The Integumentary System Complete (1).ppt

About skin and it's structure , about infections related to integumentary system.

1. The Integumentary System

2. The Integumentary System
•Integument (Covering) is skin
•Skin and its appendages make up the integumentary
system
•A fatty layer (hypodermis) lies deep to it
•Two distinct regions
•Epidermis
•Dermis

3. Functions of skin
•Protection
•Cushions and insulates and is waterproof
•Protects from chemicals, heat, cold, bacteria
•Screens UV
•Synthesizes vitamin D with UV
•Regulates body heat
•Prevents unnecessary water loss
•Sensory reception (nerve endings)

4. Epidermis
•Keratinized stratified squamous epithelium
•Four types of cells
•Keratinocytes–deepest, produce keratin (tough fibrous protein)
•Melanocytes-make dark skin pigment melanin
•Merkel cells –associated with sensory nerve endings
•Langerhans cells –macrophage-like dendritic cells
•Layers (from deep to superficial)
•Stratum basaleor germinativum–Innermost layer
made up of tall columnar cells
•Stratum spinosum–Prickle cell layer which produce Keratin
•Stratum granulosum–layers of flattened keratinocytes producing
keratin (hair and nails made of it also)
•Stratum lucidum(only on palms and soles)
•Stratum corneum–horny layer (cells dead, many layers thick)

5. Epithelium: layers (on left) and cell types (on right)

6. Dermis
•Layer between Epidermis & Hypodermis
•Cells: fibroblasts, macrophages, mast cells,
WBCs
•Fiber types: collagen, elastic, reticular
•Rich supply of nerves and vessels
•Critical role in temperature regulation (the
vessels)
•Two Layers of Dermis
•Papillary–composed of fine and looselyarranged
collagen fibers
•Reticular–composed of dense irregularconnective
tissue featuring densely packedcollagenfibers.

7. *Dermis layers
*
*
*Dermal papillae

8. Hypodermis
•“Hypodermis” (Gk) = below the skin
•Also called “superficial fascia”
•Fatty tissue which stores fat and anchors skin (areolar
tissue and adipose cells)

9. Skin color
•Three skin pigments
•Melanin: the most important
•Carotene: from carrots and yellow vegies
•Hemoglobin: the pink of light skin
•Melanin in granules passes from melanocytes to
keratinocytes in stratum basale
•Digested by lysosomes
•Variations in color

11. •Functions of hair
•Warmth –less in man than other mammals
•Sense light touch of the skin
•Protection -scalp
•Parts
•Root imbedded in skin
•Shaft projecting above skin surface
•Make up of hair –hard keratin
•Three concentric layers
•Medulla (core)
•Cortex (surrounds medulla)
•Cuticle (single layers, overlapping)

12. •Types of hair
•Vellus: fine, short hairs
•Intermediate hairs
•Terminal: longer
•Hair growth: averages 2 mm/week
•Active: growing
•Resting phase then shed
•Hair loss
•Thinning –age related
•Male pattern baldness
•Hair color
•Amount of melanin for black or brown; distinct form of melanin for
red
•White: decreased melanin and air bubbles in the medulla
•Genetically determined though influenced by hormones and
environment

13. Sebaceous (oil) glands
•Entire body except palms and soles
•Produce sebumby holocrine secretion
•Oils and lubricates

14. Sweat glands
•Entire skin surface
except nipples and
part of external
genitalia
•Prevent overheating
•500 cc to 12 l/day!
(is mostly water)
•Produced in
response to stress
as well as heat

15. Skin Eruptions “Rash"
1-Area Of Altered Colour
Macule
Small Area Less than 5mm
Patch
Large Area more than 5mm
Amaculeis a discolorationof skin that is
not elevated and is less than 5 mm in
diameter. ...Maculescan be seen on any
part of the body, but are most frequently
found on the chest, back, face, and arms.

16. 2-Palpable Rash
(Raised Lesion)
Papule
<5mm
Plaque
Large Area

17. 3-Fluid Filled Lesions
Vesicle
<5mm in size
Bulla
>5mm in size

18. •4-Pustule
Pus Filled Lesions
5-Non Blanchable
(Bleeding into Skin)
Petechia
Pin point red
purple spot
Purpura
<1cm
Echymosis
>1cm
Non-blanchable, erythematous lesions
are due to the presence of red blood cells
outside of blood vessels (extravasation).

