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The Integumentary System image (Pathology connection: (Diseases of the…
The Integumentary System
Integumentary system is comprised of skin and its accessories including hair, nails, and associated glands
The system is the most exposed system
Integumentary system performs several vital functions:
Stores fatty tissue for energy supply
Produces vitamin D (with help from sun)
Balances fluid levels
Provides sensory input
Protection from pathogens
Helps to regulate body temperature
The skin
Largest organ weighing approximately 20 pounds and covering area about 20.83 square feet on an adult
Three layers
Dermis
Layer below the epidermis
Contains the following:
Capillaries
Vasodilation causes blushing
Involuntary muscle
Nerve endings
Allows for one to sense the environment
Collagenous/elastic fibers
Makes skin elastic, preventing tearing with movement; allows the skin to return to normal while resting; loss of elasticity in older people causes wrinkles
Lymph vessels
Hair follicles
Sebaceous glands
Sudoriferous glands
Two main types
Apocrine sweat glands secrete at hair follicles in groin and anal regions as well as armpits; become active during puberty and are believed to act as sexual attractants
Eccrine glands are found in greater numbers on palms, feet, forehead, and upper lip; are important in the regulation of temperature
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Small "fingers " of tissue project surface and anchor layer to epidermal layer
Finger and toe prints arise from this layer
Subcutaneous fascia
Epidermis
Layer of skin we see on the outside; made up of five or six even smaller layers of tissue
There are no blood vessels or nerve endings in this layer (called avascular)
Outermost layer is layer of dead cells, called stratum corneum, which are flat, scaly, keratinized epithelial cells
You slough off 500 millions cells every day or about 1.5 pounds of dead skin a year allowing for rapid repair in case of injuries
Cells on the surface are constantly shedding, being replaced with new cells that grow and arise from deeper region called stratum basale every 2-4 weeks
Cells are also born in the basal layer (it is also called stratum germinativum)
Skin coloration
Melanocytes
Located deep in the epidermis and are responsible for skin color
Melanocytes produce or make melanin (this is the substance that usually affects skin color)
All people have the same number of melanocytes
There are different colors or variations of skin color because of the amount of melanin that is produced and how it is distributed
Carotene is another form of skin pigment that gives yellowish hue to skin
Albinism is where there is very little pigment in one's skin, hair, and eyes
d/t inherited gene that does not allow body cells to produce the usual amounts of melanin
Many visual problems, greater risk of cancer
Nails
Specialized epithelial cells originating from nail root (germinal matrix) form nails
As cells grow out and over nail bed, they become keratinized forming substances similar to horns on a bull (process occurs as cells dry and shrink and are pushed to the surface and filled with keratin
Cuticle is fold tissue that covers nail root
Portion that we see is called nail body
Sterile matrix is a layer of cells that helps the nail body to stick to the nail bed
Pink color of nail comes from vascularization of tissue under nails while white (half-moon shaped area or lunula is result of thicker layers of cells at base
Hair
Body hair is normal and serves important purposes
Helps to regulate body temperature and functioning as sensor to help detect things on skin such as bugs or cobwebs
Eyelashes help to protect eyes from foreign objects while hair is in nose helps filter out particulate matter
Visible hair composed of fibrous protein called keratin
Hair you see is called shaft with root extending down into dermis to follicle
Follicle is formed by epithelial cells with rich source of blood provided by dermal blood vessels
Cells divide and grow in base of follicle, older cells are pushed away and die, so shaft of hair is comprised of dead cells
Shaving or cutting hair doesn't make it grow quicker or thicker
There is a sebaceous gland associated with each hair follicle, secreting sebum that coats hair follicle and works its way to skin's surface to prevent drying of hair, acting as anti-bacterial, and lubricating hair shaft
Sebum production decreases with age, explaining why older people have drier skin and more brittle hair
Alopecia is term for any type of hair loss and can be acute or chronic
Some forms, such as male pattern baldness, do not represent a disease, but are inherited traits
