Skin anatomy and physiology

Skin anatomy and physiology

year 1

year 1

Introduction to the immune system
Cytokines
Innate immune system
Complement system
T-cell development
B-cell development
MHC class I and MHC class II molecules
T-cell activation
B-cell activation, differentiation, and contraction
Cell-mediated immunity of CD4 cells
Cell-mediated immunity of natural killer and CD8 cells
Antibody classes
Somatic hypermutation and affinity maturation
VDJ rearrangement
Contracting the immune response and peripheral tolerance
B- and T-cell memory
Anergy, exhaustion, and clonal deletion
Vaccinations
Type I hypersensitivity
Type II hypersensitivity
Type III hypersensitivity
Type IV hypersensitivity
Sepsis
Neonatal sepsis
Abscesses
Food allergy
Anaphylaxis
Asthma
Immune thrombocytopenia
Autoimmune hemolytic anemia
Hemolytic disease of the newborn
Rheumatic heart disease
Myasthenia gravis
Graves disease
Pemphigus vulgaris
Serum sickness
Systemic lupus erythematosus
Poststreptococcal glomerulonephritis
Graft-versus-host disease
Contact dermatitis
X-linked agammaglobulinemia
Selective immunoglobulin A deficiency
Common variable immunodeficiency
IgG subclass deficiency
Hyperimmunoglobulin E syndrome
Isolated primary immunoglobulin M deficiency
Thymic aplasia
DiGeorge syndrome
Severe combined immunodeficiency
Adenosine deaminase deficiency
Ataxia-telangiectasia
Hyper IgM syndrome
Wiskott-Aldrich syndrome
Leukocyte adhesion deficiency
Chediak-Higashi syndrome
Chronic granulomatous disease
Complement deficiency
Hereditary angioedema
Asplenia
Thymoma
Ruptured spleen
Immunodeficiencies: T-cell and B-cell disorders: Pathology review
Immunodeficiencies: Combined T-cell and B-cell disorders: Pathology review
Immunodeficiencies: Phagocyte and complement dysfunction: Pathology review
Glucocorticoids
Non-corticosteroid immunosuppressants and immunotherapies
Skin histology
Skin anatomy and physiology
Hair, skin and nails
Wound healing
Introduction to the skeletal system
Introduction to the muscular system
Bones of the neck
Anatomy clinical correlates: Bones, fascia and muscles of the neck
Bones of the vertebral column
Joints of the vertebral column
Vessels and nerves of the vertebral column
Muscles of the back
Anatomy of the suboccipital region
Anatomy clinical correlates: Bones, joints and muscles of the back
Anatomy of the muscles and nerves of the posterior abdominal wall
Bones of the upper limb
Fascia, vessels and nerves of the upper limb
Anatomy of the brachial plexus
Anatomy of the pectoral and scapular regions
Anatomy of the arm
Muscles of the forearm
Vessels and nerves of the forearm
Muscles of the hand
Anatomy of the sternoclavicular and acromioclavicular joints
Anatomy of the glenohumeral joint
Anatomy of the elbow joint
Anatomy of the radioulnar joints
Joints of the wrist and hand
Anatomy of the axilla
Anatomy clinical correlates: Clavicle and shoulder
Anatomy clinical correlates: Axilla
Anatomy clinical correlates: Arm, elbow and forearm
Anatomy clinical correlates: Wrist and hand
Anatomy clinical correlates: Median, ulnar and radial nerves
Bones of the lower limb
Fascia, vessels and nerves of the lower limb
Anatomy of the anterior and medial thigh
Muscles of the gluteal region and posterior thigh
