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4 skin.ppt - Dr Magrann

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					    “SKIN”

Integument System
•   Now everything so far has been just an
    introduction. Now Anatomy class begins!
•   We’ll discuss the organ systems of the body one
    by one.
•   For each system, we’ll discuss its function, the
    individual organs, its tissues, and clinical
    significance.
Integument System


    •   Integument System
        • Organs
           • Skin
           • Hair
           • Nails
           • Glands
Integument System

    •   Functions
         •   Protection
               •   Abrasion
               •   Infection
               •   UV light
               •   Dehydration
         •   Thermal Regulation
               • Insulation (fat keeps you warm)
               • Cooling (sweating cools you down)
         • Sensory Reception
         • Vitamin D Production
         • Communication (raised eyebrows)
    NOTE
    Vitamin D is made in the dermis of the skin, after exposure to sunlight. It’s function is to allow
    calcium to be absorbed from the foods you eat so your blood calcium levels are normal.
The Skin and the Hypodermis


    Skin – our largest organ
       • Accounts for 7% of body weight…it weighs twice
           as much as your brain!
       •   Divided into three distinct layers
            • Epidermis (‘epi” means above something)
            • Dermis
            • Hypodermis (“hypo” means deep to something)

    Remember, the term “SKIN” refers to all three
    layers: epidermis, dermis, and hypodermis.
Skin Structure




                 Figure 5.1
EPIDERMIS
• Primarily made up of keratinized stratified
  squamous epithelium
• The EPIDERMIS is the layer that gives strength to
  the skin.
• Varies in thickness from a few cells (eyelids) to
  dozens of cells thick (palms and soles of feet)
• It does not have any vascularization (blood supply),
  so it relies on absorbing oxygen and nutrients from
  the blood vessels in the dermis deep to it.
• The nails are made in the epidermis.
Layers of the Epidermis


    •   Stratum corneum (most superficial layer of
        epidermis)
    •   Stratum lucidum (only in thick skin)
    •   Stratum granulosum
    •   Stratum spinosum
    •   Stratum basale (the deepest layer of epidermis)
Epidermal Cells and Layers of the Epidermis




                                              Figure 5.3
STRATUM BASALE: has 3 types of cells
  •   The cell type that makes the epidermis is a
      KERATINOCYTE
      • Keratin is a protein made by these cells.
      • Keratin is waterproof and strong
  •   MELANOCYTES produce MELANIN (dark brown
      pigment)
      • Everyone has the same number of melanocytes
      • But they don’t all make the same amount of pigment, so
         people have different skin colors.
  • MACROPHAGES (Merkel cells): ingest and destroy
      dead cells, foreign debris, bacteria.
STRATUM BASALE:
  •   This is the only layer of the epidermis where the cells
      are dividing.
  •   As new cells are made in the S. Basale, the older cells
      get pushed up and become the next layer (S.
      Spinosum)
Epidermal Cells and Layers of the Epidermis




                                              Figure 5.3
STRATUM SPINOSUM
  •   They are now attached to each other by
      desmosomes, which are pointy/spiny
      (“spinosum”)
  •   The cells are still alive, but they no longer divide
      in this layer
  •   The stratum spinosum provides the strength to the
      epidermis
Epidermal Cells and Layers of the Epidermis




                                              Figure 5.3
STRATUM GRANULOSUM
 •   As more new cells are made in the S. basale, the
     S. spinosum layer is pushed up to become the S.
     granulosum layer.
 •   The cells in the S. granulosum begin to die
     because they are now too far from nutrient
     source (in dermis).
 •   The cells now have a grainy appearance, so this
     layer is called the stratum granulosum.
KERATIN
• Keratin is a waxy protein substance only found in the
  epidermis. It makes up the nails, hair, and is also in
  each superficial skin cell.
• It can absorb water, so keratin swells when soaking
  wet. It makes the skin look wrinkled when you are in
  the tub too long.
• The water evaporates when you dry off, and pulls
  more water out of your body, so soaking in the tub will
  dry your skin out…unless you put lotion on right away
  to keep the water in the epidermal and dermal layers.
  Lotions will not penetrate to the dermis, just water.
Epidermal Cells and Layers of the Epidermis




                                              Figure 5.3
STRATUM CORNEUM
  •   As more new cells are made in the S. basale, the cells are all pushed
      up again, and the S. granulosum layer becomes the S. Corneum.
  •   In this layer, the dead cells fill up with KERATIN.
  •   The cells lose their nucleus and fuse to squamous (flat) sheets,
      which are eventually shed from the surface. This process is called
      desquamation.
  •   The main difference between thick skin and thin skin relates to
      the thickness of the Stratum corneum.
  •   It takes about 6 weeks for a cell to move from the stratum basale to
      the distal edge of the stratum corneum and shed
  •   We lose half a million cells per hour; 1.5 grams a day
  •   That can be a major source of dust in the house
  •   Dust allergies are actually from the feces and saliva of dust mites
      which eat the dead skin. One house has 3 million poops per day
      from dust mites!
Epidermal Cells and Layers of the Epidermis




                                              Figure 5.3
STRATUM LUCIDUM

 This layer is only on the palms
      and soles
 It is just deep to the S. corneum
      and superficial to the S.
      granulosum

 This THIN layer provides
     protection from UV radiation.
•   Why do black-skinned people have lighter colored
    palms and soles?
•   Only the Stratum Basale has pigment-containing
    cells, but the stratum lucidum contributes the color
    of protein, which is an orange- tan color.
•   In the palms and soles, the stratum lucidum is
    present. The tan colored protein blocks the
    underlying melanocytes from view.
Conditions of the Epidermis


