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INTEGUMENTARY SYSTEM
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Integumentary System
• Skin
– Integument or Cutaneous membrane
– Epidermis
– Dermis
– Subcutaneous Layer
• Accessory Structures
– Hair
– Nails
– Glands
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Integumentary System Function
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To waterproof the body
Prevents fluid loss
Important part of the immune system
The major receptor for the sense of touch
Helps the body synthesize Vitamin D
Screens out harmful UV radiation
Regulates temperature
Excretion of some metabolic waste
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Layers and Structures of the Skin
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Epidermis
• The outmost layer of the skin
• Squamous (scalelike) epithelial tissue forms the
upper layer. These are continuously sloughed
off.
• Does not contain any blood vessels or
connective tissue; is dependant on lower layers
for nourishment
• The lower basal layer produces cells that are
pushed upward.
• The cells die when they reach the surface and
become filled with keratin (water repellant
protein)
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Epidermis
• Melanocytes are also in the basal layer.
These produce and contain melanin which
determines the color of the skin.
• Melanin protects the skin from UV
radiation
• Some UV rays help the skin produce
vitamin D
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Dermis
• The thick layer of living tissue directly
below the epidermis
• Contains connective tissue, blood and
lymph vessels, nerve fibers, hair follicles
• Sebaceous and sweat glands
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Tissues within the Dermis
• Collagen – tough flexible, fibrous tissue
(glue)
• Mast cells – in the connective tissue;
respond to injury or infection by releasing
– Heparin – anticoagulant
– Histamine – released in response to allergins
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The Subcutaneous Layer
• Located just below the skin
• Connects skin to surface muscles
• Made of loose connective tissue and
adipose tissue (fat)
• Lipocytes – fat cells are predominant in
this layer
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Sebaceous Glands
• In the dermis layer and are closely
associated with hair follicles
• Secrete sebum (oil) to lubricate the skin
and it also discourages the growth of
bacteria on the skin (slightly acidic)
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The Sweat Glands
• Found on almost all body surfaces
• Most numerous in the palms of the hands,
soles of the feet, the forehead, and the
armpits
• Hydrosis – the production and excretion of
sweat
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The Hair
• Made of tightly fused, dead protein cells
filled with hard karatin
• The hair follicles hold the root
• The arrector pili are the tiny muscles fibers
that hold the hair erect
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The Nails
• Known as unguis, is a keratin plate
• Lunula is the pale half moon-shaped
region
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Skin Lesions
• Abrasion
– Scraping or rubbing away of skin or
mucous membrane as a result of friction to
the area
– Example: carpet burn
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Abscess
Localized collection of pus in any body part
that results from invasion of pus-forming
bacteria
Example: pustule = small abscess
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Skin Lesions (continued)
• Bedsore
– Ulcer in skin over a bony prominence
– Also known as pressure ulcer
– Example: decubitus ulcer
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Blister
Small, thin-walled skin lesion containing
clear fluid
Also known as a vesicle
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Skin Lesions (continued)
• Bulla
– Large blister
• Carbuncle
– Circumscribed inflammation of skin and
deeper tissues; contains pus
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• Comedo
– Typical lesion of acne vulgaris
– Example: whitehead = closed comedo
– Example: blackhead = open comedo
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Skin Lesions (continued)
• Cyst
– Closed sac or pouch in or within the skin;
contains fluid, semifluid, or solid material
– Example: hydrocele = fluid-filled cyst
– Example: sebaceous cyst = solid-filled cyst
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Skin Lesions (continued)
• Fissure
– Cracklike sore or groove in the skin or
mucous membrane
– Example: anal fissure
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• Fistula
– Abnormal passageway between two tubular
