Every month you have a whole new layer of skin.

Your nails grow .5mm per week.You will shed 40lbs of skin in a lifetime.The average amount of head hair is 120,000.Your eyelids have the thinnest skin.Hair grows 1cm per month.

True or False:

ProtectionCushions and insulates and is waterproofProtects from chemicals, heat, cold,

bacteriaScreens UV

Synthesizes vitamin D from UV raysRegulates body heatPrevents unnecessary water lossSensory reception (nerve endings)

Functions of skin

Key TermsEpi- “above”Derm- “skin”Hypo- “below”Kerat- “horn”Melano- “black/dark”Cyte- “cell”Strata- “cover”

Integument is skinTwo distinct regions

Epidermis (keratinized stratified squamous)

Dermis (Dense Irregular CT w/ smooth muscle, nervous and blood tissue)

A fatty layer (hypodermis) lies deep to it- not a true layer of skin(areolar & adipose tissue)

The Integumentary System

Transdermal patchesnicotine patches, motion sickness, and those

associated with alleviating chest painNecrosis

Cut off of blood supply (bed sores)Blushing

Blood vessels dilate Paleness

Blood vessel constriction (low temp. or fright)

Did you know?

Keratinized stratified squamous epitheliumAvascular- top layer has poorer nutrient

supplyFour types of cells:

Keratinocytes – deepest, produce keratin (tough fibrous protein)

Melanocytes - make dark skin pigment called melanin; absorbs UV rays preventing mutations in skin cells’ DNAHave long, pigment-containing extensions that

travel upwardMerkel cells – associated with sensory nerve

endings (temperature change/ factors that can damage the epidermis)

Langerhans cells – macrophage-like cells

Epidermis

Layers (from deep to superficial)Stratum basale (germinativum) –

single row of cells attached to dermis; youngest cells that divide continuously (old cells are pushed towards the skin surface).

Stratum spinosum - bundles of protein resist tension (develop desmosomes)

Stratum granulosum – layers of flattened keratinocytes producing keratin

Stratum lucidum increased keratinocytes only on palms and soles (hairless areas)

Stratum corneum – dead cells, many layers thick (eventually shed)

EpidermisK

erat

iniz

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n

Create an acronym to remember them!

Create a Mnemonic

Bell WorkWhat are the five layers of the epidermis from deep to

superficial?

Lowest epidermal layer, near dermisGood nutrient supply (cells pushed away

from this layer die)Reproduces by mitosis (cells divide

continuously)Single row of cuboidal cells, columnar in

shapeWhere merkel cells are located (sensory

cells)Moves to upper epidermis in 27 days.

Stratum Basale

Stratum Basale

Living cells (keratinocytes, langerhans cells, melanocytes)

Cells are still dividing8-10 cells thickPolygonal in appearanceContain bundles of protein to resist

tension (support the skin)

Stratum Spinosum

Stratum Spinosum

Poor nutrient supply

Flatten layer of keratinocytes producing keratin

3-5 cells thickNo cell division

Found only in very thick skin (palms & soles)

TranslucentHighly

keratinizedMuch thickerDead cells

Stratus Granulosum Lucidum

25-30 cells thick made of dead keratinocytes.

Cells are filled with keratin and hardened.

Sloughed off.Outer most layer of epidermis.

Stratum Corneum

Include the layers, their function and an image of the layer:

Create a Flip Chart

Four basic types of tissue

Epithelium – epidermis just discussed

Connective tissue - dermisMuscle tissueNervous tissue

Remember…

Strong, flexible connective tissue: your “hide”Cells: fibroblasts, macrophages, mast cells,

WBCsFiber types: collagen, elastic, reticularRich supply of nerves and vesselsCritical role in temperature regulation (the

vessels)Two layers (see next slides)

Papillary – areolar connective tissue; includes dermal papillae (which connect to the epidermis)

Reticular – dense irregular connective tissue “reticulum” (network) of collagen and reticular fibers

Dermis

*Dermis layers

*

*

*Dermal papillae

Epidermis and dermis of (a) thick skin and (b) thin skin(which one makes the difference?)

Prints:Keep skin from tearing and aid in

gripping objects & are “sweat films” because of sweat pores

Genetically determinedResult from dermal papillae

Finger like projects that connect the epidermis to the dermis

Elevate the overlying epidermis into ridges

Flexion creases:Deep dermis, from continual folding

Fingerprints, palmprints, footprints.

Names/meaning:“Hypodermis” (Gk) = below the skin“Subcutaneous” (Latin) = below the skin“Superficial fascia”= band or sheet of connective

tissueFatty tissue which stores fat and anchors skin

(areolar tissue and adipose cells)Different patterns of accumulation

(male/female)

Hypodermis

What layers of the epidermis go through mitosis?

What layer of the epidermis is the thickest?