     •   If you frequently rub one area of the skin, it stimulates cell
         division = callous
     •   If you rub the skin too hard, the stratum basale
         tears away from the basement membrane, and
         causes a gap, which fills with fluid: BLISTER.
     •   The epidermis then dies because it’s too far away
         from nutrients. That’s why the top of a blister
         dries up.
  If the blisters are small (less than 5
  mm in diameter), they are known as
  vesicles; if they are larger (greater
  than 5 mm in diameter), they are
  termed bullae.
Vesicles
Bullae
Conditions of the Epidermis


    Skin Cancer:
    • This is the most common cancer in the USA, and
       the major risk factor of all skin cancers is
       exposure to ultraviolet light.
    Three major types:
    1) BASAL CELL CARCINOMA
    2) SQUAMOUS CELL CARCINOMA
    3) MELANOMA


    The second most common type of cancer is lung cancer.
    The least common (of the common cancers) is leukemia.
Conditions of the Epidermis


    1)   BASAL CELL CARCINOMA: Cancer of the
         blood vessels in the dermis.
    •    The most common type of skin cancer, accounts
         for about 75% of the skin cancers.
    •    Almost never metastasizes or crosses the
         basement membrane, so is almost never fatal.
    •    It is the most easily cured: surgical removal, no
         chemotherapy or radiation usually needed.
    •    Symptoms are minor: shiny nodules, usually on
         nose, face, or other sun exposed areas.
Conditions of the Epidermis


                              1)   BASAL CELL
                                   CARCINOMA:
                                   Cancer of the blood
                                   vessels.
                              •    Almost never
                                   metastasizes or
                                   crosses the basement
                                   membrane
                              •    Looks like shiny
                                   nodules

                                                    Figure 5.11
Basal Cell carcinoma
Reconstructive Surgery for Basal Cell Carcinoma
       •     Basal cell
             carcinoma,
             when left
             untreated.

This 74-year-old man developed an
enlarging tumor on his left medial canthus 3
years ago. He had been unable to wear his
glasses for two years and sought medical
attention when this tumor offended other
members of his church. Ulceration,
crusting, and drainage developed recently.
The tumor was 12 centimeters in diameter,
malodorous, and draining a foul serous
fluid. Surgical excision was easier than
expected, because the tumor was attached
by a pedicle which spared the orbit.
Conditions of the Epidermis


    2) SQUAMOUS CELL CARCINOMA
    •    25% of all skin cancers
    •    Will metastasize if not treated.
               Actinic Keratosis
 • A premalignant condition of thick, scaly,
   or crusty patches of skin.
 • It is more common in fair-skinned
   people, in sun-exposed areas of skin.

20% of these lesions
progress to squamous
cell carcinoma.

They begin as flat, dry,
scaly areas, and later
grow into tough, wart-like
lesions.
Conditions of the Epidermis


 3) MELANOMA: cancer of the melanocytes of the
    epidermis; least common (about 1% of skin cancer)
 • Highly metastatic, causes 75% of skin cancer deaths.
 • Asymmetrical, sharp but irregular borders and edges
 • Not uniform in color.
The warning signs in moles: ABC's:
A is for Asymmetry, where one side of the mole
  looks different than the other side.
B is for Border, where the border is jagged or
  irregular instead of smooth and regular.
C is for Color, where the mole contains more than
  one color.
•   The medical term for a mole = nevus (plural =
    nevi)
•   The medical term for a freckle or any other
    pigmented area that is flat and does not stick
    upwards from the skin = macula
Conditions of the Skin



         • Eczema
           • Atopic dermatitis
           • Contact dermatitis
         • Seborrheic dermatitis
         • Psoriasis
         • Vitelligo
Eczema


   •   Itchy red skin that comes and goes.
   •   Caused by an autoimmune reaction.
   •   The most frequently occuring form of eczema is
       ATOPIC DERMATITIS.
Atopic dermatitis


    •   Triggered by allergens like soaps, cosmetics,
        clothing, detergents, jewelry, or sweat.
    •   Can be triggered by changes in weather or stress.
    •   Tends to run in families.
    •   Treatment is lubricant creams daily and steroid
        creams during outbreaks.
Contact dermatitis


 •   Localized reaction from
     an allergy to something
     you touch.
 •   Common allergens are
     plastic shoes, latex gloves,
     detergents, perfume,
     makeup, jewelry, etc.
 •   People with a history of
     allergies are more likely to
     get contact dermatitis
     from these objects.
Contact Dermatitis
Seborrheic dermatitis


    •   In Children, it is called “Cradle Cap”
    •   In Adults, it is called severe dandruff
    •   Caused by an allergy to the fungus that we all have
        around our hair roots.
    •   The skin cells proliferate in an attempt to shed the
        fungus. The results is severe dandruff that does not
        respond to regular dandruff shampoo.
    •   Treatment is shampoo with ketoconazole (steroid)
        or coal tar. Usually works for one year, then you
        have to switch to another product for a year, then
        switch back.
Seborrheic dermatitis
Psoriasis


    •   An autoimmune disease of the skin (the body’s
        immune system thinks the skin is foreign so it
        attacks it).
    •   Causes silvery flaking of skin, especially knees,
        elbows, scalp.
    •   It is not itchy
    •   There are treatments, but no cure.
    •   Treatments include shampoo with coal tar or
        steroids.
Psoriasis
•   Laser
    treatment
    for psoriasis
    lesions
Vitelligo


        • An autoimmune disease of the skin
        • Destroys melanocytes, especially in areas of
            friction (eyelids, mouth, hands)
        •   Causes depigmentation.
DERMIS:
1) PAPILLARY LAYER (Papillary = “Pimple”.
  Has bumps)
2) RETICULAR LAYER
Dermis




         Figure 5.1
Dermis


   1) PAPILLARY LAYER (Papillary = “Pimple”. Has
      bumps)
   • The papillary layer of the dermis; LOOSE connective
      tissue.
   • Has ridges to increase surface area for contact with the
      epidermis
   • The papillary layer in the DERMIS is what forms our
      fingerprints.
   • Surgeons make incisions on the body based on the lines
      of cleavage of the skin formed by the papillary layer of
      the DERMIS
Skin lines of cleavage
Lines of cleavage
Dermis




