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Slide 1
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Chapter 4:
Body Membranes and the
Integumentary System
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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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Slide 2
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Introduction
• Skin often reveals our inner workings and general health
• In most manual therapies, the skin is primary interface
with clients
• Therapists may feel many differences in clients’ skin
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• Clients feel status of their tissue and quality of therapist’s
touch
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Slide 3
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Membranes
• Membrane: broad flat sheet of at least 2 layers of tissue
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• Body has 4 primary types of membranes:
– 1 of primarily connective tissue
– 3 of epithelial tissue
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Slide 4
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Connective Tissue Membranes
• Synovial membranes line fibrous connective tissue
capsules in joints
• Composed of 2 layers:
– Thick fibrous connective tissue layer on outside
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– Thin internal layer of simple epithelium
• Synovial fluid secreted by epithelial layer reduces friction
and wear to bone ends
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Slide 5
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Epithelial Tissue Membranes
• Comprised of layer of epithelial tissue attached to
connective tissue layer (basement membrane)
• Capable of rapid regeneration
• Ideal for protecting organs and lining body cavities and
passages
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• 3 types:
– Mucous
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– Serous
– Cutaneous
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Slide 6
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Mucous Membranes
• Line cavities open to external environment
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• Line respiratory, digestive, urinary, and vaginal tracts
• Secrete mucus
– Helps protect against invading pathogens
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– Helps warm and humidify air on way to lungs
• In digestive, urinary, and vaginal tracts, protects against
wear or erosion
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Slide 7
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Serous Membranes
• Found in cavities without openings to external
environment
• Folded into 2 distinct layers:
– Parietal layer lines cavity
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– Visceral layer covers organs
• Space between layers contains serous fluid
• Serous fluid provides lubrication to reduce friction
between layers, allowing smooth movement
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Slide 8
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Cutaneous Membrane
• Body’s outer covering and primary organ of
integumentary system
• Consists of stratified layer of epithelial tissue attached to
thick connective tissue layer
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Slide 9
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Integumentary System
• Comprised of cutaneous membrane and accessory
organs, including:
– Hair
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– Nails
– Sudoriferous (sweat) glands
– Sebaceous (oil) glands
– Sensory receptors
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Slide 10
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Functions of Skin
• Protection
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• Temperature regulation
• Excretion and absorption
• General sensory organ
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• Synthesis of vitamin D
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Slide 11
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Layers of the Skin
• External epithelial, deeper dermal, and subcutaneous
layers
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Slide 12
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Epidermis
• Composed of stratified squamous epithelium
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• 90% of cells are keratinocytes
• 5 strata of epidermis (see Figure 4-5):
– Horny layer (stratum corneum)
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– Clear or glassy layer (stratum lucidum)
– Granular layer (stratum granulosum)
– Spiny layer (stratum spinosum)
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– Germinating layer (stratum germinativum)
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Slide 13
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Epidermis (cont’d)
• Continually renews and replaces itself
• Melanocytes produce dark pigment that protects skin
from UV
• Malignant melanoma: serious skin cancer
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– Warning signs (ABCD) for mole: asymmetry,
indistinct border, black/brown color, larger diameter
• Breaks in skin may allow pathogens to enter
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Slide 14
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Epidermis (cont’d)
• Precautions for therapists:
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– Minimize risk of allergic response to emollients
– Avoid blocking skin pores or glands with emollient
– Attend to ingredients and purity of products applied
during exfoliations and wraps
– Be cautious with hydrotherapy treatments that open
pores and enhance skin absorbency and excretion
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Dermis
• Skin layer housing blood and lymph vessels, nerves, and
accessory organs (see Figure 4-6)
• Collagen and elastin fibers make skin extensible and
elastic
• 2 regions:
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– Papillary region
– Reticular region
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Slide 16
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Subcutaneous Layer
• Also known as hypodermis or superficial fascia
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• Attaches skin to underlying tissues and organs
• Contains adipose tissue that insulates body and stores
energy
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• Rich with blood and lymph vessels, nerves, and sensory
receptors
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Slide 17
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Accessory Organs: Hair and Nails
• Hair and nails serve protective function
• Genetics, hormone production, and nutrition influence
pattern of hair distribution over body
• Shape and color of nails may indicate systemic disorders
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– Nails may be yellow, pitted or ridged, or more
concave or convex
– Signs caused by blood, respiratory, or thyroid
disorder
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Accessory Organs: Sebaceous Glands
• Sebaceous glands secrete oily or waxy fluid (sebum)
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– Helps keeps skin soft and pliable
– Inhibits growth of certain bacteria
• Most sebaceous glands are connected to hair follicles
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• Sebaceous gland activity increases in adolescence
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Accessory Organs: Sudoriferous Glands
• Secrete sweat through pores of skin
• Support homeostasis by helping regulate body
temperature, water balance, and elimination of metabolic
byproducts
• 2 types:
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– Eccrine glands: primary sweat glands for thermal and
water regulatory ability
– Apocrine glands: concentrated in axilla, groin,
areolar breast tissue, and beard area
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Accessory Organs: Sensory Receptors
• Wide variety of sensory organs sensitive to touch,
temperature, pain, vibration, and pressure
• Receptors in papillary zone sensitive to superficial stimuli
– Free nerve endings, Merkel discs, Meissner
corpuscles
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• Receptors in deeper reticular layer more sensitive to
deep tactile stimulation
– Pacinian corpuscles, Ruffini corpuscles, hair root
plexus
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Links to the Nervous System
• Sensory receptors in skin connected to nerve cells or
fibers that carry information to spinal cord and brain
• Each region of skin (dermatome) correlated to specific
nerves and spinal levels (see Figure 4-9)
• Connective Tissue Massage (CTM) aims to create
systemic changes via dermatome stimulation
• Brain and skin are intricately linked and cannot be
functionally separated
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Links to the Nervous System (cont’d)
• Infants and children deprived of tactile and movement
stimulus often fail to thrive
• Research shows profound connection between tactile
stimulus, emotional well-being, and physiologic function
• Infants receiving regular massage:
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– Experienced fewer colds and less diarrhea
– Grew faster and gained more weight
– Exhibited less agitation and excitability
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Slide 23
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Skin Conditions and Diseases
• Therapists should be familiar with skin conditions and
diseases
• You may see skin areas clients do not see
• You can monitor changes in skin tone or appearance in
regular clients
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• Avoid direct contact with any broken skin
• Refer clients for medical attention when needed
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Common Contagious Skin Disorders
• If contagious disorder is suspected, reschedule after
medical diagnosis and treatment
• Always use proper hygiene, sanitary practices, and
universal precautions
• Common contagious disorders (see Figure 4-11):
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– Fungal infections (e.g., tinea or ringworm)
– Bacterial infections (e.g., staph)
– Viral infections (e.g., herpes simplex or zoster)
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– Parasitic infections (e.g., scabies or lice)
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Slide 25
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Common Noncontagious Skin Disorders
• Direct contact may be contraindicated
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• Common noncontagious disorders (see Figure 4-12):
– Acne
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– Eczema
– Hives (urticaria)
– Psoriasis
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– Vitiligo
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Slide 26
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Aging and the Integumentary System
• Signs of aging easily recognized in skin and hair
• General dehydration and breakdown of collagen and
elastin fibers
• Dermis begins to stiffen, wrinkle, and thin
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• Decreases in melanin production cause graying hair and
changes in skin pigmentation, including brownish age
spots
• Skin less able to regenerate and repair itself
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