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Lecture 10 : Integumentary System > Integumentary System > Flashcards

Integumentary System Flashcards

1
Q

Skin Facts (6)

A
  • Forms the integumentary systems
  • Largest Organ of the human body
  • 2sqm2
  • 0.5 -4mm thickness
  • Covers external body and continues with mucous membrane internally
  • Epithelial membrane -> Cutaneous membrane
  • Contains accessories structures : Glands, hair & nails
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2
Q

Skin Structure - 3 Main Layers

A
  1. EPIDERMIS : Superficial layer of skin formed epithelial tissue ( tightly packed together )
  2. DERMIS : connective tissues + accessory structures ( Sweat glands, hairs , sebaceous glands )
  3. SUBCUTANEOUS / ADIPOSE LAYER : Insulating & protective layer of fatty tissue. Connects the dermis to deeper lying muscle & Bone
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3
Q

Epidermis Overview

A
  • Formed of keratinised epithelium ( Protective & waterproofing )
  • varies in thickness
  • Interstitial fluid provides O2 & nutrients to cell via slow diffusion -> drained by lymph
  • Avascular ( no blood vessels) & no nerves ending
  • Attached to dermis by a basement membrane ( glue )
  • takes 40 days to replace epidermis
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4
Q

Journey of keratinocyte

A
  1. Produced at the bottom of epidermis and move up towards the surface -> become flattened
  2. They accumulate a protein call keratin on their journey to the surface ( waterproof)
  3. Suffocate cell from inside
  4. Cell die and end up on the surface of our skin
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5
Q

Epidermis Cells

A
  1. Keratinocytes (90%)
    - Though fibrous protein that protects from heat , microbes & chemicals
  2. Melanocytes (8%)
    - Synthesize melanin. Melanin is a pigment that contributes to skin colour and absorbs UV light .
    - Surround nuclei of keratinocytes ( Barrier - protect DNA )
    - 2 types of melanin : eumelanin ( brown black ) / pheomelanin ( reddish yellow ) -> fair skin less melanin protection
  3. Langerhans cells (2%) :
    - Ingesting foreign invaders.
    - immune cells involved in skin surveillance ( antigen - presentation )

Bonus : By shedding dead cells from our skin we are also removing colonies of bacteria that are living on the skin

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6
Q

Fingerprints

A
  • Develop 3rd month of foetal development
  • Ridges between dermis & epidermis create fingerprintes
  • Increase surface area & enhance grip by creating friction
  • Unique -> pressure in the womb
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7
Q

Epidermis 5 Layers

A
  1. Stratum Corneum
  2. Stratum lucidum
  3. Stratum Granulosum
  4. Stratum Spinosum
  5. Stratum Basale
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8
Q

Stratum Corneum

A
  • Can be thin or Thick
  • 25-30 layers of flattened dead keratinocytes
  • cytoplasm replaced by keratin
  • Are shed ( desquamated )
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9
Q

Stratum lucidum

A
  • 3-5 layers of dead skin

- only present in thick skin ( hands / feet )

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10
Q

Stratum granulosum

A

3-5 layers of cells undergoing apoptosis ( cell suicide )

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11
Q

Stratum spinosum

A

8-10 layers of new keratinocytes

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12
Q

Stratum basale

A

Single row dividing to form new keratinocytes

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13
Q

Skin Colour [BROWN]

A
  • Pigmentation due to varying degrees of melanin produces by melanocytes
  • Different race have same # of melanocytes but different amounts & types of melanin ( eumelanin / pheomelanin )
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14
Q

Skin Colour [PINK]

A

Color due to Blood Circulation & Oxyhaemoglobin (Red)

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15
Q

Skin Colour [NATURAL YELLOW]

A

Caused by Carotenes

-> If Yellow and not eating lot of carotenes -> issue converting it into Vit A

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16
Q

Skin Colour [ YELLOW]

A

Pathology due to bilirubin ( Jaundice , cyanosis )

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17
Q

Skin Colour [ PALE / FRECKLES ]

