2.6 The Skin Flashcards

1
Q

The skin is the biggest organ in the human body, what area and weight is it?

A

It covers an average area of about 2 square meters and weighs about 4-5 kilograms.

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2
Q

Skin covers the whole body but varies in thickness, where is the thickest found? What is the average thickness?

A

On parts of the body likely to receive the more wear and tear like the soles of the feet. The average thickness of the skin over most of the body is one - two millimetres.

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3
Q

What is the visible part of the sin and the hair comprised of?

A

The visible part of the sin and the hair are both comprised of dead cells which are constantly being shed and replaced.

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4
Q

The skin continually renews itself, old skin cells are shed and replaced by new ones with most cells being replaces every how many days?

A

Every 28 days.

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5
Q

Every minuet, his many dead skin cells do we lose from the surface of our skin?

A

About 30,000 to 40,000, which is almost 4kg of cells every year.

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6
Q

Like most of the body, skin contains a high percentage of what?

A

A high percentage of water and if it dries out this can cause skin disorders. The water content of sin needs to be maintained in order to ensure skin health.

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7
Q

Why is the skin at more risk of drying out than any other part of the body?

A

The skin is exposed to the sun and wind.

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8
Q

What important function does the skin have for the body?

A

Maintaining internal temperature. It helps the body transfer heat to the environment to cool down or reduce the energy transfers when needed to keep warm, so that under normal circumstances, the internal core temperature of the body varies by no more than 0.1 degrees C.

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9
Q

The structure of the skin has to be strong enough to keep out pathogens and protect the vital organs beneath from physical damage and dehydration, yet be sufficiently flexible to allow movement - it has three layers, what are these?

A

The epidermis, the dermis and the subcutaneous layer.

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10
Q

What layer of the skin is the epidermis?

A

The top layer.

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11
Q

What does the epidermis provide?

A

Protection and prevents micro-organisms from entering the body.

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12
Q

The epidermis is made up of a number of layers - what is the inner most layer made from?

A

The innermost layer of the epidermis is made up of rapidly dividing cells attached to a basement membrane which separates the dermis from the epidermis.

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13
Q

What cells are found in the basal layer of the epidermis? what do they produce?

A

Melanocytes are cells found in the basal layer of the epidermis which produce the protective pigment melanin in response to UV light from the sun.

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14
Q

What does melanin reduce the risk of?

A

Melanin protects the cells from UV radiation and therefore reduces the risk of radiation induced mutations taking place in the DNA of the skin cells. This in turn protects the body from the risk of skin cancers such as melanoma developing as a result of the mutations.

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15
Q

Basement membranes or basal laminae are found beneath sheets of what throughout the body?

A

Basement membranes are found beneath sheets of epithelial cells throughout the body

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16
Q

In the skin, what is the basal lamina fastened to and by what?

A

The basal lamina is fastened to connective tissue by collagen molecules - in some diseases these connections are absent and the epidermis becomes detached and blistering occurs.

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17
Q

As these rapidly dividing cells move towards the skins surface, their structure and activity change, they begin forming which protein?

A

As these rapidly dividing cells move towards the skins surface, their structure and activity change, they begin forming keratin and this continue a they move towards the surface, pushed up by new cells forming beneath them.

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18
Q

After 15-30 days, the cells reach the outer later of the epidermis called what?

A

Stratum corneum, which is made from dead keratinised cells. these gradually shed from the surface.

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19
Q

Why is the stratum corneum the major barrier to the loss of water from the body?

A

Largely because it is rich in lipids (oils) which are impermeable to water.

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20
Q

What is the stratum corneum not, despite being water resistant?

A

It is not waterproof.

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21
Q

What fluid gradually penetrates it and evaporates from the surface into the surrounding air? approx how much water is lost from the body each day in this way?

A

The interstitial fluid, approx 500cm3

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22
Q

Skin varies on different parts of the body - which skin has relatively thin epidermis and numerous sensory receptors?

A

Non-hairy skin, like that of the palms of the hand and soles of the feet.

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23
Q

Which skin has a thin epidermis and many sebaceous glands?

A

Skin with hair follicles such as the scalp.

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24
Q

What do the sebaceous glands excrete?

A

A wax/oily substance called sebum that helps lubricate and waterproof the skin.

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25
Q

When does dry skin arise?

