INTEGUMENTARY SYSTEM

The integumentary system acts as a physical barrier which is made up

of skin, hair, and the glands & nerves on skin.

skin

Skin is a soft outer covering; skin is the largest sense organ in the
body.
Major functions of skin are;
1. Protection
2. Sensation
3. Control of evaporation
4. Storage and synthesis
5. Water resistance
Skin Layers
1. Epidermis (outer layer)
2. Dermis (Middle Layer)
3. Hypodermis (subcutaneous layer) (inner layer)
EPIDERMIS (Five Sublayers)
Stratum Basale (deepest layer), stratum lucidum, Stratum spinosum,
stratum corneum, Stratum Granulosum
● Stratum Basale also called stratum germinativum
● A protein called keratin is present in the epidermal layer
Dermis Two Sublayers
- Hair, blood vessels, small nerves, nails, glands are present here
- 2nd layer
- Contains 2 sublayers called papillary and reticular
 - Glands are mainly sebaceous and sweat glands
- Sweat glands also called sudoriferous gland
Subcutaneous layer/ Hypodermis
- Also called fatty layer, contains fatty tissue and fibrous connective
tissue.
- It connects skin to underlying muscles

Hair
- Hair is a filamentous biomaterial that grows from follicles found in
Dermis
Hair types
- Lanugo
- Vellus
- Terminal

Lifespan of hair 2- 7 years

Maximum length- 70 to 90 cm
Annual growth – 12 cm

Nail
- Nail is a horn like envelop covering the dorsal
(backside/posterior/back) aspect of terminal phalanges of finger
and toes
Parts
● Nail plate
● Nail groove
● Lunule: it is a semilunar or half-moon shaped white area at the
base of nail plate. It thickens and lengthens the nail.
● Eponychium /Cuticle: It is a narrow band of epidermis at the base
and sides of nail
● PATHOLOGY
1. Bullae: Large blister greater than 1 cm diameter
2. Crust: It is a dry exudate on the skin EG: in Dandruff
3. Scales: Flakes of cornified skin layer eg: Dry skin
4. Erosion: Loss of epidermal layers
5. Scar: It is excess collagen production after a surgery or trauma
6. Polyps: Abnormal growth projecting from mucous membrane
7. Atrophy: It is the loss of some portion of skin and appears
transparent is a normal physiological response in ageing

 Pressure Ulcer /Decubitus ulcer

It occurs as a result of pressure or a force that develops over the
bony prominent areas like heal, elbow, coccyx, lower hip, sacrum
It blocks blood flow causing ischemia (temporary loss of blood
supply and tissue death)
Stages
Stage -1 – Redness of the skin (Erythema)
Stage -2 – Partial loss of skin (Epidermis /Dermis)
Stage -3 – Full thickness loss (up to subcutaneous fatty layer)
Stage -4 – Full thickness loss (Causing extensive destruction and
necrosis)

 Gangrene – black colored skin

1. Eg: chicken pox blisters
Pustule: It is an elevated area filled with purulent fluid (pus):
pimples, abscess.
8. Ulcer: It is the area of destruction of entire epidermis
Eg: mouth ulcer, diabetic foot ulcer
9. Nodule: It is an elevated area of more than 2 cm in diameter,
example: mouth ulcer, diabetic foot ulcer.
10. Alopecia: It is the loss of hair in round shape
11. Ecchymosis: Bluish or purple marks on the skin
12. Petechiae: small pinpoint hemorrhages
13. Urticaria / Pruritus /hives : Acute allergic reaction in which
red round wheals will develop on skin
14. Vitiligo: Depigmentation in the area of skin caused by the
edema in dermis, example: insect bite
15. Callus: Increased growth of cells in the keratin layer of
epidermis
16. Tumor: It is a sold mass of uncontrolled progressive division
of cells
17. Plaque: It is a flat elevated area of greater than 1 cm
diameter example: psoriasis
PATHOLOGY
1. Cyst
- It is a closed sac having distinct membrane and division of nearby
tissues
- It may contain air fluids or semisolid material
2. Fissures
- Cracks in the skin example: Athlete’s foots; they are the fissures in
corner of mouth
3. Macule: It is the flat area of color change with no elevation and
depression eg: moles
4. Papule: It is a solid elevation less than 1 cm in diameter e.g.:
Warts, elevated moles
5. Vesicle: Small blister less than 1 cm diameter is filled with serous
fluid
6. Necrosis: Black color dead tissue, Treatment – surgical
debridement
7. Paronychium: It is a soft tissue around nail border – not a part of
nail, its an condition

