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					Integumentary System


   Analyze the Anatomy and Physiology of
   the skin
Integumentary system- the skin and its
appendages
   “the skin is much more than a simple boundary of the physical
    self, a simple frontier where the person ends and the outer
    environment begins. It is more than a mere enclosure that
    restrains our viscid interior from oozing out, thus guarding our
    integrity. It is also a custom house for multifarious incident
    influences, a sensitive radar alert to the subtlest perturbations of
    the ambience, a clearing house for impulses generated within the
    body or without, and a protective barrier, a living screen of
    unmatched efficiency, whose discernment fences in the good
    and sensory receptors, the skin is the focal point of aesthesia,
    the conscious faculty that contributes to the physical
    preservation, and, just as aptly the ascetical foes of sensuality, to
    our spiritual perdition and moral ruin.
   Frank Gonzalez-Crussi, reviewing “The body’s edge: our cultural
    obsession with skin”, by M. Lappe, Holt 1996
Components of the Integumentary System

   Skin
   Hair
   Nails
   Glands
Structure of Skin

   Skin has been called a membrane because it covers
    the body; Also called an organ because it contains
    several kinds of tissue; Most studies call it a system
    because it has organs and other parts that work
    together for a particular function.
   in terms of volume of tissue the skin is the largest
    organ of the body
   two main layers: the outer epidermis and the inner
    dermis. Deep to the skin are the supporting tissues
    that include adipose tissue (fat) and connective
    tissue layers called fascia.
Epidermis
   Outer Layer
   Made of five to six smaller layers
   Two main layers
   1) Stratum corneum
     Outermost of three epidermal layers where cells constantly shed

     Contains keratin

    2) Stratum germinativum
       provides cells to replace cells in the stratum corneum


   can be of different thicknesses and types: thick & hairless (eg:
    sole of foot); thin and hairy (eg: scalp)
Epidermis continued
   new cells formed in basal layer

   cells gradually migrate to surface

   shedding (desquamation) of surface cells

   pigmented cells: melanocytes

   Contains no blood vessels

   Contains no nerve cells
Dermis

    Also called dorium or true skin
    Inner Layer
   Has framework of elastic connective tissue
   Contains blood vessels, lymph vessels, Nerves,
    involuntary muscle, sweat and oil glands, and hair
    follicles.
   Top of the dermis is covered with papillae
       Fit into ridges on the stratum germinativum of the epidermis
       Ridges from lines or striations on the skin
       Pattern of ridges is unique for each individual
           Pattern is used for fingerprints and footprints
           Form a method of identification
Subcutaneous fascia or hypodermis

   Innermost layer of skin
   Made of elastic and fibrous connective tissue
    and adipose (fatty) tissue
   Connects skin to underlying muscles
Glands of Skin

   Sudoriferous glands
       Sweat glands
       Coiled tubes that extend through dermis
       Open on surface of the skin at an opening called
        a pore
       Eliminate sweat or perspiration that contains
        water, salts, and some body wastes
Glands of skin (con’t)

   Sebaceous glands
       Oil glands
       Usually open into a hair follicle
       Produce oil called sebum
           Keeps hair from becoming dry and brittle
           Antibacterial and antifungal secretion so it also helps
            prevent infection
           Blackhead or pimple occurs when oil gland becomes
            plugged with dirt and oil
Other Integumentary System Structures

   Hair
       Consists of a root that grows in a hollow tube
        called a follicle, and a hair shaft
       Helps protect the body
       Covers all body surfaces except for the palms of
        the hands and the soles of the feet
       Alopecia or baldness
           Permanent loss of hair on the scalp
           Genetic condition
           Common in men but can occur in women
Other structures con’t

   Nails
       Protects the fingers and toes from injury
       Made of dead keratinized epidermal epithelial
        cells, which are packed closely together to firm a
        thick dense surface
       Cells formed in nail bed
       Cells will regrow if lost (If the nail bed is not
        damaged)
Functions of Integumentary system

   Protection
       Barrier for sun’s ultraviolet rays
       Protects against invasion of pathogens or germs
       Holds moisture in and prevents deeper tissues
        from drying out
Functions con’t

   Sensory perception
       Nerves present in skin
       Respond to pain, pressure, temperature (heat &
        cold), and touch sensations
Functions con’t

   Regulation on body temperature
       Blood vessels in skin help body retain or lose heat
       Dilate: Blood vessels get larger and allow and
        allow excess heat to escape through the skin
       Constrict: Blood vessels get smaller and retain
        heat
       Sudoriferous glands also help to cool body
        through evaporation of perspiration
Functions Con’t

   Storage
       Skin has tissues for temporary storage of fat,
        glucose (sugar), water, vitamins, and salts
       Stores adipose tissue in the subcutaneous fascia,
        which is a source of energy
Functions Con’t