A
  • Albinos unable to synthesise melanin
  • Could indicate anaemia
    Freckles : uneven distribution of melanocytes
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18
Q

Dermis Definition

A

Thickest layer of the skin formed of connective tissue & accessory structures - Contains matrix of collagen (strength) & elastic fibers ( stretch & recoil )

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19
Q

Sweat (sudoriferous) Glands

A
  • Consist of a gland , duct & pore. Located next to a capillaries to receive secretion .
  • Most numerous in palms , sole of feet, axillae & groin
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20
Q

Sweat Composition

A

Urea ( Waste excretion ), Na+ ( sodium ) & Salt.
Excessive sweats leads to dehydration & sodium depletion -> Need Sodium ( Jungle trek example )

Tip : Water with electrolyte including sodium if activity with lot of sweating ( hot yoga , sauna ,.. )

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21
Q

Sweat Smell

A

Created by action of bacteria breaking down substances in sweat ( like fatty acids )

Note : Western countries smell more as too much cleaning / soap remove good bacteria -> vicious bacteria left eating sweat and turning them into sticky compound

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22
Q

Sensory Nerve Ending

A
  • Meissner’s corpuscule (near surface) : sensitive to light pressure
  • Pacinian corpuscule ( deep) : sensitive to deep pressure
  • Free nerve ending : sensitive to pain & temperature

1 Nerve root for all -> Deep pressure for injection so nerve ending not able to send pain message

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23
Q

Dermis contains

A
  • Arterioles & capillaries -> thermoregulation
  • Lymph vessels & sensory nerves ending
  • Sweat & sebaceous glands , hairs & Arrector pili ( smooth muscle that erect hair follicle )
  • Fibroblasts ( making collagen & fiber )
  • Immune cells : Macrophages & mast cells
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24
Q

Dermis : Hairs

A

Columns of Dead keratinized cells bond together by proteins

  • Color is genetically determined , hormone influence distribution
  • Contains melanin pigment ( more = darker , grey = no production )
  • Hair shaft determine shape of hair (round=straight, oval / flattened = curly )
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25
Q

Arrector pili

A

Microscopic band of smooth muscle that connect Hair follicle to dermis.
When hair is erect , traps a layer of hair next to skin => thermoregulation

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26
Q

Dermis : Sebaceous Glands function

A

Secrete sebum which keeps hair soft & provides waterproofing for skin + anti microbial
- Located on face , scalp , lips , eyelids, nipples , labia folds & penis glands
- Activity increase during puberty (increase serum production -> traps in pore -> pimple )
- Fatty Acids in serum -> inhibits bacterial growth
-

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27
Q

Skin Function (6)

A
  1. Protection
  2. Thermoregulation
  3. Vitamin D Production
  4. Sensation
  5. Absorption
  6. Excretion
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28
Q

Protection

A

Against dehydration & external factors such as chemicals , toxins , trauma , light & microbes.

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29
Q

How does the skin provide protection ?

A
  1. Physical Barrier : Thanks to closely packed keratinized cells and melanin
  2. Sebum : Contains fatty acids which inhibit microbial growth
  3. Sweat : contains lysozymes which are enzymes that break down bacteria
  4. Desquamation : shedding of skin cells helps remove microbes
  5. Nerve sensors : induce protective reflexes
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30
Q

Thermoregulation : Homeostasis , Variation and control center

A
  • Body Temperature 36.5 - 37.5 , changes in evening ovulation , exercise
  • Hypothalamus & medulla oblongata control center
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31
Q

How does the skin regulate temperature ?

A
  1. Via Activity of sweat glands ( water evaporates off the skin )
  2. Activity of blood vessels :
    - Vasodilatation : arterioles in dermis
    - Vasoconstriction : vessels in internal organs -> more blood to the surface
    => Both stimulated by ANS
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32
Q

Sweat Process

A

Sweat gland secrete sweat on to the skin surface. Evaporation of sweat cools the body.