organs; or from an organ to the body surface
– Example: recto-vaginal fistula
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Skin Lesions (continued)
• Hives - urticaria
– Circumscribed, slightly elevated lesions on
skin; paler in center than surrounding edges
– Also called wheals
– Example: mosquito bite
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• Laceration
– Tear in skin; torn, jagged wound
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Skin Lesions (continued)
• Macule
– Small flat, discoloration of the skin; neither
raised nor depressed
– Example: bruises, freckles
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• Nodule
– Small, circumscribed swelling protruding
above the skin
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Skin Lesions (continued)
• Papule
– Small, solid, circumscribed elevation on the
skin
– Example: pimple, wart, elevated mole
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• Polyp
– Small, stalklike growth, protruding upward or
outward from membrane surface
– Example: nasal polyp
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Skin Lesions (continued)
• Pustule
– Small elevation of skin filled with pus
• Example: small abscess on the skin
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• Scales
– Thin flakes of hardened epithelium that are
shed from the epidermis
• Ulcer
– Circumscribed, open sore or lesion of skin,
accompanied by inflammation
• Example: decubitus ulcer
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PATHOLOGICAL CONDITIONS
INTEGUMENTARY SYSTEM
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Acne Vulgaris
• Pronounced
– (ACK-nee-vul-GAY-ris)
• Defined
– Common inflammatory disorder seen on face,
chest, back, and neck
– Appears as papules, pustules, and comedos
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Albinism
• Pronounced
– (AL-bin-izm)
• Defined
– Condition characterized by absence of
pigment in the skin, hair, and eyes
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Burns
• Defined
– Tissue injury produced by flame, heat,
chemicals, radiation, electricity, or gases
– Extent of damage determined by
• Mode and duration of exposure
• Thermal intensity or temperature
• Anatomic site of the burn
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Burns
• First-degree or superficial burns
– Example: sunburn
• Second-degree or partial-thickness burns
– Example: flash contact with hot objects
• Third-degree or full-thickness burns
– Example: deep burns from a fire
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First Degree Burn
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Second Degree Burn
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Callus
• Pronounced
– (CAL-us)
• Defined
– Common, usually painless thickening of the
epidermis at sites of external pressure or
friction, such as weight-bearing areas of the
feet and on the palmar surface of the hands
• Also known as a callosity
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Oral Candidas
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Carcinoma, Basal Cell
• Pronounced
– (car-sih-NOH-mah BAY-sal sell)
• Defined
– Most common malignant tumor of epithelial
tissue, occurring most often on areas of
skin that are exposed to the sun
• Presents as a slightly elevated nodule with a
depression or ulceration in the center that
becomes more obvious as the tumor grows
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Carcinoma, Squamous Cell
• Pronounced
– (car-sih-NOH-mah SKWAY-mus sell )
• Defined
– Malignancy of the squamous, or scalelike,
cells of the epithelial tissue; much faster
growing than basal cell carcinoma and has
greater potential for metastasis if not treated
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Carcinoma, Squamous Cell
(continued)
• Frequent Sites on Sun-Exposed Areas
– Top of nose
– Forehead
– Margin of external ear
– Back of hands
– Lower lip
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Cellulitis
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Dermatitis
• Pronounced
– (der-mah-TYE-tis)
• Defined
– Inflammation of the skin, seen in several
different forms
– Acute or chronic
– Contact or seborrheic
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Contact Dermatitis
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Contact Dermatitis
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Contact Dermatitis
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Eczema
• Pronounced
– (EK-zeh-mah)
• Defined
– Acute or chronic inflammatory skin condition
characterized by erythema, papules, vesicles,
pustules, scales, crusts, scabs, and itching
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Erythema
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Exanthematous Viral Diseases