         Figure 5.1
Dermis
   2) RETICULAR LAYER
   • DENSE IRREGULAR Connective Tissue
   • Gives the dermis its strength.
   • Remember, the epidermis is the strongest layer of the
     SKIN, but the reticular layer of the dermis is the
     strongest layer of the DERMIS.
   • This layer has lots of COLLAGEN and ELASTIN
     (elastic fibers)
   • The DERMIS is where most of the body’s
     collagen is found.
   • Stretch marks are caused from tiny tears in the
     collagen of the DERMIS.
   • Leather is made of this layer.
•   The dermis is also the area where all the glands
    of the body are located.
•   A transdermal patch (nicotine patch, etc) must
    diffuse all the way from the epidermis into the
    dermis to reach the blood vessels there.
•   The blood vessels in the dermis are what gives a
    pink color to Caucasian people.
Dermis Conditions


    What happens when you get cut?
    • Bleed, then clot
    • Macrophages eat foreign bodies and dead cells
    • Fibroblasts lay down collagen to repair the wound.
      If they produce more than normal, you get a
      SCAR.
    • If skin is cut with the grain, scar is not bad.
      Against the grain, the scar is worse.
    • Some people are more prone to scar tissue than
      others.
Keloid Scars


    Keloid Scars
    • Thick, red, sometimes painful scars
    • More common in African American, Native
      American, and Asian races
    • Treatment with cortisone injections
    • Keloid scar formers can get internal adhesions also
Keloid Scars
•   Another type of scar tissue is called an adhesion.
•   This is scar tissue in the deeper layers of the body,
    such as right outside of the intestines, outside of
    the ovaries, etc.
•   Some people form adhesions spontaneously from
    the organs rubbing against each other.
•   If the adhesions cause symptoms, they might need
    a surgery to clean them away.
•   Here are some photos of deep tissue adhesions.
Cutting the adhesions away
Dermis Conditions


    Stretch Marks
    • Caused by sudden weight gain (pregnancy)
    • Expansion of skin, collagen fibers in the dermis
      separate = stretch marks.
Do Lasers Remove Stretch marks?

    Claim
    • Lasers are used to stimulate new collagen growth and fill the stretch
       mark from the bottom up. The laser energy is absorbed in the dermal
       layer of the skin stimulating the production of new collagen. As the
       new collagen thickens and plumps the skin, it fills in the stretch mark
       from below.

    Rebuttal
    • Although some physicians claim that lasers are effective in removing
      stretch marks, the American Medical Association states that there is
      no evidence to support this. Most plastic surgeons think that lasers
      are ineffective in treating this problem.
    • Lasers are effective in removing, vaporizing, and breaking down
      tissues. They do not generally repair tissues. Stretch marks represent
      torn tissue. Hence, improvement should not be expected from laser
      treatment. Moreover, clinical studies have shown no improvement in
      stretch marks after laser treatment.
Scurvy

 • Scurvy is a disease resulting from a deficiency of
     vitamin C, which is required for the synthesis of
     collagen in humans.
 •   The chemical name for vitamin C, ascorbic acid,
     is derived from the Latin name of “scurvy”.
 •   Scurvy often presents itself initially as symptoms
     of malaise (feeling ill) and lethargy (very tired),
     followed by formation of spots on the skin and
     pale, bleeding gums.
Scurvy

    •    Spots are most abundant on the thighs and legs, and a
         person with the ailment looks pale.
    •    As scurvy advances, there can be open, suppurating
         (“weeping”) wounds, loss of teeth, and can go on to be
         fatal.
Scurvy

    •    Scurvy was at one time common among soldiers
         and sailors who were unable to obtain perishable
         fruits and vegetables.
    •    Most animals can make their own vitamin C, so
         they don’t get scurvy.
    •    Vitamin C is destroyed by the process of
         pasteurization, so babies fed with ordinary bottled
         milk sometimes suffer from scurvy if they are not
         provided with adequate vitamin supplements.
    •    Virtually all commercially available baby
         formulas contain added vitamin C for this reason.
•   Foods high in vitamin C
•   Citrus fruits such as oranges or lemons,
    blackcurrants, guava, kiwifruit, papaya, tomatoes,
    bell peppers, and strawberries.
•   It can also be found in some vegetables, such as
    carrots, broccoli, potatoes, cabbage, spinach and
    paprika.
HYPODERMIS:
• This is the fat layer. It varies tremendously in
  thickness: Shins = thin; Buttocks = thick.
Functions
• 1) Stores fat
• 2) Cushions
• 3) Insulation from cold because of heat produced
  by blood vessels in this layer.
Dermis




         Figure 5.1
Hypodermis Conditions


    •   Hypodermis is not connected to the muscle under it.
        Therefore, exercising muscle will not burn off fat only in
        that area. Fat is burned off equally over entire body.
        Losing 10 lbs is like loosing ¼” off whole body. More
        noticeable in face than in hips.
    •   By the way, there’s no such thing as cellulite. The term
        was invented by marketers. It is NOT a special type of fat.
        It’s just fat, the same as every other fat. It looks like
        wrinkled, “orange peel” skin because the collagen fibers on
        top of it bind it down like a net. There is no such thing as a
        cream to get rid of adipose.
    •   (Don’t confuse cellulite with cellulose, a plant fiber)
Cellulite is just fat, protruding around fascia fibers
LIPOSUCTION
• This is a surgical procedure where the patient has
  fat sucked out of the hypodermis layer.
• Liposuction is dangerous because hypodermis is
  very vascular, can bleed too much.
BURNS: Three types:
• FIRST DEGREE: Minor burn to the epidermis; sunburn
• SECOND DEGREE: Dermis separates from epidermis;
  blister
• THIRD DEGREE: Hypodermis is burned. (most severe
  type of burn)