  • High Temperature : Vasodilation of peripheral blood vessels to promote heat loss ( Blood closer to surface )
  • Low Temperature : vasoconstriction of peripheral blood vessels to prevent heat loss ( Blood closer to our core )
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33
Q

Thermoregulation : Heat production / Heat loss in the body

A
  • Heat production : by liver , muscles & digestive organs. Adipose tissue is an insulator
  • Heat loss : By respiration ( convection & evaporation )
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34
Q

Hypothermia

A
  • Temp <35C
  • Core temp drops below that required for normal metabolism & Body functions
  • Death < 25C
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35
Q

Hyperthermia

A
  • Core Temp elevates above>38.5C
  • 40C -> life threatening
  • 41C-> Brain death
  • 45C ->Death
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36
Q

Vit D Formation

A

ONE OF THE MOST IMPORTANT FUNCTION

  • Uv light activates a Vit D precursor in the skin : 7-dehydrocholesterol (converted to Vit D by sunlight )
  • Kidney convert it into calcitriol
  • Calcitriol : Act as an hormone to incrase Calcium + phosphorus uptake from food into blood -> support bone density
  • Stored in Liver

VIT D Note :
1.Right angle to make Vit D -> Shadow shorter than us
2.Vit D deficiency south / Northern latitude in Winter ( Uk : End Sep - May )
Best time : Midday Sun for few minutes without protection (15-20 min )

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37
Q

Absorption

A
  • Lipid Soluble Molecule : Vit A, D,E,K, medication , essential oils , O2 & CO2
  • Toxins : Acetone ( nail polish ) , Lead & Mercury , arsenic , poison oak & ivy , cosmetic
38
Q

Excretion

A
  • Salt
  • Water
  • Urea
    -Ammonia
    Note : If detoxification system overwhelmed ( liver , constipation ) trying to use the skin as an exit route
39
Q

Wound Healing - Superficial Wound ( Epidermis only )

A

Carpet burns - Abrasions & Burns

  1. Basal cells move across the gap until contact inhibition occurs ( cessation of cell division in cells that touch each other )
  2. Epidermal growth factor causes multiplication of the basal cells until space is filled
40
Q

Wound Healing - Deep Wound

A 
Affect Dermis & Subcutaneous Layer 
3 phases : 
1. Inflammatory Phase
2. Proliferative phase
3. Remodelling Phase
41
Q

Wound Healing - Inflammatory Phase

A
  • Migration of leukocytes to clean up any microbes and foreign tissue
  • Blood clot forms and becomes a scab (croute)
  • Epithelial cells migrate to repair the basement membrane
42
Q

Wound healing - Proliferative Phase

A
  • Granulation tissue is formed with the laying of collagen and blood vessels.
  • Extensive growth & Repair of epithelial cells
43
Q

Wound Healing - Remodelling phase

A
  • Can take 3 weeks to 6 months

- Scab comes off naturally and scar tissue remains ( fibrosis )

44
Q

Scar Tissue

A

A mark left on the skin or other body tissues where a wound , burn or sore has not healed completely and fibrous connective tissue has developed
Contains denser collagen fiber ( less elastic ) - fewer hairs glands , nerve endings & blood vessels ( hence whiter )

45
Q

2 Types of scar tissues

A
  1. Hypertrophic scar : Stays within boundaries of the wound & Flat
  2. Keloid Scar : Larger space than the wound ( raised )
46
Q

Skin Pathologies

SKIN LESIONS

A

Abnormal / damaged tissue with impaired function of skin

47
Q

Skin Pathologies - Papule

A

CIRCUMSCRIBED PALPABLE ELEVATION - NO FLUID

Small , firm , elevated lesion

  • Circumscribed , solid elevation of skin with no visible fluid.
  • Brown , purple, pink or red in color
  • maculopapular rash
48
Q

