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The Integumentary System
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HLTAP401A Confirm health status
Essential Knowledge and Skills
Hamish -discuss marriage with analyse assessment
 Impacting external and internal factors – key factors
necessary for healthy functioning
Integumentary System
 Also called cutaneous membrane
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 Comprised of:
Skin
Glands
Hair
Nails
A Bit About the Skin…
 1cm squared contains approximately
 15 sebaceous glands
 Almost 1m of blood vessels
 100 sweat glands
 3000 sensory cells at the ends of nerve fibres
 Almost 4m of nerves
 25 pressure apparatus to record tactile stimuli
 200 nerve endings to record pain
 2 sensory apparatus for cold
 12 sensory apparatus for heat
 300000 epidermal cells
 10 hairs
Skin
http://commons.wikimedia.org/wiki/File:Skin.jpg#file
Structure of the Skin
Integumentary System
Structure of the Skin
3 main layers
Epidermis
Outer layer
Stratified squamous epithelia
Keratinised
Dermis
Lies under the epidermis
Dense connective tissue
Subcutaneous Tissue
Below the dermis
Adipose tissue
Epidermis
5 layers
 Avascular
 Most cells are Keratinocytes
Epidermis Layers
From internal to external
Stratum Basale
Deepest layer
Cell division
Stratum Spinosum
Cells move up through this layer
Stratum Granulosum
As cells move upward they fill with keratin
Stratum Lucidium
Occurs only where the surface is
hairless & thick
Stratum Corneum
Outer layer
Replaced every 25-45 days
http://commons.wikimedia.org/wiki/File:Skin_layers.png#fil
e
Melanin
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 Pigment ranging from
yellow to black
 Produced by
melanocytes
 Melanocytes are
stimulated by sunlight
 Concentrations of
melanin manifests as
moles or freckles
Dermis
 Dense connective tissue
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 Vascular
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 Contains sensory
receptors & glands
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Dermis Layers
From internal to external
Reticular Layer
Deepest layer
Contains blood vessels, glands & receptors
Collagen & elastic fibres
Papillary Layer
Upper dermal region
Contain dermal papillae which house blood vessels
& receptors
Sensory Receptors of the Dermis
 Several including
 Meissner’s Corpuscle – light touch
 Krause’s End Bulbs
 Ruffini’s Terminals
 Pacinian Corpuscles - pressure
Hypodermis
 Subcutaneous layer
 Adipose/connective tissue
 Blood vessels
 Thickest layer
 Main support and framework provider
 Protective layer for underlying skin structures
 Functions
 Temperature regulation
 Lipid storage
Cutaneous Glands
 Types of cutaneous (exocrine) glands are:
 Sebaceous glands
 Sudoriferous glands
Cutaneous Glands
Cutaneous Glands
Type title here
Sebaceous Glands
Found all over the skin, except palms & soles
Expell sebum usually into a hair follicle
Sebum lubricates the skin and kills bacteria
Sudoriferous Glands
2.5 + million per person
2 types
Eccrine
Found all over the body
Produce sweat
Involved in heat regulation
Apocrine
Found in axilla & genital areas
Secretion contains fatty acids & protein
Precise function not known
http://commons.wikimedia.org/wiki/File:Skin_peeling.jpg#file
Hair
 Produced by hair follicle
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 Flexible epithelial
structure
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 Formed by stratum
basale cells
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Hair Follicles
 Contain 2 sheaths –
epidermal & dermal
Epidermal Sheath
Epithelial tissue
Forms the hair
Dermal Sheath
Dermal connective tissue
Supplies Blood supply
Contains arrector pili
Benign papilloma
http://commons.wikimedia.org/wiki/File:Papilloma_skin.jpg
Nails

 Modification of the epidermis

 Nails appears pink because of vascular supply

 As cells become keratinised they die
http://commons.wikimedia.org/wiki/File:Ingrown_nail_002.jpg#file
http://commons.wikimedia.org/wiki/File:Decubitus_ulcer_stage_4.jpg#file
Defence Mechanisms of the Integumentary
System
 The skin is first lines of defence
 Skin a physical barrier
 Glands secrete chemical barrier
 Immune cells with in the skin act as first line defence
mechanisms
(please spend some time doing a web search on this subject)
Factors That Affect Skin Integrity
 Risk factors include:
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Immobility/inactivity
Restlessness
Sedation
Neurological factors
Poor nutrition and hydration
Systemic and local circulation and
oxygenation
Presence or absence of excessive
moisture
wear
Infections
Skin disorders
Vascular conditions
Age related factors
Obesity
Exposure to friction/shearing forces/burns
Chemical exposure
Diseases ie/diabetes mellitus
Immune suppression
Trauma
Surgery
Ill fitting prosthesis or foot
Maintaining Skin Integrity

 Clean
 Dry
 Supple
 Intact
 Minimise risk of injury
 Management/Early
intervention
Primary Lesions
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 Papules – a pimple or small solid
elevation of the skin < 1cm e.g. small
wart
 Macule – a small flat blemish or
discolouration that is level with the
skin surface e.g. freckle
 Pustule – a small circumscribed
elevation of the skin containing pus
e.g. acne, impetigo
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Primary Lesions
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 Vesicle – elevated lesion with cavity
containig clear fluid < 1cm e.g. Herpes
simplex & Varicella
 Plaque – coalescence of macules >1cm
e.g. Measles, mongolian spot
 Bulla – similar to a vesicle but >1cm
e.g. burns, contact dermatitis, insect
bite
Primary Lesions
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 Cyst – Larger and deeper than a
pustule e.g. acne vulgaris, sebaceous
cyst.