•   2˚ and 3˚ burns over a large part of the body gives a
    survival chance proportional to the amount of skin left.
    60% burn = 60% chance of dying.
Estimating Burns Using the Rule of Nines




                                           Figure 5.10a
Third Degree Burn
Why are deep burns so dangerous?
1) Infection
2) Dehydration: nothing to keep fluid in body.
   • Therefore, they need a skin graft.
   • Skin grafts can be from a cadaver, animal,
       artificial, or from another part of the same person’s
       body.
   •   Skin grafts cause lots of scarring.
Skin graft
mesher
DECUBITUS ULCERS (bed sore)
• Epidermis is destroyed, underlying tissue is exposed.
• How decubitus ulcers form:
• If you’re sitting down, weight of the body presses against blood
  vessels, no blood flow to skin of buttocks. In you, it’s ok,
  because you’ll be walking around again in a half hour. But if it
  goes on longer than a couple of hours because one can’t move,
  tissues can’t get oxygen. Ulcer forms, can get gangrene (tissue
  death).
• It can also become systemic (bacteria enter the wound, travel in
  the blood), which can cause death. Whose fault is it? The
  nurse’s, for not moving the patient every couple of hours.
Decubitus Ulcers
Cellulitis
    •   Cellulitis is a localized or diffuse inflammation of connective tissue with
        severe inflammation of dermal and subcutaneous layers of the skin.
    •   Cellulitis can be caused by normal skin flora (bacteria) or by exogenous
        bacteria, and often occurs where the skin has previously been broken: cracks in
        the skin, cuts, blisters, burns, insect bites, surgical wounds, intravenous drug
        injection or sites of intravenous catheter insertion.
    •   Skin on the face or lower legs is most commonly affected by this infection,
        though cellulitis can occur on any part of the body.
    •   The mainstay of therapy remains treatment with appropriate antibiotics, and
        recovery periods last from 48 hours to six months.
SKIN COLOR; Caused by four things:
1) MELANIN: (dark brown pigment). More melanin, darker
   the skin.
2) CAROTENE: (a yellowish/orange pigment found only in
   plants). Accumulates more in the skins of Asians and
   Native Americans.
3) SKIN THICKNESS: thinner skin see blood vessels, looks
   pinker
4) HEMOGLOBIN: The DERMIS contains the blood
   vessels that give Caucasians the pink color to the skin.
   Even veins are red because blood is red. But when you
   look at veins through the adipose layer (the hypodermis),
   they look blue.
Carotene


    Dietary sources of carotene (These are also high in
      Vitamin A)
    • sweet potatoes
    • carrots
    • cantaloupe melon
    • mango
    • apricots
    • spinach
    • broccoli
CONTUSION: “Bruise”
• Why does a bruise look black and blue? The vessels in
  the hypodermis are ruptured, and the blood leaks out;
  looks blue. As it ages, the hemoglobin breaks down to a
  green color, then a yellow color.
• The color of the bruise depends on the age of the bruise.
CYANOSIS: Bluish color to skin.
• Caused by superficial blood vessel constriction in
   the dermis or lack of blood flow to skin
• Occurs for two reasons:
1) Cold
2) Not enough oxygen in body to go around. The
   oxygen is conserved for the vital organs, so
   oxygen to skin and nails is shut down.
Cyanosis
WRINKLES
• Over time, collagen fibers align themselves more and more
  as they are always being pulled in the same direction:
  smile, frown.
• As you age, the skin begins to sag because the body makes
  less elastin. Pinch your grandma’s skin. Does it bounce
  back, or ooze back?
• What can be done about wrinkles? Not much. A face lift
  clips off extra skin.
• Creams don’t work. Trying to fix a collagen problem with
  a cream is like trying to shampoo your carpet by putting the
  cleaner on the roof!
BOTOX
• This is a deadly poison which paralyses the
  muscles, making them sag.
• That releases the tension, and relaxes the skin line.
• In 3 months, new muscle cells are made, so
  wrinkles come back, and need new injection.
Botox Before and After: scam photos; the patient was told to
crinkle the eyes in the “before” shot.
Botox Before and After: realistic photos
COLLAGEN INJECTION
• Collagen is injected into hypodermis.
• Can last a couple of years.
MOISTURIZER CREAMS
• The secret ingredient of all moisturizers is
  WATER. They work superficially on the
  epidermis. Although keratin is waterproof, it
  swells when wet.
• So, if you put a moisturizer on skin, stratum
  corneum expands, and hides wrinkles.
• You get the same effect by soaking in the tub and
  putting on any lotion, and that’s cheaper than
  expensive creams.
TATTOOS
• Pigment is injected into the dermis. If the needle is
  sterile, there’s no health risk.
• However, the pigment diffuses with time. What
  looks good in your 20’s will look like a blob when
  you’re 50.
• Laser treatment is just burning the ink out of the
  dermis; may leave a scar. Depending on the color
  of the tattoo ink, it may only cause it to fade.
Laser Tattoo Removal
Laser Tattoo Removal
Laser Tattoo Removal
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Hemangioma


   •   Hemangioma: enlargement of the lining of
       blood vessels
   •   Laser treatment works well
Strawberry Hemangioma
Laser treatment of blood vessel problems
HAIR
  HAIR
  • There are about 2 million hairs on the body;
    200,000 on the scalp.