Skin Pathologies - Pustule

A

INFLAMMED LESION FILLED WITH PUS

Purulent material -> necrotic inflammatory cells - Can be red or white

49
Q

Skin Pathologies - Macule

A

FLAT CIRCUMSCRIBED LESION - ALTERATION IN SKIN COLOR ( non-palpable )
Freckles

50
Q

Skin Pathologies - Nodule

A

SImilar to Papule but bigger & Deeper ( RA)

May be filled with inflamed tissue or fluid - Verrue

51
Q

Skin Pathologies - Crust

A

Collection of dried body fluid ( blood plasma and exucrate ) & dead skin cells ( scab )

52
Q

Skin Pathologies - Lichenification

A

Thick dry rough Plaques of thickened skin
Visibile thickening of epidermis with pronounced lines
Hallmark of chronic eczema / dermatitis or excessive scratching

53
Q

Skin Pathologies - Erosion

A

Shallow moist cavity in the epidermis
Wearing away with loss of superficial epidermis ( from chemical , friction or pressure
Ulcer in diabetes ( carpet burn )

54
Q

Skin Pathologies - Keloid

A

Abnormal scar tissue that grows beyond the skin boundary . Strong genetic links

55
Q

Skin Pathologies - Comedone ( Acne )

A
  • Blackhead , whitehead or red bumps due to excess sebum , keratin & debris forming a plug in the sebaceous duct of a hair follicule
  • Hormones such as testosterone can cause more & thicker oil secretions that block pores
56
Q

Skin Pathologies - Comedone - Blackhead

A

Open Comedo = Blackhead ( acne vulgaris )

If oil is open to air , it will oxidise and turn dark

57
Q

Skin Pathologies - Comedone - Whitehead

A

Closed comedo = Whitehead

If skin has grown over oily material , it remains whit

58
Q

Eczema / Dermatitis

Definition

A

The term Eczema & Dermatitis are interchangeable

Very common chronic , pruritic ( itchy ) , inflammatory skin condition

59
Q

Eczema / Dermatitis

Signs & Symptoms & Complication

A
  • Flaky, dry , oedematous
  • Erythematous (red) oruritic , creusty mostly on flexor surfaces and joints
    Complications : Secondary bacterial infections
60
Q

Contact Dermatitis - Definition

A

Acute inflammation of skin caused by direct contact with an agent. Dividev into :

  1. Irritant (80%)
  2. Allergen (20%)
61
Q

Irritant Contact Dermatitis (ICD)

A

Non Specific inflammatory reaction to a susbustance contacting the skin
Irritation happens where you’ve been in contact with the irritant
Phototoxic dermatitis : Topical ( ie perfumes ) or ingested irritant are activated by exposure to UV rays.

62
Q

Allergen Contact Dermatitis ( ACD)

A
  • Type IV delayed hypersensitivity reaction ( within 72 hrs )
  • Pruritic erythematous rash
  • Can occur with various chemicals ( rubber, metal - nickel )
  • Photoallergic contact dermatitis : Substance becomes allergic only after structural change triggered by UV light ( ie sunscreens )
63
Q

Contact Dermatitis - Signs & Symptoms

A
  • Location of symptoms -> clue to the irritant / allergen
    -Pruritic rash , burning , stinging, eroded, blistered skin
    ICD : Quicker onset of symptoms ( ulceration , burning ) vs ACD ( pruritis significant )
64
Q

Contact Dermatitis - Treatment

A

Finding trigger + Calming Symptoms : Topical calendula , chikweed , St John’s wort , Aloe Vera

65
Q

Atopic Dermatitis / Eczema - Definition

A

Immune mediated inflammation of the skin due to the interaction between genetic & environmental factors
- Pruritus primary symptoms
- infancy / childhood-> urban area + developed countries
Common Allergen : Foods , airbone ( dust , moulds, pollen )
Family history (2/3) , Asthma or allergic rhinitis

66
Q

Atopic Dermatitis / Eczema - Pathophysiology

A
  • Genetic weakness in epidermal barrier function
  • Mutation in filaggrin gene ( structural protein in stratum corneum )
  • Loss of filaggrin = impaired skin’s barrier function leading to entry of foreign environmental substance that may trigger immune response
  • Skin might be deficient in ceramides ( fatty acid ) increasing transepidermal water loss
  • IgE (70-80% -> allergy )