Vessels and nerves of the gluteal region and posterior thigh
Anatomy of the popliteal fossa
Anatomy of the leg
Anatomy of the foot
Anatomy of the hip joint
Anatomy of the knee joint
Anatomy of the tibiofibular joints
Joints of the ankle and foot
Anatomy clinical correlates: Hip, gluteal region and thigh
Anatomy clinical correlates: Knee
Anatomy clinical correlates: Leg and ankle
Anatomy clinical correlates: Foot
Development of the axial skeleton
Development of the limbs
Development of the muscular system
Bone histology
Cartilage histology
Skeletal muscle histology
Skeletal system anatomy and physiology
Bone remodeling and repair
Cartilage structure and growth
Fibrous, cartilage, and synovial joints
Muscular system anatomy and physiology
Brachial plexus
Neuromuscular junction and motor unit
Sliding filament model of muscle contraction
Slow twitch and fast twitch muscle fibers
Muscle contraction
Muscle spindles and golgi tendon organs
Radial head subluxation (Nursemaid elbow)
Developmental dysplasia of the hip
Legg-Calve-Perthes disease
Slipped capital femoral epiphysis
Transient synovitis
Osgood-Schlatter disease (traction apophysitis)
Rotator cuff tear
Dislocated shoulder
Winged scapula
Thoracic outlet syndrome
Carpal tunnel syndrome
Ulnar claw
Erb-Duchenne palsy
Klumpke paralysis
Iliotibial band syndrome
Unhappy triad
Anterior cruciate ligament injury
Patellar tendon rupture
Meniscus tear
Patellofemoral pain syndrome
Sprained ankle
Achilles tendon rupture
Spondylolysis
Spondylolisthesis
Degenerative disc disease
Spinal disc herniation
Sciatica
Compartment syndrome
Rhabdomyolysis
Osteogenesis imperfecta
Craniosynostosis
Pectus excavatum
Arthrogryposis
Genu valgum
Genu varum
Pigeon toe
Flat feet
Club foot
Cleidocranial dysplasia
Achondroplasia
Osteomyelitis
Bone tumors
Osteochondroma
Chondrosarcoma
Osteoporosis
Osteomalacia and rickets
Osteopetrosis
Paget disease of bone
Osteosclerosis
Lordosis, kyphosis, and scoliosis
Osteoarthritis
Spondylosis
Spinal stenosis
Rheumatoid arthritis
Juvenile idiopathic arthritis
Gout
Calcium pyrophosphate deposition disease (pseudogout)
Psoriatic arthritis
Ankylosing spondylitis
Reactive arthritis
Spondylitis
Septic arthritis
Bursitis
Baker cyst
Muscular dystrophy
Polymyositis
Dermatomyositis
Inclusion body myopathy
Polymyalgia rheumatica
Fibromyalgia
Rhabdomyosarcoma
Lambert-Eaton myasthenic syndrome
Sjogren syndrome
Mixed connective tissue disease
Antiphospholipid syndrome
Raynaud phenomenon
Scleroderma
Back pain: Pathology review
Rheumatoid arthritis and osteoarthritis: Pathology review
Seronegative and septic arthritis: Pathology review
Gout and pseudogout: Pathology review
Systemic lupus erythematosus (SLE): Pathology review
Scleroderma: Pathology review
Sjogren syndrome: Pathology review
Bone disorders: Pathology review
Bone tumors: Pathology review
Myalgias and myositis: Pathology review
Neuromuscular junction disorders: Pathology review
Muscular dystrophies and mitochondrial myopathies: Pathology review
Pediatric musculoskeletal disorders: Pathology review
Acetaminophen (Paracetamol)
Non-steroidal anti-inflammatory drugs
Opioid agonists, mixed agonist-antagonists and partial agonists
Antigout medications