19. •6-Crusting / Scabbing
Dried serum , blood or Pus Sticks with surface wound
•7-Scalling= Flakes( Small fragment Broken From Large)
Resulting From Abnormal Keratinization
•8-Ulcers
Breach in Skin

20. Common Disorders of the integumentary
system
•Infectious Disorder
•Pigmentation Disorder
•Erythematous Disorder
•Auto Immune Disorder
•Inflammatory Disorders
•Cancerous Disorders

21. Skin Infections
•Bacterial Infections
•Viral Infections
•Parasitic Infections
•Fungal Infections

22. •Bacterial
•Impetigo
•Folliculitis
•Furuncle
•Carbuncle
•Cellulitis
•Acne

23. Impetigo

24. Impetigo
•Superficial bacterial infection of the skin
•Most commonly Staph or Strep
•Thin vesicles with honey colored crusting
•Usually on face, hands, neck & extremities
•Spread occurs via contact from fingers, towels, clothing
•Tx: Topical antibiotics, severe infections need oral

25. Folliculitis

26. Folliculitis
•Superficial or deep infection of the hair follicle
•Usually result of Staph infection
•May also occur as a result of contact/plugging with oil,
dirt, sweat, etc
•Rash appears as small, dome shaped yellow pustules
with a hair shaft in the center
•Tx: good hygiene, topical antibotics

27. Furuncle

28. Furuncle (Boil)
•Deep extension of superficial folliculitis into the dermis
and subcutaneous tissue
•Cause –Staph
•1-5 cm red/tender nodulewhich may contain pus
•Tx:
•Simple lesions-warm compress
•Severe infections –drainage & antibiotics

29. Carbuncle

30. Carbuncle
•Large deep abscess that is a progression of a furuncle
•May be 3-10 cm in size
•Can present c fever/chills
•Tx: drainage & antibiotics

31. Cellulitis

32. Cellulitis
•An acute inflammation of the skin
•S/S: redness, swelling, warmth, & tenderness of affected
area within 1-2 days of injury
•Cause Staph or Strep, complication of wound/trauma
•The bordersare well defined and change rapidly
•Immediate attention (blood test, IV antibiotics)
•Facial cellulitis can cause visual damage if spreads to the
eyes
•NEVER MISS THIS ONE!!!!

33. Acne

34. Acne
•Obstruction of sebaceous follicles (oil glands)
•Open comedones (blackhead) or closed comedones
(white head)
•Usually on the face, chest, back
•Causes:
•Stressful events (hormonal changes)
•Friction acne
•Oil based cosmetics
•NO correlation between chocolate, chips or colas
•Tx: topical +/or oral antibiotics

35. FUNGAL SKIN
INFECTIONS

36. Tineacapitis Tinea corporis

37. Tinea unguim Tinea pedis

38. Tinea infections
•T. corporis –Ringworm of the body
•T. capitis scalp
•T. cruris groin
•T. pedis foot
•T. unguim nail
•Tinea/ dermatophyte infections caused by Trichophyton,
Epidermophyton and Microsporum

39. Tinea cont..
•T. corporis:Itchy, annular patch, well defined edge, scaling more
obvious at the edges( central clearing)
•T.pedis/ Athlete’s foot:Athlete'sfoot (tineapedis) is a fungal
infection that usually begins between the toes. It commonly occurs
in people whose feet have become very sweaty while confined
within tightfittingshoes.
•T. unguim:Tineaunguiumis a common type of fungal infection. It
is also called onychomycosis. The fungus infects the fingernails and,
more commonly, the toenails. It's more common in men, older
adults, and people who have diabetes, psoriasis, peripheral
vascular disease, or another health problem that weakens the
immune system.
•T.capitis:isa disease caused by superficial fungal infection of the
skin of the scalp, eyebrows, and eyelashes, with a propensity for
attacking hair shafts and follicles

40. PARASITIC SKIN
INFESTATIONS

41. Scabies

42. Scabies
•Caused by human itch mite( Sarcoptes scabie var hominis)
•Mite burrows into upper layers of skin, where it lives and lays
its eggs
•Finger webs, ulnar border of forearm, axilla
•Intense itching, esp at night and pimple like skin rash
•Crowded conditions, contagious
•Tx: 5% permethrin cream, whole family should be treated ,
calamine / oral antihistamine for itching
•Complications: secondary infection leading to
impetigo(pustules and yellow crusty sores.)
•Prevention: avoid contact w/ infected persons

43. VIRAL SKIN DISORDER

44. Verrucae (Warts)

45. Verrucae
•Etiology:Human Papillomavirus (HPV)
•Pathology: –Virus subverts cell cycle control to allow
increased proliferation of epithelial cells and production of
new virus, Normal immune response usually limits the
growth but immunodeficiency can be associated with
it.
•Types; --Verrucae Vulgaris, Verrucae Plana, Verrucae
Plantaris, Verrucae Palmaris, Condyloma Acumintum
•Appearance & Size: Round, flesh colored and grow to be
yellowish tan & 1cm or more wide
•65% will resolve spontaneously
•Tx: destruction of epidermal cells that contain virus;
cryogenically, chemically