What layer of the epidermis is only on the palms and soles?

Bell Work

Identify the three types of fingerprints.

What is the function of hair?

What is the lunula of the nail?

Bell Work

Derived from epidermis but extend into dermis

IncludeNailsHair and hair folliclesSebaceous (oil) glandsSweat (sudoiferous) glands

Skin appendages

Summarize the articleIllustrate

Create Class Questions

Play the Role

Protective coverings made of keratin on the ends of the fingers and toes

Components:Consists of a nail plate that overlies a nail bedLunula- white part of nail; most active growing

regionCorresponds to hooves and claws

Nails

*“arrector pili” is smooth muscle*

Hair papilla is connective tissue________________

Hair bulb: epithelial cells surrounding papilla

Derived from epidermis and dermis; found everywhere but palms, soles, nipples, parts of genitalia

Hair and hair follicles: complex

Functions of hairWarmthSense light touch of the skinProtection – scalp

DevelopmentDevelops from epidermal cells at

the base of a tube-like depression- hair follicle

Components/PartsMade of hard keratinRoot imbedded in skinShaft projecting above skin surface

Three concentric layersMedulla (core)Cortex (surrounds medulla)Cuticle (single layers, overlapping

Hair growth: averages 2 mm/weekGrowth Phase: growing (90% of the

time)Resting phase then shed

Hair colorAmount of melanin for black or brown;

distinct form of melanin for redWhite: decreased melanin and air

bubbles in the medulla

Entire body except palms and solesProduce sebum (oil)Oils and lubricates

Sebaceous (oil) glands

Sweat glandsEntire skin surface except nipples and part of

external genitaliaPrevent overheating500 mL to 12 L/day! (is mostly water) Produced in response to stress as well as heat

Eccrine or merocrineMost numerousTrue sweat: 99% water, some salts, traces of

wasteOpen through pores

ApocrineAxillary, anal and genital areas onlyDucts open into hair follicesThe organic molecules in it decompose with

time - odorModified sweat glands

Ceruminous – secrete earwaxMammary – secrete milk

Types of sweat glands

Identify each type of sweat gland:Eccrine Glands

Apocrine Glands

Ceruminous Glands

Mammary Glands

Bell Work

What is the difference between a first degree, second degree and

third degree burn (based on what you already know)?

Bell Work

Threat to lifeCatastrophic loss of body fluidsDehydration and fatal circulatory shockInfection

TypesBased on the depth of burnsTotal Surface Area (TBSA) affected by the burn

Burns!

Definition – a burn that involves only the epidermis Sign / Symptoms:

Skin is dry and erythematous (redness of the skin caused by dilation and congestion of the capillaries)

Pain to site The burned area blanches

(temporary whitening) with pressure

Edema (if present) will be minimal (accumulation of fluid under the skin)

First Degree/Superficial Burn

Definition – a burn in which the epidermis is burned through and the dermis is damaged Sign / Symptoms :

Deep, intense pain and swelling

Skin is moist Skin will be hyperemic

(pink)in color Blister formation Edema will be moderate

Second Degree/Partial Thickness

Definition – a burn in which all the layers of the skin are damaged Sign / Symptoms

Skin has a dry, leathery appearance

The skin can range in color from pale yellow to cherry red, brown, or carbon black

Severe pain around periphery of burn, but little to no pain near center of burn

Will see First and Second Degree burns surrounding the Third Degree Burn

Fat, muscle and bone may be affected

Third Degree/ Full Thickness Burn

Burns First-degree(epidermis only;

redness)

Second-degree(epidermis and dermis,

with blistering)

Third-degree(full thickness,

destroying epidermis, dermis, often part of

hypodermis)

Superficial partial-

thickness burn

Deep partial- thickness burn

Full thickness burn

Burns can be categorized by the percentage of body surface damaged by the burn

Two Methods for Estimating the Total Body Surface Area (TBSA) affected by Burns: Rule of Nines (RON) Rule of Palm’s (ROP)

Total Body Surface Area (TBSA)

The Rule of Nines divides the TBSA into areas compromising 9% (multiples of 9%)The Rule of Nines is an estimate and is most

useful for adults and children over the age of 10.

The Rule of Nine’s is helpful for estimating the TBSA of large shaped burns.

Rule of Nines (RON)

Rule of Nines• Burn treatment requires estimating

the extent of the body’s affected

surface• Rule of Nines is used

to estimate the replacement of body

fluids and electrolytes lost from injured

tissues & for covering the burned area with

skin.

The Rule of Palm’s assumes that the palm size of the patient represents approximately 1% of the TBSA.

TBSA is then estimated by approximating the number of “palms” it would take to completely cover the burn.

The rule of Palm’s is helpful for estimating the TBSA of small or irregularly formed burns.

