SkinSkinIntegumentary systemIntegumentary system

20092009

Skin (cutis, Skin (cutis, dermaderma))The heaviest organ in the body - 16% of weightThe heaviest organ in the body - 16% of weight

Size: 1,2-2,3mSize: 1,2-2,3m22

Function:Function: Protection (mechanic, from desiccation) Protection (mechanic, from desiccation)

ThermoregulationThermoregulation

Sweat glands (perspiratio insensibilis)Sweat glands (perspiratio insensibilis)

Changes in blood flowChanges in blood flow

Excretion of salt (iron looses)Excretion of salt (iron looses)

Nonspecific immunityNonspecific immunity

Metabolism- ergosterol-vit.D Metabolism- ergosterol-vit.D

Sensoric endingSensoric ending

Sexual signalingSexual signaling

(Endocrine gland – adipose tissue: leptin, adiponectin, estrogenes)(Endocrine gland – adipose tissue: leptin, adiponectin, estrogenes)

DevelopmentDevelopment

EctodermEctoderm Periderm – 2 layers cuboidal and flat superficialPeriderm – 2 layers cuboidal and flat superficial Stratified squamousStratified squamous Glands, hair and nails – invagination of Glands, hair and nails – invagination of

ectoderm into dermisectoderm into dermis

Skin linesSkin lines ( (lineae distractioneslineae distractiones) )

• Externally visible skin lines:Externally visible skin lines:• Wrinkle lines: lines of expression Wrinkle lines: lines of expression • Flexure (joint) lines Flexure (joint) lines

– sulcus mentolabialis, nasolabialissulcus mentolabialis, nasolabialis

– sulcus gluteussulcus gluteus

linea oppositionis pollicis (linea oppositionis pollicis (vitalisvitalis)) linea manus clausae (linea manus clausae (cephalica, naturaliscephalica, naturalis)) linea occlusionis dig. trium ulnarium (linea occlusionis dig. trium ulnarium (mensalismensalis)) sulcus cutaneus intercarpalis (sulcus cutaneus intercarpalis ( linea rascetalinea rasceta)) linea restrictalinea restricta

Surface pattern lines - hand – Surface pattern lines - hand – Purkyně Purkyně - - chiromantiachiromantia

Skin Skin

• GroovesGrooves (sulci cutis)(sulci cutis) • Papillary ridges (friction ridges)Papillary ridges (friction ridges) ((cristae cutiscristae cutis) – dermatoglyphics - 9 ) – dermatoglyphics - 9

types (according to types (according to Purkyně) Purkyně) → → daktyloscopy – forensic importancedaktyloscopy – forensic importance• Toruli tactilesToruli tactiles – 10 in hand ( thenar)– 10 in hand ( thenar)• Lineae distractionesLineae distractiones • Retinacula cutisRetinacula cutis - (retinaculum caudale) - (retinaculum caudale)• Intristinc scarring - Intristinc scarring - Striae cutaneaeStriae cutaneae – rupture of lateral cohesion of – rupture of lateral cohesion of

the collagen fibres -growth, pregnancy and obesitythe collagen fibres -growth, pregnancy and obesity

SkinSkin

EpidermisEpidermis DermisDermis Hypodermis (Hypodermis (tela subcutanea – panniculus adiposustela subcutanea – panniculus adiposus)) Appendages:Appendages:

HairsHairs NailsNails Glands of the skinGlands of the skin Mammary glandMammary gland

EpidermisEpidermis Stratified squamous keratinized epithelium + Stratified squamous keratinized epithelium +

melanocytes, Langerhans cells, Merkel´s melanocytes, Langerhans cells, Merkel´s cellscells

Thick type: palms of hands and soles of the Thick type: palms of hands and soles of the feetsfeets