46. DERMATOSES
1-Acute Inflammatory Dermatoses
2-Chronic Inflammatory Dermatoses

47. Acute Inflammatory Dermatoses
•Urticaria (Hives)
•Acute Eczematous Dermatitis
•Erythema Multiforme

48. Urticaria
•A vascular reaction pattern of the skin marked by
the transient appearance of smooth, slightly
elevated patches that are more red or more pale
than the surrounding skin and are accompanied
by severe itching.
•Localized mast cell degranulation resulting in
dermal microvascular hyperpermeability.
•Also called hives.

50. Urticaria
•An acute or chronic condition
characterized by the appearance of itchy
weals on the skin.
•The cause may be an allergy to certain
foods , drugs, emotional stress, or local
skin irritation resulting from contact with
certain plants.
•Athletes sometimes develop hives while
exercising (exercise-induced urticaria).
The hives are small and seem to develop
in response to the release of histamines
associated with the increase in body
temperature produced by exercise.

51. Clinical Features
•Age 20 to 40 years
•Individual lesion usually fade within 24 hours but episode
may persist for days. Persistent lesions are some time
duo to urticarial vasculitis Associated with temporary
vascular damage
•Size vary from papule to plaque
•Site include any expose or pressure area
•In general this condition is more irritating than life
threatening
•Rx Antihistamine

52. ACUTE ECZEMATOUS DERMATITIS
Red,papulovesicular,oozingand crusted lesions
Types
•allergic contact dermatitis
•atopic dermatitis
•drug-related eczematous dermatitis
•stasis dermatitis
•primary irritant dermatitis

54. • Spongiosis
Accumulation of edemafluid within the epidermis
characterises All form of Acute Eczematous Dermatitis
Unlike urticaria, edemaseeps into the intercellular spaces
of the epidermis, splaying apart keratinocytes, particularly
in the stratum spinosum
•intraepidermalvesicles may form.

55. Clinical Features
•Appearance: Lesions of acute eczematous dermatitis are
pruritic(itchy) edematous, oozing plaque often contain
Vesicle and Bullae. Scaling ( Hyperkeratosis) occur duo to
persistent Ag Stimulation
•Epidermal thickening ( Acanthosis ) Can Become Chronic
Duo to Persistent Stimulation of Antigen

56. Erythema Multiform
•DefinationRecurrent Disorder of skin with distinctive
clinical & histological features resulting from variety of
stimulus
•Causes Drugs & Infections
•Pathology Subepidermal inflammation leading to WBC
infiltration and formation of subepidermal bullae
•Types
•1-Mild form
•2-Severe Form

57. Chronic Inflammatory Dermatoses
•Psoriasis
•Lichen planus
•Lichen simplex chronicus

58. Psoriasis
•Named for the Greek word psōrameaning "itch," psoriasis
is a chronic, non-contagious disease characterized by
inflamed lesions covered with silvery-white scabs of
dead skin.
•Causes: Immunologic Disease with contribution from
genetic susceptibility and environmental factors
“It is not known if the inciting antigen are self or
environmental”

61. Pathophysiology
•Normal skin cellsmature and replace dead skin
every 28–30 days.
•Psoriasiscauses skin cells to mature in less than
a week.
•Because the body can't shed old skin as rapidly
as new cells are rising to the surface, raised
patches of dead skin develop on the arms, back,
chest, elbows, legs, nails, folds between the
buttocks, and scalp.

62. Clinical Features
•It can appear anywhere on the body, but it is most
commonly found on the elbows, knees, scalp, and lower
back.
•Typical Lesion are well demarcated pink to salmon
colored plaquecovered by loosely adherent silver
white scale
•It can be quite painful and may itch, crack, and bleed.

63. Lichen Planus
•Dermatoses of unknown etiology characterised by
classical violaceous papular eruptions at specific site
and mucosal surfaces
•Associations
HCV 30%
Drugs
Autoimmune

64. Pathogenesis
•Expression of altered Antigen at the level of basal cell
layed and dermoepidermal junction may enlist CD8+ T
Cell mediated cytotoxic immune response
•Altered Antigen could be due to viral infections or Drug
treatment

66. Clinical Features
•5P’s: purple plane topped pruritic polygonal papule on
limbs generally on forearms
•These papules often highlighted by white dots or lines
known as Wickham’s Striae.
•Koebner’sPhenomenon
•Mucosal Lesions White lacy network on oral mucosa
rarely on lyranxand genetelia
•2 % chance of melagnancy

67. Lichen simplex chronicus
•Lichen simplex chronicus(LSC) is a localized, well-
circumscribed area of thickened skin (lichenification)
resulting from repeated rubbing, itching, and scratching of
the skin.