Hair loss can also be a result of chemotherapy for cancer treatments, hormonal imbalances, scale infections, severe emotional or physical stress, or side effects of other medications
Pathology connection:
Skin color and disease
Color of skin can indicate disease
Bronze color may indicate adrenal gland disease, malfunctioning adrenal gland can cause skin to produce excessive amounts of melanin
Bruised skin (ecchymosis) could indicate skin, blood, or circulatory problems
Yellow skin (jaundice) may indicate liver disease
In liver disease body cannot break down bilirubin
Yellowish color may also be seen in whites of eyes
Buildup of bilirubin gives skin yellow color
Herpes
Lifelong infection that produces clusters of small fluid-filled sacs (vesicles/blisters)
Signs and symptoms usually come and go; there are periods of remission and exacerbation
Stress and other diseases can temporarily decrease immunity and lead to symptom flares
Types
Herpes zoster
Causes extremely painful blisters/rashes that follow course of a sensory nerve
Symptoms develop when stress, disease, trauma, or aging prevent immune system from keeping virus in check
Last up to 10 days or more
Also known as shingles
Develops when dormant chickenpox virus re-activates
Herpes simplex
Type 1
Causes "cold sores" or "fever blisters" around mouth or nose
Commonly develops after common cold or fever
Type 2
Causes genital herpes
Spread by direct contact
Most contagious when in active stage; however can be spread during remission
Acyclovir (zovirax) is used to treat outbreaks
Herpes varicella
Can be spread by airborne particles or direct contact- highly contagious
Vesicles can be found on face, trunk, and extremities
Associated with intense itching
Also known as chickenpox
Vaccine given to children; if children do get it after the vaccine- light case
Human Pipilloma Virus (HPV)
Causes warts (verruca); hypertrophy of keratin cells in skin
Types
Plantar warts
Found on sole of foot
Tend to grow inwards
Can cause pain when walking
Have relatively smooth appearance on surface
Treatment: removal by surgery or freezing
Genital warts
Some types of HPV have been associated with cervical cancer
Recently developed vaccine may help prevent cervical cancer associated with certain types of HPV
Sexually transmitted and highly contagious
Common warts
Spread by scratching and direct contact
Often disappear on their own
Usually found on children's hands and fingers
Tinea
General term for fungal skin infections
Usually located in warm moist regions of body
Signs and symptoms: cracking, weeping, and itching skin
Can be a chronic condition
Types
Tinea cruris (jock itch)
Fungal infection of groin and scrotal areas
Mainly affects men
Aggravated by increasing perspiration and tight fitting shorts/pants/undergarments
Tinea corporis (ringworm)
Fungal infection of smooth skin on arms, legs, and body
There is no actual worm involved
Appearance: red, ring-shaped structure with pale center
Tinea pedis (athlete's foot)
Spread by direct contact with contaminated surfaces (like locker room floors)
Most commonly develops in warm moist area between toes
Fungal infection of foot
Tinea unguium
Fungal infection under finger or toenails
If untreated, results overgrown and thick nails with white/brittle appearance
Cellulitis
Infection of skin and subcutaneous tissue
Caused by staphylococcus
Can lead to life-threatening situations like endocarditis or even septicemia
Source of infection often wound of some kind
Lyme disease
Bacterial infection spread around by deer tick bites
Signs and symptoms:
"Bull's eye" rash: red circle with lighter center; often very first presenting sign of infection; appears few days to several weeks following tick bite
Flu-like symptoms, fever, and chills
Malaise
Joint inflammation
If untreated, can lead to neurological/cardiovascular problems and arthritis
Diagnosis: blood test can confirm presence of infection
Burns
Can be caused by heat, chemicals, electricity, or radiation
Two factors affect assessments of damage:
Depth
Depth of burn relates to layer or layers of skin affected by burn
Amount of area changed
Four degrees
Second degree burns involve entire depth of epidermis and portion of dermis
Scarring in second degree burns is common
Burn without an open blister run under cool water, dry burn carefully (avoid breaking blister) and apply a dry, sterile dressing; take Motrin to help with pain
Open blister should be covered with a dry sterile bandage
Extent of blistering dependent on depth of burn
Blistering extends after initial burn
Blisters heal within 10-14 days if there are no complications, with deeper second degree burns taking 1-3 1/2 months
Symptoms include redness, pain, and blistering
First degree burns damage only outer layer or epidermis
Pain subsides in 2-3 days; there is no scarring