Arrector
pillae                                             Hair root


                                              Hair
             Hair papilla                     matrix
Longitudinal Section of Base of Follicle




                                           Figure 5.5c, d
•   ARRECTOR PILLI: tiny muscles that make the hairs stand
    up during “goosebumps”.
•   HAIR PAPILLAE: what is destroyed by electrolysis, so
    hair won’t grow back.
•   The HAIR MATRIX is the leading edge of the papillae. It
    is actually skin cells (keratinocytes) which are rapidly
    dividing. When they die, the new ones push them out,
    forming the hair. Hair is just dead skin cells. The HAIR
    ROOT is just the base of the hair.
•   The hair matrix is the part of the follicle that is the site of
    hair growth and the location of the melanocytes that
    determine hair color.
•   Hair that goes grey has lost its melanin pigment.
Hair Loss


    •   Hair loss in men and women is due to the presence
        of a male hormone (an androgen) called DHT.
    •   Men who have gene for baldness show male
        pattern baldness.
    •   Women who have the baldness gene don’t have as
        much of the male hormone; they just get thinning
        of the amount of hair.
    •   Women get the baldness gene from their father,
        and men get the gene from their mothers.
    •   A man can tell if he will go bald by looking at his
        mother’s father.
Hair Loss


    •   Hereditary hair loss and premature greying are
        some of the most common genetic conditions.
    •   Hereditary baldness, in men also known as male
        pattern baldness, is not exclusively a male
        concern.
    •   An estimated 25% of women suffer from female
        pattern baldness but, since their hair loss is
        diffuse, it is not as easily recognizable as the male
        form.
Life Cycle of Hair


    •   For most hair loss treatments to be effective, the
        hair's growth phase has to be interrupted and the
        hair shed.
    •   Only the new budding hair that comes out of a hair
        follicle after a short resting period can be of
        noticeably better quality than its predecessor.
    •   This replacement can sometimes come in a shock
        wave called shedding and it is frequently
        misunderstood by hair loss sufferers as a negative
        reaction to the new treatment and so the treatment
        is then discontinued.
Life Cycle of Hair

   •The life cycle of hair is divided into three phases. The
   actively growing (anagen) phase, the transitional
   (catagen) phase and the resting (telogen) phase.
   •Growth phase: 3-6 years, growing 10mm a month.
   About 85% of the hair on any head at any given time is in
   the growth phase.
   •At the end of this period, blood supply to the hair bulb
   slows down and eventually stops.
   •As a result, the hair ceases to grow and moves into the
   transitional phase, which lasts only about two weeks.
   •Resting phase:,hair just sits on the head for about three
   months. Then, it falls out, to be replaced by the next
   budding hair in the growth phase which begins to grow
   from the same hair follicle.
Life Cycle of Hair

   •These replacement hairs get finer and thinner due to an
   increase in an androgen hormone (DHT) as a person
   ages.
   •In most settings of baldness, the hair follicle finally shuts
   down and refuses to produce more hair to replace the
   ones that have fallen out.
   •Good treatment enables you to maintain the hair you
   have remaining. The maximum improvement you can
   expect is to regain the hair you have lost in the last three
   years.
   •Do not wait for too long. The later you start treating the
   baldness, the less successful your treatment will be. Do
   not let your follicles die. You need at least the vellus hair
   (peach fuzz) to start with.
Hair Loss Medicines

 •   Current antiandrogen modes of action include
     • (a) preventing the creation of DHT
     • (b) preventing DHT from binding to the receptor site
     • (c) blocking activity in the androgen receptor itself.
 •   There are two FDA-approved oral medicines for
     treating hair loss: Finasteride (Propecia) and
     Minoxidil (Rogaine).
Hair Loss Medicines
 •   Finasteride (Propecia)
 •   It is the first and only FDA-approved pill proven to
     treat male pattern hair loss on the vertex and middle
     front of head.
 •   The great majority of dermatologists agree that this is
     currently the No.1 cure for hair loss.
 •   In tests, 66% of men grew hair in back and 42% grew
     hair up front. Almost all the rest stopped losing hair.
 •   It cannot be used by women.
 •   Dutasteride is another pill that may be receiving FDA
     approval soon. It appears to be at least as powerful as
     finasteride, but it is more expensive.
Hair Loss Medicines

    • MINOXIDIL (Rogaine) comes as a pill and a topical foam that are
        both used by the patient. It is available over the counter.
    •   Minoxidil is a vasodilator that was originally used to treat severe blood
        pressure. Its bizarre side effects, such as the ability to reverse or slow
        down the balding process, were accidentally discovered in the late
        1970s.
    •   Minoxidil promotes enhanced follicular size, resulting in larger hair
        shaft diameters. It also stimulates and prolongs the growth phase of the
        hair growth cycle. It takes 4 months to notice results
    •   Rogaine's effectiveness is established in front and back for women but
        only in back (vertex) for men.
    •   After 1 year of use, 48% reported moderate to dense re-growth of hair,
        36% reported minimal re-growth, and 16% reported no re-growth.
    •   Once started, topical minoxidil treatment is a lifetime commitment if
        the treatment proves effective. If regular application of topical
        minoxidil is halted, all hair grown in response to the therapy will be
        rapidly lost over the next 3 to 6 months.
Hair Loss Medicines

    •   SPIRONOLACTONE is a diuretic used to lower
        high blood pressure. In addition, it possesses anti-
        androgenic properties as it binds to the androgen
        receptor in the hair follicle and thus prevents it
        from interacting with DHT.
    •   Hence, spironolactone is also used to treat acne,
        hirsutism (excess body hair) and hair loss in
        women.
    •   It is not for oral use by men, because it causes
        impotence, loss of sex drive, and breast
        development.
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Split end of hair
Head louse
Eyelash Mite
Eyelash Mites
Chemotherapy causing hair loss


    •   Chemotherapy causes hair loss because the drugs
        target any cell that is rapidly dividing.
    •   Since the hair roots divide rapidly, they are killed
        off along with the cancer cells.
    •   The stomach lining is also rapidly dividing, so
        they also get nausea.