Osteoporosis medications
Fever of unknown origin: Clinical
Infective endocarditis: Clinical
Pneumonia: Clinical
Tuberculosis: Pathology review
Diarrhea: Clinical
Urinary tract infections: Clinical
Meningitis, encephalitis and brain abscesses: Clinical
Bites and stings: Clinical
Skin and soft tissue infections: Clinical
Protein synthesis inhibitors: Aminoglycosides
Antimetabolites: Sulfonamides and trimethoprim
Antituberculosis medications
Miscellaneous cell wall synthesis inhibitors
Protein synthesis inhibitors: Tetracyclines
Cell wall synthesis inhibitors: Penicillins
Miscellaneous protein synthesis inhibitors
Cell wall synthesis inhibitors: Cephalosporins
DNA synthesis inhibitors: Metronidazole
DNA synthesis inhibitors: Fluoroquinolones
Herpesvirus medications
Azoles
Echinocandins
Miscellaneous antifungal medications
Anthelmintic medications
Antimalarials
Anti-mite and louse medications
Joint pain: Clinical
Pediatric orthopedic conditions: Clinical
Rheumatoid arthritis: Clinical
Lower back pain: Clinical
Immunodeficiencies: Clinical
Fat-soluble vitamin deficiency and toxicity: Pathology review
Water-soluble vitamin deficiency and toxicity: B1-B7: Pathology review
Zinc deficiency and protein-energy malnutrition: Pathology review
Viral hepatitis: Clinical
HIV and AIDS: Pathology review
Integrase and entry inhibitors
Nucleoside reverse transcriptase inhibitors (NRTIs)
Protease inhibitors
Hepatitis medications
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Neuraminidase inhibitors
Seronegative arthritis: Clinical
Systemic lupus erythematosus (SLE): Clinical
Sjogren syndrome: Clinical
Inflammatory myopathies: Clinical
Vasculitis: Clinical
Preoperative evaluation: Clinical
Postoperative evaluation: Clinical
General anesthetics
Local anesthetics
Neuromuscular blockers
Laxatives and cathartics
Anticoagulants: Heparin
Anticoagulants: Warfarin
Anticoagulants: Direct factor inhibitors
Antiplatelet medications
Insulins
Traumatic brain injury: Clinical
Neck trauma: Clinical
Chest trauma: Clinical
Abdominal trauma: Clinical
Anatomy of the vertebral canal
Anatomy of the descending spinal cord pathways
Anatomy of the ascending spinal cord pathways
Anatomy clinical correlates: Vertebral canal
Anatomy clinical correlates: Spinal cord pathways
Superficial structures of the neck: Posterior triangle
Superficial structures of the neck: Cervical plexus
Superficial structures of the neck: Anterior triangle
Deep structures of the neck: Prevertebral muscles
Anatomy of the thyroid and parathyroid glands
Anatomy of the larynx and trachea
Anatomy of the pharynx and esophagus
Anatomy of the lymphatics of the neck
Deep structures of the neck: Root of the neck
Fascia and spaces of the neck
Anatomy clinical correlates: Vessels, nerves and lymphatics of the neck
Anatomy clinical correlates: Viscera of the neck
Introduction to pharmacology
Enzyme function
Pharmacodynamics: Drug-receptor interactions
Pharmacodynamics: Agonist, partial agonist and antagonist
Pharmacodynamics: Desensitization and tolerance
Pharmacokinetics: Drug absorption and distribution
Pharmacokinetics: Drug metabolism
Pharmacokinetics: Drug elimination and clearance
Drug administration and dosing regimens
Mechanisms of antibiotic resistance