A

When there is not enough water in the stratum corneum

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26
Q

What is the normal water content of this later of tissue and when do symptoms of dry skin appear?

A

The normal water content is between 10% - 20% and when the water content falls below 10% the symptoms of dry skin appear

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27
Q

What are a number of reasons dry skin can occur?

A
  • Ageing = as an individual grows older, the epidermis begins to thin and loses the ability to retain moisture, the skin therefore becomes dryer.
  • Over exposure to the sun
  • Exposure to cold weather
  • Inflammatory conditions such as dermatitis and eczema are associated with dry skin.
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28
Q

What symptoms may people suffering from dry skin experience?

A

Loss of flexibility, roughness, hyperkeratosis (a thickening of the outer layer of the skin), inflammation and pruritus (itching)

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29
Q

The dermis contains cells in a network made up of which two main types of protein?

A

Collagen and elision.

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30
Q

What do the collagen fibres and elastin provide?

A

The collagen fibres provide strength while elastin gives the skin its flexibility.

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31
Q

What other structures are found in the dermis?

A

Network of blood vessels.
Sweat glands which are found all over the skin and secrete a dilute sale solution onto the skins surface.
Sebaceous glands which are associated with hair follicles and secrete sebum onto the surface of the skin.
Sensory receptors which detect changes in the environment such as pressure and temperature.

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32
Q

All over the skin of mammals there are hairs, each hair grows from its own individual hair follicle. How does new hair form inside the follicle?

A

Inside the follicle, new hair cells form at the root of the hair shaft, as the cells form, they push older cells out of the follicle, as they are pushed out, the cells die and become the hair we see.

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33
Q

What is the growth phase ?

A

The period where a follicle will produce new cells for a certain period of time depending on where it is located on the body.

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34
Q

What is the rest phase?

A

When the follicle stops producing new cells for a period of time, before restarting the growth phase again, at this stage the old hair falls out and is replaced by a new one.

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35
Q

What muscle us the hair follicle attached to?

A

The arrestor pili (also called erector pili or hair erector muscle).

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36
Q

What do the arrestor pili do? What is an example of this?

A

They contract to pull the hair shaft erect - in furry animals when the hairs stand on end this traps a later of insulating air to help conserve heat in the body.

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37
Q

What are goose pimples?

A

We get goose pimples when out hairs stand on end, the goose pimples are the effect on the skin of the contractions of the arrestor pili muscles on the hair follicles.

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38
Q

Why can adult man lose their scape hair?

A

It is caused by increased sensitivity to male sex hormones (androgens) in certain parts of the scalp - this tendency for male pattern baldness is pass on from generation to generation.

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39
Q

How many sweat gland in the dermis does the average person have?

A

2.5 million.

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40
Q

What is the watery secretion, sweat very important for?

A

Maintaining homeostasis, if the core body temperature begins to rise, swear production increases, the sweat cools the body as it evaporates from the surface of the skin.

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41
Q

What re aprocine sweat glands?

A

They are found adjacent to hair follicles in the hairy areas of the body such as the armpit and the grown - they produce sweat that contains organic chemicals inc. proteins, when these are broken down by the bacteria on the skin, they can produce an unpleasant body odour.

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42
Q

What are the eccrine sweat glands?

A

The rest of the skin has eccrine sweat glands which basically produce salty water - they are sited between hair follicles.

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43
Q

What do sebaceous glands nearly always connect to?

A

Hair follicles.

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44
Q

What do sebaceous glands produce?

A

A lipid containing sebum secretion onto the surface of the skin which helps to keep the skin water resistant and supple.

45
Q

The size of the sebaceous gland and therefore the amount of sebum itself varies according to what?

A

Body region - the glands on the face are bigger than those found on the arm or lefts.

46
Q

What causes acne?

A

During puberty, the sex hormones cause changes in the skin which can result in acne, his is inflammation and infection of the sebaceous glands.
In boys it is caused by testosterone and in girls the cause is less clear but it may be the balance between the different hormones. It is not infectious but can cause psychological distress to those who suffer badly. It can get better beyond puberty but not always and the skin can be very badly affected by scarring.

47
Q

What is the subcutaneous layer of the skin made up of?

A

Fatty tissue which acts as a cushioning later and as an energy store for the body. It contain sensory nerve endings. Obese people have a very thick layer of subcutaneous fat.

48
Q

What do each one of us have that is unique on our skin?