 Wheal – superficial, raised
erythematous lesion, irregular shape
e.g. mosquito bite, urticaria
 Tumour – large, deep elevated lesion
e.g. fibroma.
Secondary lesions
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 Crust- is the formation of exudate
which protects the healing skin
 Scale – compact layers of the epithelial
tissue shed from the skin
 Ulcer – depressed circumscribed area
involving loss of the epidermis and
may involve subcutaneous tissue
Secondary lesions
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 Fissures – a crack in the skin e.g. edge of the sole
of the foot when it dries out or a painful split or
cleft in the mucous membranes of the anus.
 Lichenification – thickening and hardening with
exaggeration of normal markings
 Excoriation – an abrasion to the skin
characterised by reddening and burn like lesion or
area of the skin
Secondary lesions
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 Scar – the latter stages of skin healing after injury.
The epithelium regenerates to replace lost tissue
and to bring wound edges together.
 Keloid scar – an overgrowth of scar tissue at the
site of a skin injury. Is elevated, rounded and firm.
More common on dark skinned people and young
women.
Trauma
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 Abrasion- An abrasion is a superficial injury where
the skin is rubbed or torn
 Laceration – a wound with torn and ragged edges
– not a clean cut
 Puncture – a wound or opening made made by
piercing
 Excoriation – an injury to the surface of the body
caused by scratching, abrasion, and chemical or
thermal burns
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Skin disorders
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 Desquamation – peeling of the
superficial layer of the skin either in
flakes or in powdery form (dandruff)
 Pruritis - great irritation of the skin. It
may affect the whole surface of the
body as in certain skin diseases and
nervous disorders, or it may be in a
limited area.
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Skin disorders
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 Dermatits – Inflammation of the
skin, A reaction arising from having
contact or touching a substance to
which the person is sensitive. (itis means inflammation)
 Can be contact dermatitis or atopic
(systemic)
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Skin disorders
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 Purpura - a condition of characterised by
extravasation of blood in the skin and mucous
membrane, causing purple spots and patches.
 It may be a primary disease, most probably an auto
immune process or a secondary sign in other
diseases where there is a failure of platelet
production (liver disease)
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Urticaria (hives)
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 Nettle plant can cause a rash or hives.
 A skin condition characterised by
recurrent appearance of an eruption
of wheals.
 This condition causes great pain and
irritation.
Urticaria (hives)
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 The condition is probably due to hypersensitiveness
to some form of protein, and is therefore allied to
hay fever.
 Clinical manifestation
 rash over entire body
 appears in the form of flushing with the sense of
warmth and diffused erythema (redness)
Urticaria (hives)
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Treatment
Investigate what is the causative agent that is
causing this reaction and avoid contact
Use cooling solutions (ie Calamine lotion)
Tepid baths to decrease rash & heat
Cool cotton clothing
Cut clients nails to avoid them scratching and
increasing the risk of secondary infection (by
breaking) of the skin
Sebaceous gland disorders
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 Acne vulgaris– a multifactorial skin disorder
characterised by chronic inflammation of the
pilosebaceous unit
 Seborrheic dermatitis - non-infectious, scaling
inflammation of the skin appearing in areas of
increased sebaceous gland activity
Skin and soft tissues infections41
 Folliculitis – inflammation within the hair follicle,
resulting in the formation of pustules
 Furuncles (boils)
 Carbuncles (several furuncles interconnect within
the subcutaneous tissue)
 All are commonly caused by Staphylococcus aureus
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Skin and soft tissues infections42
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 Abscess –a cavity containing pus surrounded by
inflamed tissue usually caused by a staphylococcal
infection. Often needs incision and drainage.