    •   Fun fact: Men without hair on their chests are
        more likely to keep the hair on their head, but are
        more likely to get cirrhosis of the liver. Men with
        hairy chests are more likely to go bald.
Electrolysis


    •   Electrolysis involves sticking a fine wire into the follicle
        and administering an electrical current to kill the hair
        papillae.
    •   Treatments are repeated weekly for up to 18 months.
    •   Hair follicles that are in the telogen phase are more
        difficult to destroy than hair follicles in the anagen phase.
    •   Shaving approximately 3 days before an electrolysis
        treatment ensures that the hairs that are visible and
        encourage them to enter into the anagen phase.
    •   Finally, side effects can include pain, infection, keloid
        formation (for people who are susceptible),
        hyperpigmentation, or hypopigmentation.
•   Piebaldism: a rare autosomal dominant disorder of
    melanocyte development, causing a congenital
    white patch of hair.
•   HAIR FOLLICLES
Fun Fact: How does heat straighten hair?

    •   There are three types of bonds that make up hair.
        Salt bonds are broken by heat. When the heat hits
        the hair the salt bonds break. When the hair cools
        the bonds rebuild themselves in its new shape.
    •   Chemicals can be applied to hair to straighten it or
        to curl it. The chemicals break the stronger bonds
        in the hair and cause the bonds to reform in the
        desired position.
    •   Coloring hair strips the color from the shaft and
        replaces it with a dye. The new color may fade
        with time.
Structures Associated With Hair Follicles


    1.   SEBACEOUS GLANDS
         1. Found all over the body
         2. Produce sebum (oil that coats the hair and epidermis)
             When you wash it away, the skin gets dry. The best moisturizer
               is lanolin, which is made from sheep sebum.
PIMPLES
•   Some of the largest sebaceous glands are associated with
    the smallest hairs (face).
•   Pimples begin when oil gland ducts (sebaceous glands)
    become blocked by viscous (thick) sebum and the gland
    swells.
•   The sebum in the gland is exposed to oxygen and turns
    black, called a blackhead.
•   The black part of a blackhead is oxidized sebum.
•   In puberty, there is an increase in hormones, and an
    increase in gland secretion, leading to pimples.
•   Pimple
Sebaceous and Sweat Glands




                             Figure 5.1
•   Skin - Acne and skin aging:
• http://www.skintactix.com/free_radical_damage.htm
• http://www.skintactix.com/acne_&_premature_skin_aging.htm
Acne Vulgaris


    •   Acne develops as a result of blockages in hair
        follicles.
    •   Hyperkeratinization and formation of a plug of
        keratin and sebum (a microcomedo) is the earliest
        change.
    •   Enlargement of sebaceous glands and an increase
        in sebum production occur with increased
        androgen (DHEA-S) production at adrenarche.
    •   The microcomedo may enlarge to form an open
        comedone (blackhead) or closed comedone
        (milia).
                                              136
Acne Vulgaris


    •   Comedones are the direct result of sebaceous
        glands' becoming clogged with sebum, a naturally
        occurring oil, and dead skin cells.
    •   In these conditions, the naturally occurring largely
        commensal bacterium Propionibacterium acnes
        can cause inflammation, leading to inflammatory
        lesions (papules, infected pustules, or nodules) in
        the dermis around the microcomedo or comedone,
        which results in redness and may result in scarring
        or hyperpigmentation.

                                                137
Clinical Manifestations
•   Closed comedone (Whitehead): when a pore clogs
    up beneath the skin and closes.

•   Open comedone (Blackhead): when a pore clogs up
    and reaches the surface of the skin, but stays open.

•   Papules: inflamed, tender lesions that pop up as
    small, pink bumps on the skin.



          ► Pustules:  pimples topped by
             white or yellow pus-filled lesions.

          ► Cysts  and nodules - large,
             inflamed, pus filled lesions deep
             under the skin that can cause
             pain and scarring.
             Acne Vulgaris Lesions
 Lesions can be described in 3 categories, as
  follows:

  1. Comedonal:
     The open comedo appears as a flat or
      slightly raised lesion with a central dark-
      colored follicular impaction of keratin and
      lipid.                                         Open comedone (blackhead)




     The closed comedo is a pale, slightly
      elevated, small papule without a visible
      orifice and is a potential precursor for the
      larger inflammatory lesions.

                                                     Closed comedone (whitehead)
Acne Vulgaris Lesions (con’t)

2. Inflammatory: Inflammatory lesions
   vary from small papules with an      Inflammatory
   inflammatory areola to pustules to
   large, tender, fluctuant nodules
   (nodular).




3. Scars: These appear as depressed
                                        Scars acne
   or hypertrophic papules of varying
   sizes and shapes.
Acne Vulgaris: Cause
   •   GENETIC
       • The tendency to develop acne runs in families.
   •   PSYCHOLOGICAL
       • It is associated with increased stress levels
   •   DIETARY
       • A high glycemic load diet is associated with
         worsening acne. There is also a positive association
         between the consumption of milk and a greater rate
         and severity of acne. Other associations such as
         chocolate and salt are not supported by the
         evidence. However, products with these ingredients
         often contain a high glycemic load.
   •   HORMONAL                                   141
Acne Vulgaris: CAUSE


    •   HORMONAL CAUSES
    •   Hormonal activity, such as menstrual cycles and
        puberty, may contribute to the formation of acne.
    •   During puberty, an increase in male sex hormones
        called androgens cause the follicular glands to
        grow larger and make more sebum.
    •   Use of anabolic steroids may have a similar effect.




                                               142
Acne Vulgaris


    •   Development of acne vulgaris in later years is
        uncommon, although this is the age group for
        rosacea, which may have similar appearances.
    •   True acne vulgaris in adult women may be a
        feature of an underlying condition such as
        pregnancy and disorders such as polycystic ovary
        syndrome or the rare Cushing's syndrome.




                                             143
Acne Vulgaris


    •   Menopause-associated acne occurs as production
        of the natural anti-acne ovarian hormone estradiol
        fails at menopause.
    •   The lack of estradiol also causes thinning hair, hot
        flushes, thin skin, wrinkles, vaginal dryness, and
        predisposes to osteopenia and osteoporosis as well
        as triggering acne (known as acne climacterica in
        this situation).