A

Each one of us has a unique healthy skin flora of microorganisms that keep pathogenic (disease causing) microorganisms off. Millions of microorganisms live harmlessly on our skin.

49
Q

Unless the skin is damaged, What role does it have?

A

It stops most microorganisms getting into the body cells or the blood and causing infection

50
Q

What does keratin protect?

A

The underlying tissue from microbes, abrasion, heat an chemicals.

51
Q

What does sebum contain?

A

Bactericidal chemicals that kill unwanted surface bacteria.

52
Q

What does melanin protect the skin cells and the cells under the skin from?

A

damage by UV light

53
Q

What do WBCs (macrophages) in the dermis do?

A

Kill bacteria and viruses that get past the defences in the epidermis.

54
Q

What does the acid pH of sweat also prevent?

A

The growth of some microbes.

55
Q

Vitamin D is synthesised in the dermis of the skin when it is exposed to sunlight, a precursor molecules in the skin is activated by UV rays in sunlight to form vit D. why is this important?

A

This is important because vit D is needed for the body to absorb calcium from food and calcium is needed for the formation of healthy bones and teeth. If the skin is not exposed to sunlight regularly, the body may suffer form a lack of Vitamin D which in turn causes soft of brittle bones leading to conditions such as rickets and osteoporosis.

56
Q

How does the skin also act as a blood reservoir?

A

The dermis has an extensive network of blood vessels that carry about 10% of the total blood flow in a resting adult.

57
Q

What does the internal core body temperature need to be maintains at around and why?

A

37 degreesC for body systems, tissues, organs and enzymes to function normally - so enzymes of the metabolism work as well as possible.

58
Q

What happens when we do strenuous activity?

A

It leads to an increase in energy transfer from the big skeletal muscles to the blood, warming it up - warmed blood flows through the temperature regulation regions of the brain and sensory receptors register the rise in core temperature - the body reacts in a series of responses that lower the core temperature again.

59
Q

How are we able to cool down a little by increased breathing?

A

Water evaporates from the surfaces of our mouth and nose.

60
Q

What is the main organ by which we cool down?

A

The skin is the major organ by which we cool down, transferring energy to our surroundings. A rise in core temperature as a result of increased metabolism or a fever causes an increase in blood flow through the blood vessels of the skin and the skin becomes warm to touch. cooling may then occur in a number of ways.

61
Q

How does evaporation cool the core body temperature?

A

A rise in the core temperature causes sweat to be produced onto the skin surface - the water in the sweat evaporates transferring energy from the body to the surroundings in the process, cooling the body down.

62
Q

How does radiation cool the core body temperature?

A

Vasodilation takes place in the blood vessels feeding the skin capillaries, so more blood flows through the capillaries close t the surface of the skin - the skin flushes and as a result energy is transferred from the blood to the surrounding air by radiation.

63
Q

How does conduction cool the core body temperature?

A

Energy will be transferred from the body to any object the is cooler than the skin temperature by conduction, cooling the body down.

64
Q

How does convection cool the core body temperature?

A

Energy from the body will be transferred to the closet later of air warming it, the warmer air rises to be replaced by cooler air and more energy will be transferred from the skin surface, cooling it down each time.

65
Q

If the core body temperature starts to drop then the skin is also involved in preventing further cooling. How does vasoconstriction prevent further cooling?

A

Vasoconstriction takes place in the blood vessels supplying the skin capillaries, the flow of blood through the skin is reduced and so less energy is transferred to the environment by radiation as a result little cooling takes place.

66
Q

What other ways does the skin prevent further cooling?

A
  • Very little or no sweat forms, no water evaporates from the skin surface and no cooling takes place.
  • Arrestor pili contract, pulling hairs upright to trap an insulating layer of air and prevent energy transfer by conduction and convection
  • Shivering, which is the involuntary contraction of the skeletal muscles warms the body.
  • In some animals and very young babies, special brown fat is metabolised just to transfer energy and warm the body if the temperature severely drops.
67
Q

What happens if the body temperature drops below 35 degrees C?

A

The reactions of the body do not take place rapidly enough to maintain life - thermogenesis is not sufficient and the metabolic reactions begin to shut down, the person develops hypothermia, where the normal mechanisms to conserve the body temperature fails and without intervention the affected person may die.

68
Q

What happens if the body temperature goes too high and reaches above 40 degrees C?

