Chapter 13: Skin, Hair, and Nails Part 1

Skin Largest organ system in the body Covers and protects the internal structures of the body from: o Trauma o Pathogens o Dirt It adapts to other environmental influences o E.g. heat & cold

Layers of Skin Skin consists of 2 layers: o Epidermis o Dermis Subcutaneous tissue lies beneath these layers

Epidermis Outer layer Made of squamous epithelial tissue Its thin Tough Consists of several layers o Stratum germinativum (Basal Cell): Forms new skin cells Their major ingredients is keratin Melanocytes interspersed along this layer produce pigment melanin which gives brown tones to skin and hair. Melanocytes productivity depends on genetic, hormonal, and environmental influences. From the basal layer cells migrate up and flatten into Stratum Corneum. Stratum Corneum: o Consists of dead keratinized cells that are closely packed o They are constantly being shed o Replaced with new cells from below. Epidermis is completely replaced in 4 weeks. We shed kg of skin each year. Epidermis is thin except on the surfaces which are exposed to friction. o E.g. palms and hands o These areas are where skin is thicker because of work and weight bearing. Epidermis is avascular; supplied by blood vessels in dermis below Skin colour: o Derived from 3 sources 1. Melanin brown pigment 2. Carotene - yellow orange tone 3. Red purple tone underlying vascular bed Skin is further modified by thickness of skin and edema.

Dermis Thick deeper layer Consists of connective tissue and collagen Consists of an extracellular material (matrix) which contributes to the skins strength and pliability. Location of blood vessels, lymphatic vessels, nerves, hair follicles, sweat and sebaceous glands. Enables skin to resist tearing. Allow the skin to stretch with body movements because of its elastic tissue.

Subcutaneous Layer Beneath dermis and epidermis Consists mostly of adipose and other connective tissue Stores fat for energy provides, insulation for temperature control, and aides in protection soft cushioning effect

Function of the Skin Skin is waterproof Protection: minimizes injuries from physical, chemical, thermal, and light wave sources. Prevents penetration: skin acts as a barrier, stops invasion of microorganism, and loss of water from within the body. Perception: skin is a vast sensory surface holding the neurosensory end organs for touch, pain, temperature, and pleasure. Temperature Regulation: skin allows heat dissipation through sweat glands and heat storage through subcutaneous insulation. Identification: self-image Communication: emotions are expressed in the sign language of the face and in the body posture. Wound Repair: skin allows cell replacement of surface wounds. Absorption & Excretion: skin allows limited excretion of some metabolic wastes, by-products of cellular decomposition such as minerals, sugars, amino acids, cholesterol, uric acid, and urea. Production of Vitamin D: the skin is the surface on which ultraviolet light converts cholesterol into vitamin D.

Hair Formed from keratin produced by matrix cells in the dermal layer of the skin. Each hair lies in a hair follicle No longer needed for protection from cold and trauma Important for cosmetics/psychological meaning Structure: o Hair shaft: visible projecting part o Root: below surface embedded in the follicle o Bulb Matrix: at the root, its the exposed area where new cells are produced at a high rate Each follicle function is independent so while some hairs are resting others are growing. 2 types of hair: o Vellus Hair: fine faint hairs, covers most of body expect palms, sole, fingers, and umbilicus o Terminal Hair: darker and thicker. Hair that grows on scalp, brows, axilla, face and chest.

Sebaceous Glands Produce a protective lipid substance sebum Secreted through hair follicles. Sebum: o Oils and lubricates the skin and hair and forms an evulsion with water that retards water loss from the skin. o Not located in palms and soles o Most abundant in scalp, face, forehead, and chin.

Sweat Glands: Eccrine Glands Coiled tubules Open directly into skin surface and produces a dilute saline solution called sweat Evaporation of sweat reduces body temperature Throughout the body Matures in 2month old infants

Sweat Glands: Apocrine Glands Nails Are formed when epidermal cells are covered into hard plated of keratin Nail plates are clear with fine longitudinal ridges Pink colour from underlying vascular epithelial cells (bleed when trauma occurs to nail) Lunula: the white opaque area at the proximal end of the nail; this is where new keratinized cells are formed Cuticle: works like a gasket to cover and protect the nail matrix Produce thick, milky secretions, and open into hair follicles Located mainly in axillae, genital areas, nipples, and naval areas Active during puberty Bacterial flora residing on the skin surface react with apocrine sweat to produce musty body odour As people age these glands slowly go away

Developmental Care: Infants and Children Hair follicles develop in fetus at 3 months gestation Most skin is covered in fine downy hair at mid gestation Few months later after being born hair is replaced with vellus hair At birth baby is covered in vernix: o Thick cheesy substances made up of sebum and shed epithelial cells. Newborns skin is similar to adults but its function is not fully developed Newborn skin is tin, smooth, and elastic and more permeable than that of the adult. Therefore at greater risk for fluid loss. Sebum which holds water in skin is present for first few weeks of life producing milia and cradle capes in skin. Sebaceous glands decrease in size and production and come back into function when puberty hits.

Eccrine glands do not secrete in response to heat unit first few months of life and only work a little throughout childhood. Skin does not protect against cold because it cannot contract and shiver and subcutaneous layers are inefficient. Pigment is inefficient at birth.

Child Developmental Stages Epidermis thickens, toughens, and darkens Skin becomes lubricated Hair growth increases Puberty bits and sweat glands become active from emotional stimuli or change in environmental temperature Develop odour Sebaceous gland become active o Skin looks oily o Acne develops Subcutaneous fats increase in females than males Hairs start popping in areas that werent there in the beginning. E.g. axilla, pubic area, and facial hair

Pregnant Female Change in hormone level Increase pigmentation in nipples and areolae, vulva, and mid abdomen Stretch marks Connective tissues develops and increase fragility resulting in striae gravidarum This may develop in skin of abdomen, breast, and thighs. Metabolism is increased, this helps dissipate heat, causes dilation of skin, sweat and sebaceous glands increase secretions. Fat deposits increase, especially in buttocks and hips as maternal reserves for nursing baby.

Aging Adult Slow atrophy of skin Skin loses elasticity, folds, and sags Ages 70-80 skin looks like parchment paper (lax, dry, and wrinkled) Epidermis thins Wrinkling occurs o Underlying dermis thins and flattens Loss of elastin, collagen, and subcutaneous fat, which increases tearing and shearing of skin.

Aging Adult: Hair Looks grey and white Thin and fine Testosterone decreases in both female and males Females estrogen also decreases and females may develop facial hair Nails grow slower

Assessment: Subjective Data Previous history of skin disease (allergies, hives, psoriasis, eczema) Changes in pigmentation Change in mole size and colour Rash or lesion Medications Excess bruising Hair loss Environmental or occupational hazards