                                                144
Propionibacterium acnes


    •   When a pore is blocked, P. acnes, an anaerobic
        bacterium, overgrows and secretes chemicals that
        break down the wall of the pore and form an acne
        lesion (folliculitis).
   •    This leads to the possible spilling of
        bacteria such as Staphylococcus aureus
        into the broken skin.
   •    Preliminary research shows healthy pores are
        only colonized by P. acnes while unhealthy
        ones universally include the non-pore-resident
        Staphylococcus epidermidis, amongst other
        bacterial contaminants.
                                                     145
Propionibacterium acnes


    •   Under normal conditions, P. acnes is beneficial: creates
        low pH skin environment hostile to pathogens.
    •   P. acnes can be killed by benzoyl peroxide, tetracyclines ,
        Clindamycin, azithromycin, Fluoroquinolones such as
        nadifloxacin, ciprofloxacin, ofloxacin and levofloxacin.
    •   These are normally prescribed 500 mg by mouth, three
        times weekly for 4 to 6 weeks.
    •   There are also many antibacterial preparations, including
        clove oil, PCMX, and chlorhexidine gluconate.
    •   Tetracycline-resistant P. acnes is now quite common.



                                                      146
BOILS (Furuncles)
• Unlike pimples, boils are caused by bacteria that
  enter a gland and invade into the hypodermis.
• They are local infections that swell to a size that is
  larger than pimples.
• They are not blackheads.
Boil
•   Most boils run their course within four to ten days. For
    most people, self-care by applying a warm compress or
    soaking the boil in warm water can help alleviate the pain
    and hasten draining of the pus ("bringing the boil to a
    head").
•   Once the boil drains, the area should be washed with
    antibacterial soap and bandaged well.
•   In serious cases, prescription oral or topical antibiotics are
    used.
2. NAILS
• The EPIDERMIS gives rise to the nails.
• The nails are made of keratin (no collagen or
   calcium)
• Taking calcium won’t make the nails any stronger
   because there is no calcium in keratinocytes.
• At the nail matrix, there is rapid division of
   keratinocytes (cells that make keratin), and as they
   die, the skin moves up and creates the nail.
Structure of a Nail




   The proximal nail fold creates the cuticle. The cuticle is
   called the eponychium. The white half-moon visible under
   the proximal part of a fingernail is the lunula.
                                                         Figure 5.9
GLANDS
• ECCRINE (MEROCRINE) SWEAT GLANDS.
• APOCRINE GLANDS
    • PUBIC HAIR GLANDS
    • MAMMARY GLANDS
•   CERUMINUS GLANDS
1.   ECCRINE (MEROCRINE) SWEAT
     GLANDS. These are found all over the body,
     and produce a watery secretion which evaporates
     and cools the body.
-Fun Facts: A pair of human feet contains 250,000 sweat
     glands.
-There is about one trillion bacteria on each of your feet.
-Your body gives off enough heat in 30 minutes to bring half
     a gallon of water to a boil.
Sebaceous and Sweat Glands




                             Figure 5.1
•   Anhidrosis: Lack of sweat glands
•   Hyperhydrosis: Excessive sweating

•   Microwave removal of sweat glands
•   http://miradry.com/patients/what-miradry-solution
2.   APOCRINE GLANDS are associated with
     pubic hairs in the axilla and pubic region, as well
     as the mammary glands.
     The ones associated with pubic hairs produce a
     secretion to coat the hairs.
     The hairs function as a wick to draw the
     secretions to the surface.
     These glands also produce a type of protein (a
     hormone once it is inhaled) known as a
     PHEROMONE.
• Pheromones function for sexual attraction.   There
  is no conscious odor. The smell from the axilla is
  from bacteria that are attracted by the gland.
  Expensive perfumes have pheromones. Guess
  where they get them from? The anal glands of
  male cats! They are designed to attract females.
  They are used so women will buy expensive
  perfume.
• Pheromones also function to regulate menstrual
  cycles of females. If you put several women in one
  room for months, their menstrual cycles will all
  start to occur at the same time.
3. MAMMARY GLANDS are apocrine glands.
   They secrete milk. Each breast has dozens of
   glands with their own duct to the surface in the
   nipple and areola. In a woman who is not
   lactating, the majority of tissue is adipose. To
   change the size of breasts, lose or gain weight!
4. CERUMINUS GLANDS are only found in the
   ear, and they produce wax.
  • They keep the ear canal from drying out
  • They discourage insects from crawling in; they
     don’t like walking on the wax.
GLANDS


  Summary
  • EXOCRINE GLANDS secrete substances into a
    duct that leads to the surface of the skin or into a
    lumen.
  • ENDOCRINE GLANDS secrete hormones into
    the blood. They are ductless.
  • A GOBLET CELL is a unicellular gland that
    secretes mucus.
  • A PLASMA CELL is a type of blood cell that
    secretes antibodies. We’ll talk more about that
    when we get to the cardiovascular system.
CANCER


Cancer starts out as a
mutation in one gene
in one cell. Then the
mutated cell starts
dividing itself rapidly
and taking over the
whole area.
Cancer
Cancer


    •    LEUKEMIA is a cancer in blood-forming cells.
    •    LYMPHOMA is a tumor developing in lymphatic
         tissues.
    •    CARCINOMA is a tumor developing in any part
         of the epithelium.
    •    MELANOMA is a tumor developing in the
         pigment-producing cells of the skin.
    •    SARCOMA is a tumor developing in muscles,
         bones, organs, and connective tissues.
Cancer

    CHARACTERISTICS OF CANCER CELLS
    • 1. LACK DIFFERENTIATION
    • Normal cells have specialized functions, but cancer cells do not
      differentiate and do not contribute to the function of the body.
    • 2. ABNORMAL NUCLEI
    • They have large or multiple nuclei with mutated chromosomes.
    • 3. FORM TUMORS
    • Cancer cells grow and divide rapidly until they accumulate and form a
      lump of cancer cells called a tumor. A BENIGN tumor is an
      accumulation of non-cancerous cells because they stay in their own
      capsule (encapsulated) and do not invade.
Cancer
Cancer