Thin type: rest of the bodyThin type: rest of the body

Cell renewal in epidermis:15 – 30 daysCell renewal in epidermis:15 – 30 days

EGF, Keratinocyte growth factor, retinoic acid (vit. A)EGF, Keratinocyte growth factor, retinoic acid (vit. A)

EpidermisEpidermis Stratum basale Stratum basale (basophilic cuboid to columnar cells (basophilic cuboid to columnar cells

on lamina basale – stem cells)on lamina basale – stem cells) Stratum spinosumStratum spinosum – polygonal cells, contain of – polygonal cells, contain of

cytokeratin filament, desmosomescytokeratin filament, desmosomes Stratum granulosumStratum granulosum – 3 – 5 layers of cells – – 3 – 5 layers of cells –

keratohyalin granules – basophilic; lamellar keratohyalin granules – basophilic; lamellar granules – lipids (ceramids) – barrier – sheet granules – lipids (ceramids) – barrier – sheet containing lipidcontaining lipid

Stratum lucidumStratum lucidum – in thick type -eosinophilic – in thick type -eosinophilic Stratum corneumStratum corneum – cells filled by keratin filament – cells filled by keratin filament

are packed together by filaggrin; desmosomesare packed together by filaggrin; desmosomes

Stem cellsStem cells

Stem cellsStem cells in the bulb region of the hair follicle – in the bulb region of the hair follicle – indepedent migration:indepedent migration:

Bulb-hair stem pathway Bulb-hair stem pathway – at the apex of the dermal – at the apex of the dermal papillapapilla

Bulb-epidermis cell pathway –Bulb-epidermis cell pathway – epidermis – stratum epidermis – stratum basalebasale

Sebaceous glandsSebaceous glands

Differentiation of a keratinocyteDifferentiation of a keratinocyte

Cells of stratum spinosumCells of stratum spinosum – synthesis of – synthesis of acylglucosylceramide – RER + GA = membrane-acylglucosylceramide – RER + GA = membrane-coating granules (or lamellar bodies)coating granules (or lamellar bodies)

Bb. stratum granulosumBb. stratum granulosum – proteosynthesis = – proteosynthesis = keratohyaline granules, lamellar bodies release keratohyaline granules, lamellar bodies release ceramide into the intercellular spaces ceramide into the intercellular spaces

Bb. stratum lucidumBb. stratum lucidum – intermediate layer - – intermediate layer - eosinophiliceosinophilic

Bb. stratum corneum –Bb. stratum corneum – without nuclei, keratin without nuclei, keratin croslinked by filaggrin, together with ceramide form croslinked by filaggrin, together with ceramide form cell envelope, cells are joined by desmosomescell envelope, cells are joined by desmosomes

MelanocytesMelanocytes Development from neural crest Development from neural crest Eumelanin, pheomelanin (contains cysteine) - red hairEumelanin, pheomelanin (contains cysteine) - red hair Tyrozine – dopa – dopaquinone – melanin (tyrozinase)Tyrozine – dopa – dopaquinone – melanin (tyrozinase) Synthesis:vesicle with enzymatic activity, fine granular Synthesis:vesicle with enzymatic activity, fine granular

materialmaterial Melanosome – filaments with periodocity 10nmMelanosome – filaments with periodocity 10nm Dense granuleDense granule Melanosome visible in LM, size 1x0,4 Melanosome visible in LM, size 1x0,4 mm

MelanocytesMelanocytes

Cytocrine secretion melanosomes transferred Cytocrine secretion melanosomes transferred to keratinocytesto keratinocytes

Function – protection from UV radiationFunction – protection from UV radiation Epidermal – melanin unit – about 1000/mm2Epidermal – melanin unit – about 1000/mm2 Higher number in the skin of scrotum, circum-Higher number in the skin of scrotum, circum-

anal region, areola mammae) anal region, areola mammae)

Merkel´s cellsMerkel´s cells

Present in thick skin in stratum basalePresent in thick skin in stratum basale Small dense granules (neurotransmiters)Small dense granules (neurotransmiters) Nerve endingNerve ending Sensoric mechanoreceptorsSensoric mechanoreceptors