68. Signs and symptoms
•People burdened with LSC reportpruritus, followed by
uncontrollable scratching of the same body region,
excessively.
[2]
Most common sites of LSC are the sides of
the neck, the scalp, ankles, vulva, pubis, scrotum, and
extensor sides of the forearms.

70. Basal cell carcinoma
Sqaumous cell carcinoma
Melanoma
Skin Cancer

71. Skin Cancer
•Skin cancer is the most common form of cancer in the United States.
•More than one million skin cancers are diagnosed annually.Each year
there are more new cases of skin cancer than the combined incidence of
cancers of the breast, prostate, lung and colon.
•One in five Americans will develop skin cancer in the course of a lifetime.
•Basal cell carcinoma(BCC) is the most common formof skin cancer;
about one million of the cases diagnosed annually are basal cell
carcinomas. basal cell carcinomas are rarely fatal, but can be highly
disfiguring
•Squamous cell carcinoma(SCC) is the second most common form of
skin cancer. More than 250,000 cases are diagnosed each year, resulting
in approximately 2,500 deaths.
•Basal cell carcinoma and squamous cell carcinoma are the two major
forms of non-melanoma skin cancer. Between 40 and 50 percent of
Americans who live to age 65 will have either skin cancer at least once.
•About 90 percent of non-melanoma skin cancers are associated with
exposure to ultraviolet (UV) radiation from the sun.
•Up to 90 percent of the visible changes commonly attributed to aging are
caused by the sun.

72. Basal Cell Carcinoma
•Basal cell cancer most often appears on sun-exposed
areas such as the face, scalp, ears, chest, back, and
legs.
•The most common appearance of basal cell cancer is
that of a small dome-shaped bump that has a pearly
white color.
•Blood vessels may be seen on the surface.
•Basal cell cancer can also appear as a pimple-like
growth that heals, only to come back again and again.
•A very common sign of basal cell cancer is a sore that
bleeds, heals up, only to recur again.

76. Squamous Cell Carcinoma
•A firm, red noduleon your face, lower lip, ears, neck,
hands or arms.
•A flat lesion with a scaly cruston your face, ears,
neck, hands or arms.
•A new ulceration or raised area on a pre-existing
scar or ulcer.
•An ulcer or flat, white patch inside your mouth.
•A red, raised patch or ulcerated sore in the anus or
on your genitals.

80. Melanoma
•A highly malignanttype of skin cancer that arises in
melanocytes, the cells that produce pigment.
•Melanoma usually begins in a mole.
•A popular method for remembering the signs and
symptoms of melanoma is the mnemonic "ABCD":
•Asymmetricalskin lesion.
•Borderof the lesion is irregular.
•Color: melanomas usually have multiple colors.
•Diameter: moles greater than 6mm are more likely to
be melanomas than smaller moles.

84. Disorders Of Pigmentation
•Vitiligo
•Albinism
•Melasma

85. Vitiligo
•It’s a hypomelanoticcondition probably Auto immune in
origincharacterised by formation of convex milky white
macules which increase in size by Confluence.
•Association
Addison’s Disease
Hashimoto’s Thyroditis
•Causes
40% cases have Family History
There is no truth in believe that vitiligoresult from
taking fish with milk

86. Clinical Features
•Age < 20y
•Milky white macule which increase in size by confluence
that gives to formation of milky white patch
•Old patchesmay disappear and new appear
•Siteusually back of arms forearm face and neck
•Marginsare hypermelanotic
•Skin eruptions are symptomless but sun light can
produce redness and itching
•Hairof affected area also turned white

89. Albinism
•Congenital Disorderof absent of melanin in skin and
organ
•Autosomal Recessive Genetic Problem
•Melanocytes present in this disease but lack of
conversion
Tyrosine
By
Tyrosinase
Dopamine

91. Clinical Features
•Errors of refraction Photophobia & Nystagmous
•↓ Fertility
•↓ Survival
•↓ I/Q
•↓ Frackle on skin
•Risk of squamous Cell CA

92. Burns
First-degree
(epidermis only; redness)
Second-degree
(epidermis and dermis,
with blistering)
Third-degree
(full thickness, destroying
epidermis, dermis, often part
of hypodermis)

93. Critical burns
•Over 10% of the
body has third-
degree burns
•25 % of the body
has second.
•Third-degree
burns on face,
hands, or feet
Estimate by “rule of 9’s”