• Pronounced
– (eks-an-THEM-ah-tus viral diseases)
• Defined
– Skin eruption or rash accompanied by
inflammation, having specific diagnostic
features of an infectious viral disease
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Exanthematous Viral Diseases (continued)
• Examples:
– Rubella = German Measles = 3 day measles
– Roseola Infantum
– Rubeola = Red Measles = 7-10 day measles
– Erythema Infectiosum = Fifth disease
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Gangrene
• Pronounced
– (GANG-green)
• Defined
– Tissue death due to loss of adequate blood
supply, invasion of bacteria, subsequent
decay with foul odor
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Gangrene
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Gangrene
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Herpes Simplex
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Herpes Zoster
• Pronounced
– (HER-peez ZOS-ter)
• Defined
– Acute viral infection, characterized by painful,
vesicular eruptions on the skin that follow
along the nerve pathways of underlying spinal
or cranial nerves
– Highest incidence in adults over 50
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Herpes Zoster (continued)
Image courtesy of Robert A. Silverman,
M.D., Pediatric Dermatology,
Georgetown University
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Herpes Zoster
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Impetigo
• Pronounced
– (Im-peh-TYE-goh)
• Defined
– Contagious superficial skin infection
characterized by serous vesicles and pustules
filled with millions of staphylococcus or
streptococcus bacteria (usually forming on the
face)
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Impetigo
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Impetigo
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Kaposi’s Sarcoma
• Pronounced
– (CAP-oh-seez sar-KOH-ma)
• Defined
– Rare malignant lesions beginning as soft
purple-brown nodules or plaques on the feet
– Gradually spreads throughout the skin
– Increased incidence in men with AIDS
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Keloid
• Pronounced
– (KEE-loyd)
• Defined
– Enlarged, irregularly shaped, elevated scar
that forms due to the presence of large
amounts of collagen during the formation of a
scar
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Keratosis
• Pronounced
– (kair-ah-TOH-sis)
• Defined
– Skin condition in which there is a thickening
and overgrowth of the cornified epithelium
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Seborrheic Keratosis
• Pronounced
– (seb-oh-REE-ik kair-ah-TOH-sis)
• Defined
– Brown or waxy yellow wart-like lesions that
are loosely attached to the skin
– Also known as senile warts
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Actinic Keratosis
• Pronounced
– (ak-TIN-ic kair-ah-TOH-sis)
• Defined
– Premalignant, gray or red-to-brown, hardened
lesion caused by excessive exposure to
sunlight
– Also known as solar keratosis
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Leukoplakia
• Pronounced
– (loo-koh-PLAY-kee-ah)
• Defined
– White, hard, thickened patches firmly
attached to the mucous membrane – in the
mouth, vulva, or penis
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Malignant Melanoma
• Pronounced
– (mah-LIG-nant mel-ah-NOH-mah)
• Defined
– Malignant skin tumor originating from
melanocytes in preexisting nevi, freckles,
or skin with pigment
– Darkly pigmented tumor with irregular
surfaces and borders; variable colors
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ABCDS Of Malignant Melanomas
• Asymmetry
• Borders
• Color
• Diameter
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Melanoma
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Melanoma
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Nevus
• Pronounced
– (NEV-us)
• Defined
– Visual accumulation of melanocytes, creating
a flat or raised rounded macule or papule with
definite borders
– Commonly known as a mole
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Onychocryptosis
• Pronounced
– (on-ih-koh-krip-TOH-sis)
• Defined
– Ingrown nail – most commonly involves the
large toe
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Onychomycosis
• Pronounced
– (on-ih-koh-my-KOH-sis)
• Defined
– Fungal infection of the nails
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Pediculosis
• Pronounced
– (pee-dik-you-LOH-sis)
• Defined
– Highly contagious parasitic infestation caused
by blood-sucking lice
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Pediculosis (continued)
• Pediculosis capitis
– Head
• Pediculosis corporis
– Body
• Pediculosis palpebrarum
– Eyelashes and eyelids
• Pediculosis pubis
– Pubic hair