Langerhans´ cellsLangerhans´ cells

Mainly in stratum spinosumMainly in stratum spinosum Bone marrow derived - antigen presenting cells Bone marrow derived - antigen presenting cells

– in lymphatic nodes - they differentiate into – in lymphatic nodes - they differentiate into activated dendritic cells – (contain Birbeck´s or activated dendritic cells – (contain Birbeck´s or vermiforms granules - rodlike)vermiforms granules - rodlike)

DermisDermis

Dense collagen connective tissue with elastic Dense collagen connective tissue with elastic fibres. Main glycosaminoglycane is dermatan fibres. Main glycosaminoglycane is dermatan sulphatesulphate

Attachment to epidermis – hemidesmosomes and Attachment to epidermis – hemidesmosomes and anchoring filaments (laminin 5) and fibriles anchoring filaments (laminin 5) and fibriles (collagen VI) – blister, pemphigus(collagen VI) – blister, pemphigus

Stratum papillareStratum papillare Stratum reticulareStratum reticulare

Skin appendages – glands, hairs, nailsSkin appendages – glands, hairs, nails Sensoric ending (Vater-Paccini, Meissner etc.)Sensoric ending (Vater-Paccini, Meissner etc.)

Fissionability linesFissionability lines

podle Kraisla

• Along the collagen fibres in dermis• Important for cosmetic surgery and for cutting motion

HypodermisHypodermisTela subcutaneaTela subcutanea

• Loose collagen tissue and adipose tissueLoose collagen tissue and adipose tissue• Is not present in eyelids, clitoris and penisIs not present in eyelids, clitoris and penis• Retinacula cutisRetinacula cutis• Panniculus adiposusPanniculus adiposus

– Stratum musculorumStratum musculorum– Stratum fibrosumStratum fibrosum

• Stratum membranosumStratum membranosum• Textus connectivus laxusTextus connectivus laxus• Bursae synoviales subcutaneaeBursae synoviales subcutaneae

Skin appendagesSkin appendages

Hair and hair follicleHair and hair follicle Sebaceous glandsSebaceous glands Sweat glandSweat gland Apocrine glandsApocrine glands

HairHair

Hair follicleHair follicle Hair bulb (bulbus pili)Hair bulb (bulbus pili) Dermal papillaDermal papilla Hair (cuticle of hair, cortex, and medulla)Hair (cuticle of hair, cortex, and medulla) Internal (epithelial) root sheatInternal (epithelial) root sheat External (epithelial) root sheatExternal (epithelial) root sheat Connective tissue sheatConnective tissue sheat Arrector pili muscleArrector pili muscle

NailsNails

Nail root hidden in nail grooveNail root hidden in nail groove Eponychium or cuticleEponychium or cuticle Nail plate (stratum corneum) on the nail bed Nail plate (stratum corneum) on the nail bed

(stratum basale and spinosum)(stratum basale and spinosum) Nail plate arises from nail matrix (root and Nail plate arises from nail matrix (root and

lunula)lunula)

Glands of the skinGlands of the skin

Sebaceous glandsSebaceous glands – holocrine glands, – holocrine glands, composed alveolar composed alveolar

Duct – stratified squamous epitheliumDuct – stratified squamous epithelium Not present in thick typeNot present in thick type Duct usually ends in the upper part of hair Duct usually ends in the upper part of hair

folliclefollicle Directly on surfacer: glans penis, clitoris, Directly on surfacer: glans penis, clitoris,

labia minora, lips, areola mammaelabia minora, lips, areola mammae

Glands of the skinGlands of the skin

Sweat glands - eccrine Sweat glands - eccrine (merocrine) – simple coiled (merocrine) – simple coiled tubular glandtubular gland