A

The enzymes start to denature and can no longer catalyse the metabolic reactions of the body - the person develops hyperthermia and may die, this is why it is so important to get the body temperature down if someone has a very high fever a a result of disease and why antipyretic medicines are important.

69
Q

The skin contains a number of different sensory receptors. What are mechanoreceptors?

A

Mechanoreceptors are responsive to the mechanical stimuli such as stretching, deformation or bending of cells (for example by touch and pressure)

70
Q

What are photoreceptors?

A

These respond to light, cells in the epidermis produce melanin when exposed to IV radiation, the depth of the pigmentation reflections the intensity and duration of time exposed to UV light.

71
Q

What are thermoreceptors?

A

These respond to both heat and cold, they protect you from picking up objects that are too hot or too cold and help the body thermoregulate by giving an awareness of the external temperature.

72
Q

What are nociceptors?

A

These are pain receptors, they respond to physical or chemical damage to tissues.

73
Q

What are the 2 main types of wound to the skin?

A

Epidermal wound and deep wounds.

74
Q

What do epidermal wounds involve?

A

Epidermal wounds involve slight to moderate damage of epidermal cells, like an abrasion or small cut.

75
Q

What is the skins response to epidermal wound?

A

In response to an epidermal wound, the cells of the epidermis surrounding the wound enlarge and cover it until they meet in the middle where they stop moving due to contact inhibition.

76
Q

What happens as the cells move across the wound?

A

A hormone , epidermal growth factor, stimulates the epidermal cells to divide and replace the ones that have moved to seal the wound.

77
Q

What do deep wounds involve?

A

Deep wounds involve injury or damage to there dermis and subcutaneous later meaning multiple tissue layers have to be repaired. Scar tissue is formed and the healed tissue may lose some of its function

78
Q

What are the four phases that occur in the healing process of a deep wound?

A

1) Inflammatory phase - a blood clot forms in the wound and loosely unites the two edges.
2) Migratory phase - the blood clot becomes a scab and epithelial cells migrate below the scale to seal the wound, damaged blood vessels behind to regrow.
3) Proliferative phase - extensive growth of epithelial cells and collagen fibres deposited by fibroblasts - growth of blood vessels continues
4) Maturation phase - the scab sloughs off once the epidermis reaches normal thickness.

79
Q

What is the term dermatitis used to describe? What is it?

A

Dermatitis is a term used to describe many inflammatory conditions on the skin and is also known as eczema. There are many different kinds of dermatitis which may be acute of chronic.

80
Q

There are a number of different causes of dermatitis, what are these?

A

They include irritants such as cleaning products, allergens such as flour or animal fur and the body own immune system.

81
Q

What does one form of dermatitis, allergic contact dermatitis, result from?

A

Exposure to a sensitising allergen, resulting in a definitive red, slightly roughened itchy area with blisters that weep when scratched.

82
Q

What is Urticaria?

A

Known as hives, is another common form of dermatitis that may be caused by allergens or by a response of the body to internal factors such as stress of infection - it produces pale red, raised, itchy bumps on the skin.

83
Q

What is psoriasis?

A

This is a relatively common, chronic, autoimmune skin disorder which produces thickened inflamed areas of skin.

84
Q

How does psoriasis cause its symptoms?

A

The epidermal cells divide and move more quickly thank normal from the base of the epidermis to the stratum corneum - they then shed prematurely after seven to ten days. The cells form flaky, silvery scales.

85
Q

What is the trigger for this autoimmune disease?

A

The trigger for this autoimmune disease is not yet understood and the condition can be anything from relatively mild, occurring occasionally linked to stress or severe and constant.

86
Q

What is acne?

A

Acne is a common skin disorder that results from an overproduction of sebum from the sebaceous glands, normally during teenage years. The excess sebum mixes with dead skin cells and bacterial and can block hairs follicles as well as sebaceous, aprocine and eccrine ducts causing inflamed, painful, pus-filed areas which may even form cysts. Cystic acne can scar the epidermis permanently. Acne can be mild, moderate or severe.

87
Q

What percentage of the population is affected by acne and need medical treatment.

A

Around 20%.

88
Q

Fungal infections are any inflammatory condition caused by a fungus - what is the most common fungal infection in the skin?

A

The most common function infections are caused by the dermatophytes, fungi which digest keratin.