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Pilonidal Cyst
• Pronounced
– (pye-loh-NYE-dal SIST)
• Defined
– Closed sac located in the sacrococcygeal
area of the back; sometimes noted at birth as
a dimple
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Psoriasis
• Pronounced
– (soh-RYE-ah-sis)
• Defined
– Common, noninfectious, chronic skin disorder
manifested by silvery-white scales over round,
raised, reddened plaques producing itching
(pruritus)
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Scabies
• Pronounced
– (SKAY-beez)
• Defined
– Highly contagious parasitic infestation caused
by the “human itch mite”, resulting in a rash,
pruritus, and a feeling in the skin of
“something crawling”
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Scleroderma
• Pronounced
– (sklair-ah-DER-mah)
• Defined
– A gradual thickening of the dermis and
swelling of the hands and feet to a state in
which the skin is anchored to the underlying
tissue
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Systemic Lupus Erythematosus
• Pronounced
– (sis-TEM-ic LOO-pus air-ih-them-ah-TOH-sis)
• Defined
– A chronic, multi-system, inflammatory disease
characterized by lesions of the nervous system
and skin, renal problems, and vasculitis;
characteristic “Butterfly rash” is often seen on
the nose and face
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Tinea
• Pronounced
– (TIN-ee-ah)
• Defined
– A chronic fungal infection of the skin;
characterized by scaling, itching, and
sometimes painful lesions
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Tinea (continued)
• Tinea capitis
– Scalp
• Tinea corporis
– Body
• Tinea cruris
– Groin
• Tinea pedis
– Foot
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Verruca
• Pronounced
– (ver-ROO-kah)
• Defined
– A benign, circumscribed, elevated skin lesion
that results from hypertrophy of the epidermis
– Commonly known as a wart
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Verruca (continued)
• Verruca vulgaris
– Common wart on face, elbow, fingers, or
hands
• Plantar warts
– Singly or in clusters on the sole of the foot
• Venereal warts
– Transmitted by sexual contact
• Seborrheic warts
– Seen in the elderly on the face, neck,
chest, or upper back
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DIAGNOSTIC TECHNIQUES AND
PROCEDURES
INTEGUMENTARY SYSTEM
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Diagnostic Techniques and Procedures
• Allergy Testing
– Various procedures used to identify specific
allergens in an individual by exposing the
person to a very small quantity of the allergen
• Cautery
– Heat or caustic substances that burn and scar
the skin
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Diagnostic Techniques and Procedures
(continued)
• Cryosurgery
– Noninvasive treatment that uses
subfreezing temperature to freeze and
destroy tissue
• Curettage and electrodesiccation
– Scraping away of abnormal tissue,
followed by destroying the tumor base with
a low-voltage electrode
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Diagnostic Techniques and Procedures
(continued)
• Debridement
– Removal of debris, foreign objects, and
damaged or necrotic tissue from a wound
in order to prevent infection and promote
healing
• Dermabrasion
– Removal of the epidermis and a portion of
the dermis with sandpaper or brushes in
order to eliminate superficial scars of
unwanted tattoos
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Diagnostic Techniques and Procedures
(continued)
• Dermatoplasty
– Skin transplantation to a body surface
damaged by injury or disease
• Electrodesiccation
– A technique using an electrical spark to
burn and destroy tissue
– Also known as fulguration
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Diagnostic Techniques and Procedures
(continued)
• Electrosurgery
– Removal or destruction of tissue with an
electrical current
• Escharotomy
– An incision made into the necrotic tissue
resulting from a severe burn
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Diagnostic Techniques and Procedures
(continued)
• Liposuction
– Aspiration of fat through a suction cannula
or curette to alter the body contours
• Skin biopsy
– Removal of a small piece of tissue from
skin lesions for the purpose of examining it
under a microscope to confirm or establish
a diagnosis
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Diagnostic Techniques and Procedures
(continued)
• Skin graft
– Process of placing tissue on a recipient
site, taken from a donor site, in order to
provide the protective mechanisms of skin
to an area unable to regenerate skin
• Wood’s lamp
– Ultraviolet light that is used to examine the
scalp and skin for the purpose of observing
fungal spores
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