder
than that of hair
• stratum basale of the nail
area continuously
proliferates and rapidly
keratinizes
• white cuticle of nails is
called eponychium
• nail root – region with
special epithelial cells
 nail body
• nail bed – area of
keratinization
• cuticle – fold of skin
that hides nail root
• lunula – area of thick
germinal area
 Meissner’s corpuscles
• present in the dermal
papillae
• surrounds nerves
• connective tissue
capsules
• function as
mechanoreceptors
for fine touch
 
Pacinian corpuscle
• found within the
dermis and
hypodermis
• surround nerves and
look like onions
• function as
mechanoreceptors
for pressure &
vibration.
 First-degree burns
• red and painful affect the epidermis
only (e.g. sunburn).
Second-degree burns
• characterized by
blisters and pain, reach
through the epidermis
to parts of the dermis
(e.g. minor burns from
fires)
Third-degree burns
• damage all layers of the skin,
including appendages, blood
vessels, and nerve endings.
• The destruction of nerve
endings is the reason why
severe burns are not painful.
 Management of Burns
• Treatment for all burns starts with removing all
clothes and substances touching the skin, and
copiously irrigating all chemical burns with water.

• Eye burns require up to 8 hours of flushing. All

burn patients should be up to date with tetanus
prophylaxis
• Second- and third-degree burn patients must
have their calculated fluid loss volumes
replaced.
 Management of Burns
• First-degree burns are managed merely by
keeping them clean.
• Second-degree burns require the removal of
the blisters, and application of antibiotic
ointment such as silver nitrate or silver
sulfadiazine or mafenide or betadine, and
then dressing. Removal of much burn tissue
is termed debridement.
• Third-degree burns, however, necessitate
excision of the eschar and split-thickness
skin grafting. Although minor burns are
dressed with sterile bandage, major burns are
not.