Inflammatory Disorders
1. Atopic Dermatitis
- It is a chronic inflammation or erythema or erythema mainly seen
in allergic persons, asthma, dry skin, eczema
- Most affected categories children and infants
- Treatment – Antihistamines, steroids, antibiotics, smoothening
lotions
2. Allergic contact dermatitis
- Potential caused are hypersensitivity to allegiant, drug metals,
chemical, plants, etc.
3. Stasis Dermatitis
- It is usually present on the legs mainly associated with varicose
vein, phlebitis
- Treatment -> elevate legs, reduce standing, antibiotics for
ruptured lesions
4. Seborrheic Dermatitis
- - Chronic inflammation of sebaceous gland with periods of
remission exacerbation, treatment – shampoo, facewash, steroids
etc.
5. Psoriasis
- It is a chronic relapsing proliferating skin disorder begins by the
age of 20 main etiological factors etc. hereditary, anxiety, stress,
biochemical alternations.
- Most commonly affected sites are face, scalp, knee, leg, forearm,
elbow, Treatments include – steroids, skin emollients, vit. D
supplements, coal for PUVA therapy – Psoralens and ultraviolet A
therapy
 6. Acne Vulgaris
Different types: - 1. White heads, 2. Black heads
Treatment: anti biotic, salicylic acid, benzoyl peroxide

Bacterial skin infections

1. Impetigo – Causative agent – staph curves (staphylococcus)
2. Cellulitis – Causative agent – Staphylococcus aureus
3. Furuncles – Staphylococcus
4. Erysipelas – Streptococcus
5. Flesh Eating disease – (Acute necrotizing fasciitis and cystitis)
– Streptococcus
VIRAL INFECTION OF SKIN
HSV – Herpes simplex virus/ cold sores
Varicella zoster Virus (VZV) – eg: chicken pox
herpes zoster virus
Warts (Verrucae Vulgaris) – HPV (Human papilloma Virus)

Fungal Infections
1. Tinea capitis – Fungal infection in scalp
Tinea corporis - superficial dermatophyte infection
Onychomycosis unguium (nail infection)
2. Candidiasis- caused by a yeast (a type of fungus) called candida.
Tumor of Skin
Benign Malignant
1. Moles/ Nevi 1.
2. Kerato Cyanthoma 2. Basal cell carcinoma
3. Actinic Keratosis 3. Malignant Melanoma
Burns
1st Degree – Superficial epidermis
2nd – 2 layers (epidermal dermal)
3rd degree – 3 layers (epidermal, dermal, subcutaneous)
Treatment
% Burn calculates by -> Rule of nine (Adults), Lund Browder (in children)
Complication – Compartment syndrome (due to fluid loss)
Keloids – Sharply elevated irregularly shaped scar
Cicatrix – Normal scar left after and wound healing
Procedure
1. Cryosurgery: It is the use of a cold temperature with liquid
nitrogen to destroy the tissue
2. Mohs Surgery: Thin layers of malignant tissue are removed and
each one is examined under a microscope to check the adequacy
3. Skin biopsy: Suspected malignant skin lesions are involved and
examined microscopically by the pathologist
4. Skin testing for allergy – substances are injected intradermally or
applied to the skin and results are observed eg: patch test, scratch
test
5. Electrodessication: Destruction of tissue by burning

Abbreviations:
 I&D – Incision and Drainage
 D&C – Dilation and Curette
 Bx – Biopsy
 S/c - Subcutaneous
 10.PPD – (TB test) – Purified protein derivative