Filaggrin keep our cells together tighly.Dry skin loose ceramid.
->If filaggrin missing -> Cells not tightly packed together -> irritant & allergens get in , disrupting skin immune system & creating inflammation & itching => Scratching => further compromise skin barrier => microbes ++

67
Q

Atopic Dermatitis / Eczema - Signs & Symptoms

A
  • Red scaly lesions on FLEXOR SURFACES & Cheeks , Very itchy
  • Lichenification
  • Infection on skin ( inflamed + pus)
68
Q

Atopic Dermatitis / Eczema - TReatment

A

Identify allergen , avoiding skin irritant
2 Angles :
1. Help support immune system to be more tolerant
2.Help skin barrier to work properly
=> DIET - Elimination diet
=> Inflammation + Immune system : Quercetin , Vit D , Probiotics ( GIT health )
Allopathic : Corticosteroid

69
Q

Urticaria ( Hives) - Definition + Pathophysiology

A

Itchy , red Blotchy & Raised rash resulting from swelling of the superficial skin
- Can develop in & out of the pharyngeal mucosa causing swelling & obstruction
-Occurs due to release of histamine from mast cells
Cause : Medication , allergies , food, stings ,stress

70
Q

Urticaria ( Hives) -Treatment

A

Immune Support , Cause , Elimination diet , Lower histamine , Vit C ( Similar to Eczema except histamine )

71
Q

Psoriasis - Definition + Pathophysiology

A

Chronic , Auto immune inflammatory skin disease
Stratum Basale is diving too quicly making abnormal keratin -> Stratum corneum renewal 7 days vs 40
Silvery Scales & flakes due to reduce shedding an accumulation fo stratum corneum
-> Cells not fully matures , didn’t accumulate enough keratin to die => Plaques

72
Q

Psoriasis - Causes

A
  • Auto-immune : T-Lymphocyte mediated hyperproliferation of keratinocytes.
  • Environmental , genetic & immunologic factors
    => susceptibility might be due to genetic defects in detoxification enzymes.
    Triggers : Infection , chemicals , alcohol , stess ,beta-blockers
73
Q

Psoriasis - Naturopathic Causes

A

Leaky Gut , poor digestion , altered immunity.
Driven by Auto-intoxication => poor digestion => Food putrfying / rotting in intestines => Creates polyamines => Leaky Gut => Allow content of disgestive system ( microbes , undigested food ) to interact with immune system. Influx of antigens => IS overwhelmed & liver is triggering immune system.=> PSORIASIS

74
Q

Psoriasis - Signs & Symptoms

A
  • Red scalpy plaques covered with overlapping silvery shiny scales ( may bleed )
  • Extensor surface ( wrist , elbow, knees ) & Scalp
  • Arthritis (14% -> Auto immune )
75
Q

Psoriasis - Treatment

A
  • Diet : Digestion , Gut Health , Semi-vegan diet , no Dairy or gluten , anti inflammatory , anti- oxydant => Juice fasting ( Heal & Seal )
  • Gastro intestinal support , probiotics
  • Detoxification , liver support
  • Aloe vera , Epsom Salt Baths
76
Q

Acne Vulgaris : Definition + Pathophysiology

A

Blockage of sebaceous / hair follicle duct.
- Male and puberty
- Oil normally drained to skin surface gets blocked by excess skin cells inside of the follicle -> bacteria proliferation
- Face and Back + Chest
=> Lack of desquamation , left of the skin -> sebum becomes trapped + overproduction
Testosterone stimulate sebaceous glands ( Puberty )

77
Q

Acne Vulgaris - Cause

A
  • Environmental including diet ( western)
  • Diet high in Glucose -> Insuline level + -> Oil production + -> Excess skin cell production in follicle.
    Stimulation of testosterone production
    Dairy -> IGF + Insulin +
    => EXCESS INSULINE
  • Excess testosterone ( puberty )
    -Hormonal imbalance
    -Oily creams
78
Q