Excretory duct opens at the skin surfaceExcretory duct opens at the skin surface Dark cellsDark cells – glycoproteins – glycoproteins Clear cells Clear cells – glycogen, basolateral labyrinth – – glycogen, basolateral labyrinth –

secretion of water and ionts (Na, Cl)secretion of water and ionts (Na, Cl) Myoepithelial cellsMyoepithelial cells Ducts - pseudostratified epithelium and space Ducts - pseudostratified epithelium and space

between keratinocytesbetween keratinocytes Function - thermoregulationFunction - thermoregulation

Glands of the skinGlands of the skin

Apocrine glands Apocrine glands – present in axilla, anal and – present in axilla, anal and genitregion, areola mammae, modified in ear genitregion, areola mammae, modified in ear (ceruminous) and eyelid (glands of Moll)(ceruminous) and eyelid (glands of Moll)

Secretory part is wider, ducts opens in hair Secretory part is wider, ducts opens in hair follicle, secretory activity starts at puberty follicle, secretory activity starts at puberty (merocrine secretion with changes of cell (merocrine secretion with changes of cell size)size)

Adrenergic inervationAdrenergic inervation

Mammary gland (Mammary gland (glandula mammariaglandula mammaria))

• The greatest gland of the skinThe greatest gland of the skin• Lactation Lactation →→ newborn nutrition newborn nutrition • Paired glands – sulcus intermammariusPaired glands – sulcus intermammarius• From 3th – 6From 3th – 6thth ribs, parasternal ribs, parasternal ► anterion ► anterion

axillar lineaxillar line• Upon the deep pectoral fascia Upon the deep pectoral fascia • Retromammary space – loose connective tissueRetromammary space – loose connective tissue• 11 cm x 12 cm11 cm x 12 cm• 150g, during lactation 300-800g150g, during lactation 300-800g

DevelopmentDevelopment

Mammary ridgeMammary ridge

Only in thoracal regionOnly in thoracal region

(Supernumerary breasts and nipples)(Supernumerary breasts and nipples) Development of nipple and glandsDevelopment of nipple and glands 15-20 lobes epithelial buds – lactiferous ducts 15-20 lobes epithelial buds – lactiferous ducts Before puberty lactiferous ducts and lactiferous sinuses, Before puberty lactiferous ducts and lactiferous sinuses,

onlyonly Increase in size after puberty (influence of estrogens) - Increase in size after puberty (influence of estrogens) -

terminal interlobular ducts + adipose tissueterminal interlobular ducts + adipose tissue

Mammary gland (Mammary gland (glandula mammaeglandula mammae))

• Corpus mammae – glandular tissueCorpus mammae – glandular tissue - processus - processus axillarisaxillaris

• 15-20 compound tubo-alveolar glands15-20 compound tubo-alveolar glands• Ducts = Ducts = lactiferous ducts lactiferous ducts → lactiferous sinuses → → lactiferous sinuses →

nipple (nipple (mammary papillamammary papilla)) and areola and areola• Lobes Lobes → lobules →glandular alveoles surrounded → lobules →glandular alveoles surrounded

by dense connective tissue and adipose tissue by dense connective tissue and adipose tissue • Fibrous condensations of stromal tissue -to the Fibrous condensations of stromal tissue -to the

dermis suspensory ligaments (dermis suspensory ligaments (of Astley Cooperof Astley Cooper) ) Retinaculum cutis mammae = ligg. suspensoria Retinaculum cutis mammae = ligg. suspensoria mammaria mammaria CooperiCooperi

MammaMamma

Menstrual cycleMenstrual cycle Progesteron stimulates cyclic Progesteron stimulates cyclic changes – alveolar buds develop under the changes – alveolar buds develop under the influence of progesteron, old regress (apoptosis)influence of progesteron, old regress (apoptosis)

Pregnancy Pregnancy – Prolactin and placental lactogen – – Prolactin and placental lactogen – development of secretory acinidevelopment of secretory acini