Complete healing takes about 1 week
Symptoms include redness and pain but no blister
Third degree burns affect all three layers of skin
Patient feels no pain because pain receptors are destroyed
Also destroyed are sweat and sebaceous glands, hair follicles, and blood vessels
Fluid replacement, antibiotics, and skin grafting
Surface of burn has leathery feel and will range in color from black, brown, tan, red, or white
Fourth degree burns are worst burns
Destroy tendons and muscle
Rule of nines to estimate extent of area damaged by burns
Body divided into following regions, each given percentage of body surface value:
Back of trunk and buttocks: 18%
Front of legs: 18%
Front of trunk: 18%
Back of legs: 18%
Each upper limb: 9%
Perineum: 1%
Head and neck: 9%
Penetrate bone and causes bone damage
Clinical concerns for burn victims relate to functions of skin:
Fluid loss
Heat loss
Bacterial infections
Severe burns require healing steps at severe intensity level- body cannot manage on its own
Fluids, antibiotics, tetanus, hyperbonic oxygen treatment
Damaged skin must be removed as soon as possible and skin grafting must be started
Autografting is using patient's own skin, while heterografting is required if patient suffered large area of burn and has little healthy skin to graft
Grafting requires many trips to or because large areas cannot be done all at once and often grafts don't take
It is possible to grow sheets of skin tissue in laboratory from patient's cells or utilization of synthetic materials
Lice
Lice infestation is called pediculosis
They insect parasites that live on scalp/skin
Lice spread by direct contact with infested person or infested objects (hair brushes, etc)
Types:
Body lice: result of poor personal hygiene and can carry disease
Pubic lice: spread through sexual contact; also known as "crabs"
Head lice: extremely common; checked for in schools
Treatments
Bathing or shampooing with medicated shampoo; shampoo eliminates lice and their eggs (called "nits")
Thorough cleaning of all bedding, towels, clothing hats, combs, and hairbrushes (alternatively, these items can be discarded)
Scabies
Tiny mite that burrows into skin to lay eggs
Transmitted via direct contact with infected individual
Mites typically lodge in folds of skin (wrist, undergarment, groin, under breasts, etc)
Without treatment cycle develops
Eggs are laid under skin
Eggs hatch in 3-5 days and young mature in 2-3 weeks
Mites mate and start process over again
Treatment: specially formulated cream is applied to skin
Symptoms: intense itching, vesicles, and pustules
Skin lesions
Pathologically altered piece of tissue
Types:
Nodule: larger papule
Vesicle: small fluid filled sac (blister)
Papule: solid,elevated area on skin
Bulla: large vesicle
Wheal (urticaria): localized evanescent elevation of skin that is often accompanied by itching
Pustule:pus-filled lesion
Macule: discolored spot on skin
Ulcer: eating or gnawing away of tissue
Scale: thin, dry flake of cornified epithelial cells
Fissure: crack-like slit that extends through epidermis into dermis
Crust: dry, serous, brown, yellow, red, or green exuadation
Diseases of the Integumentary System
Abrasion
Signs and symptoms: loss of skin surface integrity, redness, swelling, inflammation
Diagnostic tests: visual examination
Etiology: mechanical removal of skin tissue
Treatment: proper cleansing technique, removal of any foreign matter, antiseptic, bandage if necessary
Acne
Signs and symptoms: inflammation of hair follicles/sebaceous glands especially on face, neck, chest, upper back/ shoulders; can form blackheads, cysts, nodules, pustules, and pimples
Diagnostic tests: visual examination
Etiology: metabolic condition, allergies, various drugs, or endocrine disorders are possible causative agents
Treatment:
Mild: proper cleansing techniques and OTC treatments
Severe: proper cleansing techniques including prescribed medications, antibiotics, steroids, and all-trans retinoic acid
Decubitus ulcer (pressure ulcers; bedsores)
Signs and symptoms: red, inflamed, crater-like lesion usually located over bony prominence
Diagnostic tests: visual inspection, culturing of site for infection
Etiology: tissue injury resultant of unrelieved pressure placed upon a specific area
Treatment: preventative measures such as turning and padding important; treat infection of the sore
Boil (furuncle)
Signs and symptoms: inflammation, localized encapsulated pus-filled lesions, painful affected site; carbuncles are a large abscess- composed of several furuncles
Diagnostic tests: visual examination, site culture
Etiology: staphylococcus bacteria
Treatment: proper antiseptic cleansing techniques, antibiotics, application of warm moist heat, depending on the severity, may require draining
Eczema