89
Q

What do dermatophyte fungal infections appear as?

A

These fungal infections which appear as characteristic raised patches of skin are defined by the area of body they invade. For example - tine capitis is scalp ringworm, tine corpora is body ringwork and tine media is athletes foot. (although called ringworm they have nothing to do with worms.

90
Q

How is the disease spread?

A

Through contact with the fungus

91
Q

What is impetigo?

A

This is a bacterial infection of the skin that is quite common in school-age children producing pink, water-filled raised lesions, commonly around the mouth and nose - they develop a yellow crust and eventually repute and the discharge from the lesions is highly contagious.

92
Q

What causes Impetigo?

A

It may be caused by streptococcal bacteria, staphylococcal bacteria or a combination.

93
Q

What are cold sores?

A

These are small fluid filled blisters which itch and sting when they are appearing and while they last.

94
Q

What causes cold sores?

A

It is caused by herpes simplex virus - they virus remains formant in the nerves of the skin until it is activated by a triggering event such as an emotional upset, fever or UV radiation - once you have caught herpes it cannot be cured.

95
Q

What causes chickenpox?

A

The varicella-zoster virus (VZV) causes chickenpox, a common infectious disease usually affecting children.

96
Q

What happens to VZV once you have caught it?

A

It remains dormant in the nervous system after the chickenpox is resolved.

97
Q

What is the result of the reactivation of the VSV, often may years after the original infection?

A

Herpes zoster, or shingles results from the reactivation, shingles is most common in people over 50 years old

98
Q

What causes the reactivation of VZV?

A

It is sometimes in response to stress of infection and soemtimes for no apparent reason at all.

99
Q

What does shingles appear as?

A

The shingles rash may be preceded by a phase of tingling or pain followed by painful and tender blistering which occurs on one side of the body only. The blisters occur in crops and then crust over - the rash lasts for 2-4 week. Pain, sometimes severe can persist for many weeks or months after the disappearance of the blisters.

100
Q

What is rosacea?

A

Rosacea is a common inflammatory rash mainly affecting the face. It causes facial flashing, inflammatory papule and pustule affecting the nose, forehead and cheeks. Often causing significant psychological distress because it is obvious on the face and affect appearance.

101
Q

When is the onset of rosacea? what makes it worse?

A

The onset is usually in middle age and is more common in women, the flushing can be made worse by alcohol, hot drinks and sunlight.

102
Q

Name some topical treatments that are applied to the skin itself?

A
  • Moisturising agents/emollients for dry skin.
  • Steroids may be used topically to reduce inflammation in the short term.
  • Topical antibacterials may be used for bacterial skin in sections and medicine containing erythromycin or benzoyl peroxide for acne.
  • Antivirals used for viral skin infections scubas herpes simple (cold sores) they must be applied at the very first onset of symptoms and they do not cure the condition but they ca reduce the severity of the flare up.
  • Antifungals for fungal skin infections such as ringworm and athletes foot.
  • Coal tar, vitamin D analogues and phototherapy for treatment of psoriasis.
103
Q

Systemic treatments include:

A
  • Oral steroids for severe skin inflammation
  • Oral antibiotics and antivirals for skin infections
  • Oral retinoids for psoriasis
  • Oral agents affecting the immune response to treat autoimmune disease including some forms of dermatitis and psoriasis.
104
Q

Injectable (IV or subcutaneous) treatments include:

A

Biological agents acting through the immune system to treat psoriasis.

105
Q

Most medicines are absorbed into the body through the digestive system or by injection into subcutaneous tissue or muscle what other way can be a useful route of administration of medicines?

A

Although the skin is a very effective barrier against the entry of water or microorganisms into the body, it can provide a useful route for the administration of medicines. The transdermal or transcutaneous method enable a medicines to pass across the epidermis into the blood vessels of the dermis via an adhesive skin patch.

106
Q

How do adhesive skin patches work?

A

The medicine is release continuously at a controlled rate over a period of time, commonly one to several days.

107
Q

Where about do the skin patches need to be applied?

A

Because the stratum corneum is fairly impenetrable, skin patched need to be applied where the epidermis is thinner such as the upper arms, face, scalp or scrotum.

108
Q

What are transdermal patches commonly used in the administration of?

A

Nicotine to help people stop smoking, and in the delivery of HRT. it is also possible to implant medicines under the skin such as female contraception.