Transcript

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The skin makes up around 16% of total body weight, making it the largest organ in the body - although it’s hard to imagine it as a single organ. The skin along with its accessory structures--like oil and sweat glands--makes up the integumentary system. The integumentary system protects the body from infections, helps regulate body temperature, and contains nerve receptors that detect pain, sensation, and pressure.

Now, the skin is divided into three layers--the epidermis, dermis, and hypodermis. The epidermis forms the thin outermost layer of skin. Underneath, is the thicker dermis layer that contains the nerves and blood vessels. And finally, there’s the hypodermis which is made of fat and connective tissue that anchors the skin to the underlying muscle.

The epidermis itself is made of multiple layers of developing keratinocytes - which are flat pancake-shaped cells that are named for the keratin protein that they’re filled with. Keratin is a fibrous protein that allows keratinocytes to protect themselves from getting destroyed when you rub your hands through the sand at the beach. Keratinocytes also make and secrete glycolipids, glyco meaning part sugar and lipid meaning part fat. Glycolipids help to prevent water from easily seeping into and out of the body. Keratinocytes start their life at the lowest layer of the epidermis called the stratum basale, or basal layer, which is made of a single layer of stem cells that continually divide and produce new keratinocytes. These new keratinocytes then migrate upwards to form the other layers of the epidermis. The stratum basale also contains another group of cells - melanocytes, which secrete a protein pigment, or coloring substance, called melanin. Melanin is actually a broad term that constitutes several types of melanin found in people of differing skin color. These subtypes of melanin range in color from black to reddish yellow and their relative quantity define a person’s skin color. When keratinocytes are exposed to the sun, they send a chemical signal to the melanocytes, which stimulates the melanocytes into making more melanin. The melanocytes move the melanin into small sacs called melanosomes, and these get taken up by newly formed keratinocytes. Melanin then acts as a natural sunscreen, because its protein structure disspitates, or scatters, UVB light--which if left unchecked can damage the DNA in the skin cells and lead to skin cancer. Darker types of melanin and greater quantities of of this kind of melanin are produced by individuals living close to the equator because they typically get more sun exposure. However, it’s a fine balance because UVB light helps us generate vitamin D, which is an important regulator of calcium absorption. Keratinocytes contain cholesterol precursor molecules that are activated by UVB into Vitamin D.

As keratinocytes in the stratum basale mature and lose the ability to divide, they migrate into the next layer, called the stratum spinosum which is about 8 to 10 cell layers thick. Keratinocytes in the stratum spinosum layer have tiny proteins on the membrane that look like tiny spines; these help the cells adhere to one another. The stratum spinosum layer also has dendritic cells lurking around - these are star-shaped immune cells, that are constantly patrolling - looking for invading microbes.

The next layer up is the stratum granulosum which is 3 to 5 cell layers thick. Keratinocytes in this layer begin the process of keratinization, which is the process where the keratinocytes flatten out and die, and in the process they create the epidermal skin barrier. To do this, keratinocytes in the stratum granulosum layer produce large amounts of keratin precursor proteins and glycolipid which remain within granules called keratohyalin granules and lamellar granules, respectively. Keratohyalin granules eventually start to aggregate and cross-link forming enormous bundles of keratin within the keratinocyte. Lamellar granules, on the other hand, get secreted and stick to the outer cell surface. It forms a sort of cement between the cells, making them more resistant to external forces and water loss. Over time, the intracellular organelles disintegrate so the cells flatten out and die.

Keratinization leads to development of the stratum lucidum layer which is 2 to 3 cell layers thick of translucent, dead keratinocytes that have secreted most of their lamellar granules. The stratum lucidum is only found in thick skin like on the palms and soles of the feet, because those are the areas that need extra protection. The stratum lucidum is absent in thin skin, which covers the rest of the body, and the other layers are thinner.

Key Takeaways

The skin or the integumentary system is the largest organ of the body that has many important functions in physiology. It protects the body from infections, helps in thermoregulation, and contains nerve receptors that detect pain, sensation, and pressure.

The integumentary system is divided into three major components including the epidermis, dermis, and hypodermis. The epidermis is the most superficial layer and it's responsible for protection from pathogens, and the environment, for vitamin D production, and for giving the skin its color. The dermis lies below the epidermis and controls temperature regulation and helps with sensation. The hypodermis lies below the dermis and provides a point of attachment for the skin to the deeper muscles.

The skin also contains several accessory structures, including hair, and nails. Hair provides protection and insulation, while nails provide support and protection for the tips of the fingers and toes.

Sources

  1. "Medical Physiology" Elsevier (2016)
  2. "Physiology" Elsevier (2017)
  3. "Human Anatomy & Physiology" Pearson (2018)
  4. "Principles of Anatomy and Physiology" Wiley (2014)
  5. "The skin: an indispensable barrier" Experimental Dermatology (2008)