LactationLactation Nerve stimulus – oxytocin – contraction of Nerve stimulus – oxytocin – contraction of

myoepithelial cells – rejection of milkmyoepithelial cells – rejection of milk Prolactin – milk secretionProlactin – milk secretion Colostrum -první mlékoColostrum -první mléko Milk – Milk –

Proteins – merocrine secretionProteins – merocrine secretion Lipids -apocrine secretionLipids -apocrine secretion Sugar (lactosa) production in GASugar (lactosa) production in GA

Immunoglobulins (IgA) -plasma cellsImmunoglobulins (IgA) -plasma cells Decrease of prolactin level – apoptosis - regressionDecrease of prolactin level – apoptosis - regression

Mammary glandMammary gland – – arteriesarteries

Arcus aortaeArcus aortae → a. subclavia → a. thoracica interna → a. subclavia → a. thoracica interna Internal thoracic arteryInternal thoracic artery

aa. intercostales anterioresaa. intercostales anteriores (I.-V./VI.) (I.-V./VI.) → rr. perforantes → rr. perforantes Arcus aortaeArcus aortae → a. subclavia → a. axillaris → a. subclavia → a. axillaris Axillary arteryAxillary artery→ → a. thoracica superiora. thoracica superior→ → (r. pectoralis a. thoracoacromialis, a. thoracica lat., a. (r. pectoralis a. thoracoacromialis, a. thoracica lat., a.

subscapularis)subscapularis)Aorta thoracicaAorta thoracicaaa. intercostales posterioresaa. intercostales posteriores Intercostal arteriesIntercostal arteries (II.- (II.-

V.) V.) → rr. perforantes → rr. perforantes /II./II.

Mammary glandMammary gland – – veinsveins

• Circular venous plexus Circular venous plexus Halleri Halleri – around – around areaolaareaola

v. axillarisv. axillaris v. internal thoracicv. internal thoracic vv. intercostalvv. intercostal

Mammary gland - nervesMammary gland - nerves

nn. intercostales IV.- VI. nn. intercostales IV.- VI. rami ant. + lat.rami ant. + lat.

sensoric (T4)sensoric (T4) and sympathetic fibres and sympathetic fibres

Mammary gland – lymph vesselsMammary gland – lymph vessels

4 quadrants4 quadrantsPlexus subareolaris SappeyiPlexus subareolaris Sappeyi• Contralateral breastContralateral breast and axillaand axilla• Internal mammary lymph node chainInternal mammary lymph node chain

nodi l. parasternalesnodi l. parasternales nodi. mediastinales ant.nodi. mediastinales ant. nodi epigastrici sup. + inf.nodi epigastrici sup. + inf.

• Axillary lymph nodesAxillary lymph nodes– Sorgius – The most cranial from nodi l. Sorgius – The most cranial from nodi l.

pectorales,on 2./3. dens of m. serratus ant.pectorales,on 2./3. dens of m. serratus ant.• nodi l. supraclavicularesnodi l. supraclaviculares

Carcinoma of mammary gland Carcinoma of mammary gland The most frequent tumor in females - 9% women suffer from this illness

Clinical signs – swelling -tumor, skin pulling, ulcers

Examination – palpation, sonography, mamography, lymphatic nodes

• exstirpation

• mastectomy (parcial, total)

Carcinoma of mammary glandCarcinoma of mammary gland

90% of carcinoma develop from ductal 90% of carcinoma develop from ductal epithelium, only 10% within lobular alveolo-epithelium, only 10% within lobular alveolo-ductal epitheliumductal epithelium Ductal epithelium has estrogen receptorsDuctal epithelium has estrogen receptors

Paget carcinoma – in the nipplePaget carcinoma – in the nipple Intraductal– within lactiferous ducts Intraductal– within lactiferous ducts Lobular carcinomaLobular carcinoma