Rule of Palm's

Inhalation Burns – burns in the upper and lower airways, caused by the inspiration of heat, toxic, smoke, or other gases.

Thermal Burns- tissue injury caused by exposure to extreme radiant heat

Industrial/Chemical Burns- occur when the patient comes in direct contact with chemical agents

Electrical Burns- electrical current, including lightning, can cause severe damage to the body. The skin is burned where the energy enters the body and where it flows into the ground. Along the path of this flow, tissues are damaged due to heat.

Types of Burns

Types of BurnsInhalation Burns –

burns in the upper and lower airways, caused by the inspiration of heat, toxic, smoke, or other gases.

Types of Burns

Thermal Burns- tissue injury caused by exposure to extreme radiant heat

Types of Burns

Industrial/Chemical Burns- occur when the patient comes in direct contact with chemical agents

Types of BurnsElectrical Burns- electrical current,

including lightning, can cause severe damage to the body. The skin is burned where the energy enters the body and where it flows into the ground. Along the path of this flow, tissues are damaged due to heat.

Remove the patient from the environment where the burn occurred

Remove any substance which will continue to burn the patient

Fluid Replacement Therapy: Second- and Third- degree burns require

massive amounts of fluids to properly resuscitate a patient.

Dressings- initially, most burns can be irrigated with cool water then cover with a dry, sterile, bulky dressing

Treatment of Burns

What are the ABCDE’s of tumors on the skin?

Bell Work

Benign, e.g. warts, some moles Malignant (cancerous) – associated with UV

exposure (also skin aging)Basal Cell Carcinoma- cells of stratum basaleSquamous Cell Carcinoma - keratinocytesMelanoma – melanocytes: most dangerous;

recognition:A - AsymmetryB - Border irregularityC - ColorsD - Diameter larger than 6 mm

Tumors of the skin

Symmetrical, round or ovalBorder is sharp and well-definedColor is usually uniform tan, brown, or skin

colorUsually less than a quarter of an inch in

diameterDevelop throughout childhood and early

adulthoodNormal, benign moles usually look very

similar to each other

Healthy Moles

Basal cell carcinoma

Sqaumous cell carcinoma

Melanoma

Skin Cancer

The surrounding area of a wound becomes inflamedBlood vessels in the affected area become

dilated & more permeable (provide more nutrient & oxygen which aids healing)

If a wound is shallow, epithelial cells divide rapidly

If a wound is deep…blood clots form scabs to protect underlying

tissuesfibroblasts migrate to the injured areanew collagen fibers form & new blood vessels

extend beneath the scab

Healing of Wounds

Look at the depth of the open wound. Can you see yellow, fatty tissue? Is bone exposed? Is there a lot of flesh exposed?Is the wound more than 1/4 inch (6 mm) deep?

Look at the width of the wound.If the wound is too wide to be held together with

bandaging easily, then it will need stitching as this will pull the skin together so it can heal correctly.

Look at the location of the open wound. If the wound is in an area where you move a lot,

you need stitches

Stitches?

The epidermis thinsEpidermal cells grow larger/ more irregular in

shape but fewerPresence of “Liver Spots”- sites of oxidation of

fats in secretory cellsThe dermis is reduced

Production of elastin and collagen slows; loss of fat from the subcutaneous layer result in wrinkling

Fewer fibroblasts delay wound healingSebaceous glands secrete less oil which dries

the skinNumber of sweat glands decrease

The Beauty in Aging

Skin Disorders Acne (acne vulgaris)-

occurs when oil glands attached to hair follicles are congested on the face, chest, and back as congested pores . If the wall ruptures, the pore is exposed to bacteria access.

Skin Disorders

Psoriasis- Red and inflamed and may become white scaly patches; commonly found on the elbows, knees, scalp and the lower back.Skin cells mature

about 5x fasterThese cells pile up on

the skin's surfaceCause is linked to

genes and triggers

Skin Disorders Eczema-

inflammation of the skin characterized by patches of red, blistering, dry, itchy skin (unknown cause).Appearance variesCauses intense

itching can cause blisters, lesions, dry and scaly skin

Skin Disorders Athlete’s Foot-

superficial fungal infection of the skin of the foot

Skin Disorders

Vitiligo- pigmentation disorder in which melanocytes in the skin are destroyed

resulting in white patches that appear on the skin in different parts of the body.

Skin Disorders

Albinism- a recessive inherited disorder in which melanin is not produced

What happens to the layers of skin as you

age?

Bell Work

Two GroupsQuestion given to each individual of each

groupIf the student gets the answer correct, the

team gets one point… the student gets to throw the ball into the trash canIf you choose to throw from across the room

and you make it, the team gets 3 pointsIf you choose to throw from 6 feet and make it

the team gets 1 point. The next team gets their chance.

Trash Ball