   Absorption
       Certain substances absorbed through the skin
       Examples: medications for motion sickness and
        heart, nicotine patches to stop smoking, pain
        patches, etc
           Transdermal medications
           Sticky patches placed on the skin
Functions Con’t

   Excretion
       Helps body eliminate salt, a minute amount of
        waste, and excess water
       Done through perspiration and sweat
Functions of Integumentary system con’t

   Production
       Skin helps in the production of Vitamin D
       Uses ultraviolet rays from the sun to form an initial
        molecule of vitamin D that matures in the liver
Skin Color

   Pigmentation
    Skin color is inherited and determined by pigments
    in the epidermis
    Melanin
         1) Brownish-Black pigment
         2) Leads to a black, brown, or yellow skin tint
    depending on racial origin
         3) Absorbs ultraviolet light to tan the skin
         4) Small concentrated areas of melanin pigment
    form freckles
Skin Color Con’t

   Carotene
       Yellowish-red pigment
       Also helps o determine skin color
Skin Color con’t

   Albino
       Absence of color pigments
       Skin has a pinkish tint
       Hair is pale yellow or white
       Eyes are red in color and very sensitive to light
Skin Color Con’t

   Abnormal Colors
   Erythema
       Reddish color
       Caused by burns or a congestion of blood in
        vessels
Skin Colors
Abnormal Colors con’t
   Jaundice
       Yellowish discoloration
       Can indicate presence of bile in blood as a result
        of liver or gallbladder disease
       Also seen in certain diseases that involve
        destruction of red blood cells
Skin colors
Abnormal colors con’t
   Cyanosis
       Bluish discoloration
       Caused by insufficient oxygen
       Associated with heart, lung and circulatory
        diseases



    Gray or brown discoloration; chronic poisonings
Skin Eruptions
   Macules (macular rash)
       Flat spots on the skin
       Example: Freckles
   Papules (papular rash)
       Firm raised areas
       Seen in pimples, stages of chicken pox and syphilis
   Vesicles
       Blisters or sacs full of fluid
       Seen in some stages of chicken pox
   Crusts
       Areas of dried pus and blood
       Commonly called scabs
   Wheals
       Itchy, elevated areas with an irregular shape
       Seen in hives and insect bites
   Ulcer
       Deep loss of skin surface that may extend into the dermis
       May cause periodic bleeding and formation of scars
Diseases and abnormal conditions
   Acne Vulgaris
     Inflammation of sebaceous glands

     Etiology unknown
           Usually occurs at adolescence
           Hormonal changes and increased sebum probably underlying
            causes
       Symptoms
           Papules, pustules, and blackheads
           Hair follicle becomes blocked with dirt, cosmetics, excess oil, and/or
            bacteria
       Treatment
           Frequent thorough washing of skin
           Avoid creams and heavy makeup
           Antibiotics or vitamin A ointments
           Ultraviolet light treatment
Disease’s and abnormal conditions con’t

   Athlete’s foot
   Contagious fungal infection, usually on the
    feet
   Symptoms: Skin itches, blisters, and cracks
    into open sores
   Treatment
       Antifungal medication
       Keep area clean and dry
Diseases and abnormal conditions con’t

   Dermatitis
       Inflammation of the skin
       Caused by any substance that irritates the skin
       Frequently caused by allergic reaction to detergents,
        cosmetics, pollen, or certain foods
       Contact dermatitis is caused by contact with poison ivy,
        poison sumac, or poison oak
       Symptoms: dry skin, erythema or redness, itching, edema,
        macular-papular rashes, scaling
       Treatment
           Eliminate cause especially if allergens
           Anti-inflammatory ointments
           Antihistamines and steroids
Diseases and abnormal conditions con’t

   Eczema
       Noncontagious inflammatory skin disorder
       Caused by reaction to allergen or irritant: diet,
        cosmetics, soaps, medications, and/or emotional
        stress
       Symptoms: dryness, erythema, edema, itching,
        vesicles, crusts and scaling
       Treatment: remove irritant and apply
        corticosteroids
Diseases and abnormal conditions con’t

   Impetigo
       Highly contagious skin infection
       Etiology: streptococci or staphylococci infection
       Symptoms: dryness, erythema, oozing, vesicles,
        pustules, formation of yellow crusts
       Treatment
           Wash lesions with soap and water to keep dry
           Topical and oral antibiotics
Diseases and abnormal conditions con’t

   Ringworm
       Highly contagious fungus infection of skin and
        scalp
       Symptoms: flat or raised circular area with clear
        central area surrounded by an itchy, scaly, or
        crusty outer ring
       Treatment: oral and topical antifungal medications
Diseases and abnormal conditions con’t

   Verrucae or warts
       Viral infection of the skin
       Form rough, hard, elevated, rounded surface on
        skin
       Some disappear spontaneously
       Other removed with electricity, liquid nitrogen,
        acid, chemicals, or laser
Disease’s & Conditions