Signs and symptoms: skin inflammation, redness, vesicles, scales, crusting, pustules
Diagnostic tests: visual examination, history
Etiology: genetic predisposition to allergies (in infants it may include reaction to milk/dairy products, other foods), stress
Treatment: no true cure, reduce stress, topical corticosteroidal creams, skin moisturizers, antihistamines
Folliculitis
Signs and symptoms: small pustules that form around base of hair follicle
Diagnostic tests: visual examination, site culture
Etiology: bacteria (usually staphylococcus)
Treatment: proper daily cleansing with antiseptic cleanser, oral antibiotics (chronic or severe cases)
Hives (urticaria)
Signs and symptoms: itchy wheals surrounded by red inflamed area; can cover most of body
Diagnostic tests: visual examination, patient history
Etiology: allergic reaction to external agent such as bee stings, plants, temperature extremes, sunlight, or internal agents such as foods, food additives, medication, antibiotics, or specific disease conditions
Treatment: antihistamines, allergen avoidance
Malignant melanoma
Signs and symptoms: brown or black irregular patch that appears suddenly; a color or size change in a preexisting wart or mole may also be an indication
Diagnostic tests: biopsy
Etiology: occurs in melanocytes, excessive exposure to the sun
Treatment: surgical removal and the surrounding area; chemotherapy
Psoriasis
Signs and symptoms: red skin with silvery patches, rapid replacement of epidermal cells, dry cracking skin with crusting, can be painful; common to have periods of remission then exacerbation; may be arthritic component
Diagnostic tests: visual examination, patient history
Etiology: possible genetic basis with attacks being triggered by emotional stress, illness, sunlight, or skin damage
Treatment: supportive, skin applications to deal with symptoms; medications: steroids and UV light
Keloid
Etiology: tissue trauma or surgical incision
Signs and symptoms: overproduction of collagen during tissue repair often creating larger structure than original scar/ traumatized area
Diagnostic tests: visual inspection
Treatment: surgical removal but there is a great potential for keloids to grow back
How skin heals
Everyone has skin injuries from time to time
If skin is punctured and wound damages blood vessels, wound fills with blood; blood contains substances that cause clotting; top part of clot exposed to air hardens to form scab, nature's Band-Aid, forming barrier and preventing pathogens from entering
Next, the inflammatory process kicks in and white blood cells enter and destroy any pathogens, while fibroblasts come and begin pulling edges of wound together; basale layer hyper-produces cells for repair of wound
If wound is deep, scar, composed of collagen fibers, develops; scars don't contain any accessory organs or nerve endings; stitches, adhesive strips (butterflies), or special glue reduce scarring
Note, wound ideally starts to heal from inside out; this aids in preventing pathogens from becoming trapped between healed surface and deeper layer of skin where they could develop into pocket of infection
Temperature regulation
Integumentary system plays major role in regulation of body's temperature
Part of regulation of temperature is accomplished by changes in size of blood vessels
Vasodilation exposes heated blood to external cooling air
Vasoconstriction keeps cooling of blood to minimum when it's cold outside
Sweat glands excrete water onto skin's surface allowing cooling through evaporation; requires adequate hydration to continue to produce sweat
By the time you feel thirsty you're already dehydrating; you can potentially secrete 12 liters of sweat in a 24 hour period
Shivering causes muscle activity that produces heat to warm you when you're cold
Hairs on skin stand erect when arrector pili muscles contract; known as goosebumps; these hairs create dead space insulating you from cooler surroundings, like a goose down jacket
Pharmacology
Transdermal patches
Allows medication to be slowly absorbed over time
Examples:
Nitroglycerin (a heart medication)
Birth control
Nicotine (for smoking cessation)
Placed on skin in morning and left in place for 24 hours (or more)
Topical creams
For skin irritation: mild prescriptions stop itching; more powerful prescriptions containing corticosteroids work as local anti-inflammatory agents; because cream is not fully absorbed into bloodstream
Antifungal: treat fungal infections like ringworm and athlete's foot
Anti-viral: used to treat herpes and other viral skin infections
Antibiotic: used to treat bacterial infection; can also be used to prevent wound from being infected
Medicated shampoos: useful in treating lice and dandruff (excessive dry scalp with sloughing skin)