Acne Vulgaris - Characteristic ( Signs )

A
  • Closed comedones ( whiteheads ) -> Trapped sebum & bacteria below the surface
  • Open comedones ( blackheads ) -> Oxidised lipids -> black
  • Inflammatory acne
  • Cysts : follicle rupture -> pustule / nodule
79
Q

Acne Vulgaris - Treatment

A
  • Hormone balancing
  • Diet : WFPD , water
    AVOID : Excess oild , processed food , Dairy , wheat
  • Detox , skin hygience , Zinc , B5 , Aloe vera gel + Spray of colloidal silver ( control microbial growth )
80
Q

Quick overview Skin Lesion

A

Papule : CIRCUMSCRIBED PALPABLE ELEVATION - NO FLUID
Macule : FLAT CIRCUMSCRIBED LESION - ALTERATION IN SKIN COLOR
Pustule : INFLAMMED LESION FILLED WITH PUS
Nodule : Similar to Papule but bigger & Deeper ( RA)

81
Q

Acne Rosacea - Definition

A

Chronic inflammation of skin associated with vascular changes which results in flushing ( change in blood vessels structure becomes permanent )
Accompanied by seborrhoea ( excessive discharge of sebum )
More common in Women

82
Q

Acne Rosacea - Signs & Symptoms

A

Facial flushing, seborrhoea ( oily skin ) with papule & pustules

83
Q

Acne Rosacea - Cause

A
  • Skin overreactive -> exaggerated vasodilatory response to hyperthermia
  • H.Pylori (88%) & Gastrin ( Gastrin = h.pylori growth )
  • environmental , cosmetics , medications , stress
84
Q

Acne Rosacea - Treatment

A
  • Treat digestive system ( lack of stomach acid )
  • Identify food allergies , intolerance
  • Support blood vessels : Vit C
  • Aloe vera
85
Q

Warts & Verrucas

A
  • Benign proliferation of skin & mucosa caused by infection with Human Papillomavirus (2&4)
  • Signs : Papular lesion with a coarse rouhened surface
  • Treatment : Often disappear spontaneously : Antiviral herbs ( thuja , olive leaf , St John’s Wort , lysine )
86
Q

Skin Tags

A

Small overgrowths attached to skin by stalk

  • Generally occurs in areas where skin rubs
  • Skin colour or darker - can bleed when knocked - often drop off
  • Associated with hyperinsulinemia -> PCOS or diabetes type 2 precursor
87
Q

Vitiligo

A

Skin loses it’s pigmentation due to loss of melanocytes.
Onset any age
Genetic susceptibility
Autoimmune link ( Langerhans cells proliferation may inhibits melanocytes proliferation )
Few options of therapy available

88
Q

Burns - Defintion

A

Injury to skin or tissues causes by heat , cold electricity , radiation , chemicals

89
Q

Burns - Signs & Symptoms

A

Necrosis -> Pain

Electrical burn -> extend beyond tissue damage -> arrhythmia / fibrillation

90
Q

Burns - Treatment

A

Allopathic : Skin graft , fluid & electrolyte replacement , pain management
=> Calorie requirement increase to heal
Natural :Manage small burn , aloe vera , calendula

91
Q

Burns Classification

A

Schema
1st degree : Epidermis
2nd degree : All epidermis + some dermis
3rd degree : Extends to subcutaneous tissue
4th degree : Extends into muscles & tendons

92
Q

Burns - Complications

A
  • Dehydration -> Loss of water & plasma through skin surface
  • Hypothermia -> Impaired thermoregulation & heat loss
  • Hypovolaemic shock
  • infection
  • Renal failure : Urea & uric acid production that overwhelm the kidney
  • contractures : scar tissue contracts distorting skin & impairing movement

Lecture 10 : Integumentary System (2 decks)

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