   Psoriasis
       Chronic inflammatory skin disease
       Characterized by the development of dry reddish
        patches which are covered with silvery-white
        scales
       Usually found over the elbows, knees, shins,
        scalp, and lower back
       Unknown cause-can be triggered by stress,
        trauma or infection
       There is no definitive treatment
           Moisturizers help keep skin soft and prevent cracking
Conditions & Diseases

   Urticaria or Hives
   Recognized by the appearance of intensely
    itching wheals or welts. These welts have an
    elevated, usually white center
       Usually a response to an allergen, such as an
        ingested drug or food
       Complete avoidance and elimination of the
        causative factor(s) alleviate the problem
       Antihistamines (ex: Benadryl) can provide
        temporary relief
Diseases & Conditions

   Boils or carbuncles
       painful
   Bacterial infection of the hair follicle or
    sebaceous gland (staphylococcus organism)
   If a boil becomes more extensive or deeply
    embedded, it is called a carbuncle
   Treatment requires antibiotics and excision
    and drainage of the affected area
Diseases & Conditions
   Herpes
   Viral infection that is usually seen as a blister
       Most common types:
       Herpes simplex
           Occurs around the mouth
           Known as a fever blister or cold sore
       Genital herpes
           Occurs as a blister in the genital area
           Spread through sexual contact
           No cure-treatment is with acyclovir
       Herpes zoster (Shingles)
           Virus infection of the nerve endings
           Commonly seen on the chest or abdomen
           Painful
           Treatment consist of pain medication, itching medication and protecting the area
Diseases and abnormal conditions con’t

   Cancer
   Skin cancer has been associated with exposure to ultraviolet light and scientists
    are cautioning people to limit their exposure to direct sunlight. Skin cancer is the
    most common type of cancer in people.
   Occurs in different forms
       Basal Cell carcinoma-most common; least malignant
       Squamous cell carcinoma-grows rapidly and metastasizes to the lymph nodes
       Malignant melanoma-occurs in melanocytes; metastasizes quickly
   Frequently develops from a mole or nevus that changes in color, shape, size or
    texture
   Bleeding or itching of mole can also indicate cancer
   Causes
       Exposure to sun
       Prolonged use of tanning beds
       Irritating chemicals
       Radiation
   Treatment
       Surgical removal
       Radiation therapy
Burns

   Burns occur as the result of radiation from the
    sun (sunburn), a heat lamp, or contact with
    boiling water, steam, fire, chemicals, or
    electricity.
   When skin is burned, dehydration and
    infection may occur-either condition could be
    life threatening.
Burns

   RULES OF NINES
   Measures the percent (%) of the body
    burned: the body is divided into 11 areas and
    each area accounts for 9% of the total body
    surface.
       For example, the entire arm is 9%; the perineal
        area accounts for 1%
Burns

   First Degree Burns
   Involve only the epidermis
   Symptoms are redness, swelling, and pain
   Treatment consists of the application of cold
    water
   Healing usually occurs within 1 week
   Will not leave a scar
Burns

   Second degree Burns
   May involve the epidermis & dermis
   Symptoms include pain, redness, swelling and
    blistering
   The skin may also be exposed to infection
   Treatment may include pain medication and dry
    sterile dressings applied to the open skin areas.
   Healing generally occurs within 2 weeks
   May or may not scar
Burns

   Third degree burns
   Involves complete destruction of the epidermis,
    dermis, and subcutaneous layers.
   Symptoms include loss of the skin, eschar
    (blackened skin), yet possibly no pain.
   May be life threatening depending on the amount of
    skin damaged & body fluids lost
   Treatment consist of the prevention of infection,
    contracture, and fluid replacement. Skin drafting is
    done as soon as possible.
   Will scar
Skin Lesions

   Pressure Ulcer/Decubitus
   Also known as bedsores
   Are preventable
   Decubitus ulcers form on pressure points over
    bones such as the spine, coccyx, hips, elbows and
    heels
   The constant pressure against the area causes a
    decrease in blood supply there and thus the tissue
    begins to decay.
   Decubitus ulcers are prevented by frequent changes
    in position
Skin Lesions

   Decubitus
   Stage I involves surface reddening, but the
    skin is unbroken
       Treatment is to relieve the pressure
   Stage II is characterized by blisters that are
    either broken or unbroken. The surrounding
    area is red and irritated.
       Treatment is to protect and clean the area and
        alleviate pressure
Skin lesions

   Decubitus continued
   Stage III presents with skin breaks through all layers
    of skin.
       Primary site for infection
       Medical treatment is necessary to prevent infection and
        promote healing.
   Stage IV ulcers have an ulcerated area that extends
    through the skin and involves the underlying
    muscles, tendons and bones.
       This can produce a life-threatening situation
       Treatment is with surgical removal of necrotic (dead) or
        decayed area and antibiotics. Sometimes the wound will
        require skin grafting

				
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