 Infected lacerations
 Impetigo - school sores (a pyoderma or pus forming
disease) commonly caused by S. aureus or Bhemolytic streptococci
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Skin and soft tissues infections43
 Cellulitis – a diffuse, pus forming
inflammation of the dermis and
subcutaneous tissue commonly caused
by S. aureus or B-hemolytic
streptococci. Represents failure of the
inflammatory response to adequately
contain the infecting organism,
permitting wider and deeper extension.
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Skin and soft tissues infections
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Infections caused by:-Direct hand transfer
-Ingestion of food
-Nasal secretions, draining of wounds-asymptomatic nasal carrier
-Intravenous drug abuse
-Contamination of wound during dressing changes
Skin and soft tissues infections
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Treatment
 High effective
dosage of
antibiotics (IV)
 Strict isolation of
clients with
staph
 Strict asepsis with
dressing wounds
Parasites
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 Are multicellular organisms that live on another
organism without contributing anything to the host
(i.e. - arthropod species) and include scabies and
“nits”
 Pediculi (nits), treatment with a anti-parasitic e.g.
permethrin
 Scabies, treated with anti-parasitic e.g. benzyl
benzoate
Fungal infections
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 Tinea – fungal infection of superficial skin layers,
classified according to body location. Contact
with contaminated items (fomites) or infected
person.Treated with anti-fungals e.g. fluconazole
 Candidiasis – (moniliasis) caused by normal
flora (Candida albicans), a superficial fungal
infection of skin and mucous membrane. May be
sexually transmitted and may become pathogenic
when environment promotes
overgrowth.Treatment: anti-fungals e.g. Nystatin
Viral infections
48
 Verrucae (warts)
 Herpes simplex (cold sores)
 Herpes Zoster (shingles)
 Varicella (chicken pox)
 Rubeola (measles)
 Rubella (German measles)
Psoriasis
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 A chronic inflammatory disorder of the skin
characterised by episodes of excessive rapid
turnover of keratinicytes. Production of keratin is
abnormal, resulting in thick poorly adhesive cells
that appear as silvery scales. Lesions appear most
often on the elbows, knees, scalp, lumbosacral
area, gluteal cleft and penis.
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Psoriasis
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 No known cure or prevention– topical or systemic
corticosteroids are often used for antiinflammatory effects.
 Other treatments may include agents which decrease
the rate of cell proliferation (anthralin, a topical
medication) and use of UV light and a
photosensitising drug (psoralen).
Burns
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 Tissue damage inflicted by excessive
heat, corrosive chemicals, electricity,
or radiation, which denature proteins
and cause cell death in the affected
areas.
Effects of Severe Burns
 Loss of body fluids resulting in dehydration and
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electrolyte imbalance.
Loss of fluids will lead to renal shutdown and
circulatory shock.
Nutritional demands increase sharply
After the initial crisis infection is the major threat
and cause in burns victims
After 24 hours pathogens easily invade the destroyed
skin barrier
Classification of Burns
 According to severity
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First Degree – epidermis damage
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Second Degree – epidermis and upper dermis region
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Third degree – involve entire thickness of the skin
Skin Cancer
 Most common :
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Basal cell carcinoma
 Least
malignant and most common
 Invade dermis and hypodermis
 Appear as tiny dome shaped nodules which later develop a
central ulcer with a pearly beaded edge
 Slow growing – most often on sun exposed areas of the
face
 Usually noticed before metastasis occurs
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Squamous cell carcinoma
Arises from the stratum spinosum
 Appears as a scaly reddened papule
 Most often on the head and hands
 Grows rapidly and metastasizes if not removed
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malignant melanoma.
Cancer of the melanocytes
 Most dangerous skin cancer because it is highly metastatic and
resistant to chemotherapy
 Malanoma can begin anywhere there is pigment
 Appears as a spreading brown tot black patch
 About 1/3 develop from pre-existing moles
 Regular checks using ABCD(E) rule
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AT HOME ACTIVITYS
 Read Agost and Pakiam
for Next Week
 Visit the moodle site and check
out the resources
 Suggest any resources you come
across while researching