    •    MALIGNANT tumors are cancerous cells that spread
         and invade.
Cancer

    4. ANGIOGENESIS (INDUCE BLOOD VESSEL
       FORMATION)
    • Since these tumors need nutrients, they create new blood
       vessels just for them to feed on.
    5. METASTASIZE
    • Pieces of the tumor break off and travel in the bloodstream
       to any new location, invade nearby tissues and continue
       their massive cell division and growth there. If there is a
       tumor in the lung, it is biopsied (the doctor surgically takes
       out a piece). If the cells are lung cells, it is lung cancer. But
       if the cells are pancreas cells, it is pancreatic cancer that
       has metastasized.
NUMBER OF
  CANCER
 CASES BY
 SITE AND
    SEX
Cancer

    ORIGIN
    • There are many factors that play a role in the development of cancer,
      including heredity factors, carcinogens, and mutagens.
    • CARCINOGEN is an environmental agent that contributes to
      cancer
    • Examples of a carcinogen are ultaviolet radiation, toxic chemicals,
      and viruses.
    • MUTAGEN is an agent that increases chances of DNA change or
      mutation. Examples are x-rays and some medicines (thalidimide;
      caused birth defects).
Cancer


    1. CARCINOGENS
    • a) RADIATION is from overexposure to
       sunlight.
    • b) ORGANIC CHEMICALS include tobacco,
       foods (salted pork), and pollutants
    2. HEREDITY
    • Particular types of cancers run in families, such as
       breast, lung, and colon cancer.
Cancer
  DIAGNOSTIC PROCEDURES
  • PAP SMEARS detect cervical cancers. They just swab the
    cervix and look at the cells under a microscope.
  • MAMMOGRAMS are diagnostic procedures to detect
    breast cancer. The breast is just placed on a special type of
    machine like an x-ray.
  • 20% of breast cancers are not detected by mammogram and can
    only be detected by ultrasound.
  • Those at high risk for breast cancer should get an MRI instead of
    a mammogram, since the x-ray might induce cancer.
  • COLONOSCOPY is a diagnostic procedure to detect colon
    cancer. A scope is inserted into the rectum so the doctor can
    look for polyps.
Cancer


    The American Cancer Society says the following are signs of
      cancer: C-A-U-T-I-O-N
    • Change in bowel or bladder habits (colon cancer)
    • A sore that does not heal (skin cancer)
    • Unusual bleeding or discharge
    • Thickening or lump in breast or elsewhere (breast cancer)
    • Indigestion or difficulty swallowing (GI system cancer)
    • Obvious change in wart or mole (skin cancer)
    • Nagging cough or hoarseness (lung cancer)
PREVENTION OF CANCER

   1. BEHAVIORS

   • DON’T smoke, sunbathe, drink alcohol, or get too many
       x-rays. Smoking cigarettes is associated with many
       types of cancers, including cancer of the lung, larynx,
       throat, and urinary bladder.

   •   DO be tested (self-breast exams and testicular self-exams
       every month, and Dr. check-ups), be aware of chemical
       hazards at work, and be aware that using estrogen for
       menopause symptoms must be combined with
       progesterone, otherwise there is an increased risk of
       cancer.
PREVENTION OF CANCER

   2. DIET
   • Avoid fats, salty, smoke-cured, pork, and pickled foods.
   • Eat plenty of fiber, green leafy vegetables and fruits, and eat cabbage,
      broccoli, Brussels sprouts, and cauliflower, vitamins A and C.

   • For more information on smoke-cured meat, read the articles posted at
      the bottom of our Lecture Unit 1 webpage.

   PREVENTION OF SKIN CANCER:
   • A. use broad-spectrum sunscreen
   • B. stay out of the sun altogether from 10-3
   • C. wear protective clothing
   • D. wear sunglasses
   • E. do not use tanning machines
TREATMENT OF CANCER


  1. RADIATION
  • When someone has surgery to remove a tumor, it is often
     followed by radiation because the cancer cells may have
     spread throughout the body. Cells that are in the process
     of dividing are the most likely cells to be killed by
     exposure to radiation. Since cancer cells are always in the
     process of dividing, exposing them to x-rays may kill
     them. The x-ray beam is coned down so just the tumor is
     exposed. However, scatter radiation kills off other cells
     that rapidly divide (stomach lining and hair follicles), so
     the side effects include baldness and nausea.
TREATMENT OF CANCER


  2. CHEMOTHERAPY
  • This is for cancer that has metastasized. It is also
     good for cancer of the blood (leukemia). The
     drugs are designed to specifically kill just the
     cancer cells, but it tends to also kill off the normal
     blood cells that are just being formed in the bone
     marrow. Thus, bone marrow transplants are also
     needed sometimes.
TREATMENT OF CANCER


  3. BONE MARROW TRANSPLANTS
  • Someone needs to volunteer to donate a small
     piece of bone from the crest of their hip. This bone
     marrow will contain healthy new blood cells that
     can repopulate the depleted bone marrow of the
     sick person. These cells are injected into the sick
     person’s vein.
TREATMENT OF CANCER


  4. IMMUNOTHERAPY
  • Blood cells are taken from the sick person and are
     fused with an antibody that is specifically
     designed to seek out and destroy the cancer cell.
TREATMENT OF CANCER


  5. GENE THERAPY
  • This is new research, attempting to find a gene
     that will shrink tumors.
TREATMENT OF CANCER


  6. COMPLEMENTARY THERAPIES
  • This involves natural healing therapies such as
     biofeedback, acupuncture, and exotic foods. It’s
     worth a try if you’re going to die!

				
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