ANATOMY

AND PHYSIOLOGY
OF SKIN
Dr. Cita Rosita Sigit Prakoeswa, dr, Sp.KK(K), FINSDV, FAADV
DEPT. DERMATO - VENEREOLOGY
Airlangga University Faculty of Medicine /
Dr. Soetomo General Hospital
SURABAYA

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 SKIN STRUCTURE

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 SKIN ANATOMY

3 layers :
 Epidermis
 Dermis
 Sub-cutaneous

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  Anatomically, skin is structured from three
layers, but has different thickness. Thickest
epidermis  palmar manus and plantar pedis,
+/- 1,5 mm
 The thinnest site  eyelid +/- 0,1 mm
 The thickest dermis  upper back, 30-40
times than normal epidermis
 The thickest subcutaneous site  abdomen
and buttock, compared to nose and sternum

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 Mature Epidermis

 Divided on three basic cells:

– Keratinocyte
– Melanocyte
– Langerhans cells

 Two types additional cells:

– Intermediate dendritic cell
– Merkel cells

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 Keratinocytes Cells
 Also known as squamous cell  primary
cell in epidermis origin from ectodermal, its
function is to form keratin

 Keratinocytes will build skin, hair and nail

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 Epidermal Structure
(from Inner to Outer)
1. Basal / germinativum stratum
2. Malphigi / spinosum stratum
3. Granulosum stratum
4. Lucidum stratum
5. Corneum stratum

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 Epidermal Structure
(from Inner to Outer)

Besides various of epidermal thickness, dermis

and sub cutaneous, there is also various
differentiation zone from epidermis, based on
skin site

Corneum stratum and Granulosum Stratum

– The thickest  palmar manus and plantar pedis
– The thinnest  flexor arm, abdomen

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 Melanocytes
Origin from neural crest
Every 10 basal cells surround 1 melanocytes cell
Producing melanosom
Count of melanocytes among all rases are the same
Skin color depends on quantity / size of melanosom
In vitiligo  melanocytes destruction  decrease of
melanosom  decrease of pigmen production
Albino  melanocyte count is normal  not able to
produce melanosom
Nevi / nevus is a benign proliferation of melanocyte
Melanoma is a malignant proliferation of
melanocytes

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Kamis, 29 Oktober 2015
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 Langerhans Cells
Origin from bone marrow
Scattered on spinosum stratum
Detected by “gold impregnated
peroxydase”
Function:
– As monocyte macrophage lineage, play
role in induction of graft rejection
– Contact sensitivity
– immunosurveillance

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 Skin Appendages
Sweat gland eccrine
Apocrine gland
Pilosebaceous unit

Re-epithelialization in skin surface after

wound, mainly happen because of the
keratinocytes migration from skin appendage
epithelial along skin surface

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 Eccrine Sweat Gland Unit
Almost whole skin surface
Mostly on palmar manus and plantar
pedis
Mediated by cholinergic innervation
Mainly induced by heat but also
physiologic and emotional stress
Secretion  isotonic

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 Apocrine Gland
Not origin from skin surface but from upper site of
hair follicle
Odorless secret  skin surface  bactery hydrolysis
 smelly odor
Secreted from adrenergic mediator & cathecolamine
circulation from adrenal medulla
Periodic excretion, function: not defined (in human),
in animal as protection / sexual function
Found in axilla, areola mammae, genital, eyelid,
externa auditory canal
Gland dysfunction cause Fox Fordyce disease and
hydraadenitis supurativa .
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 HYDRADENITIS SUPURATIVA

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 HAIR FOLLICLE
• Hair growth in human work in
cycle, where each follicle
doesn’t depend to each other
• Hair growth rate depends on
bulbar cell mitotic activity
• Transversal section of hair
depends on cell structure in
bulbar matrix
• Hair shape depends on
transversal section
• Color depends on melanosom
• Melanosom large and numerous
 black
• Few melanosom  grey hair

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 HAIR GROWTH
Divided in three phase:
– Anagen phase / grow
– Catagen phase / transisional
– Telogen phase / resting
Hair growth cycle depends on its
region
Scalp hair  3-4 months, followed
by resting phase three months
85-90%  anagen  shortening
depends on age and male pattern
baldness
Growth depends:
– Endogenous factor 
pregnancy
– Exogenous  chemotherapy
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 SEBACEOUS / GREASE GLAND

On almost every sites of body except

palmar manus / plantar pedis, mostly
found in face and scalp

Always comes with hair follicle except

eyelid, buccal mucosa, vermillion border,
preputium, aerola mammae

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 NAIL
Function  protect tip
of fingers against
trauma
Nail growth 0,1 mm/day
and cover whole nail
plate in 4-5 months
Foot nail grow slower
12-18 months

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 DERMIS
Divided in 2 layers : reticullare and papillare
Component : collagen bundle
Fibrous protein
Substance: mucopolysacharide
Glikosaminoglican
Neutral polysacharide
Hyaluronic acid

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 SKIN SURFACE

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 EFLORESENCE
Skin abnormality that can be observed by
naked eyes (objective)

2 types:
– Primer  skin abnormality occurs in early
process
– Secondary  skin abnormality occur during
course of disease / environment factor

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 Primary
Macule
Papule
Nodule
Vesicule
Bullae
Urtica
Pustule

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 MACULE (SPOTS)
skin color alteration with various size and shape
without elevation or skin depression
Influenced by:
– Vascular abnormality  erythema, purpura,
telangiectasia, petechie, echimose
– Pigmentary abnormality  hypo / hyper /
depigmentation
Plaque
– Elevation occur in wide area compared by the height
of skin surface

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 MACULE

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 MACULE

Drug erruption due tophenoplphtalein

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 PAPULE

Solid skin elevation with diameter < 0,5

cm & the largest part is above skin
surface
Caused by metabolite deposition, local
hyperplasia of dermis / epidermis, local
infiltrate of dermis

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 PAPULE

A : Dermal celluler
infiltrate
B : cells hyperplasia
C : Papulosquamous
in psoriasis

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 PAPULE

Lichen planus 

Dermal melanositic
nevi 

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 PAPULE

Condyloma acumminata
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 NODULE
Similar with papule but larger size and
deeper, commonly persistent
Tubercle, phyma  synonym from
nodule
Tumor  common term to show an
existing of mass whether its benign /
malignant with size > than nodule

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 NODULE

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 NODULE

Melanoma metastasis

Broken nodule  Basal cell

carcinoma

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 VESICULE

Skin elevation sharp margin contains

fluid with diameter 1-10 mm
Uniloculer and multiloculer
May broken / confluent forming bullae

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 VESICULE

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 VESICULE

Herpes zoster
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 BULLAE
Diiffered with vesicule based on
larger size with diameter > 1 cm
Location of bullae : subcorneal,
intraepidermis, subepidermis

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 BULLAE

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 BULLAE

Impetigo  subcorneal bullae

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 BULLAE

Bullous Pemphigoid 
sub epidermal bullae
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 PUSTULE

As vesicle but
contain pus

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 PUSTULE

Pustular Psoriasis
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 URTICARIA
Flat skin elevation caused by
upper dermal edema
Itchy, rapid onset and rapid
healing, widening pores, skin
pallor

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 URTICARIA

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 URTICARIA

Cholinergic urticaria
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 URTICARIA

Urticaria caused by penicillin

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 SECONDARY
Scales
Erosion
Excoriation
Crust
Cicatrix
Ulcer
Cyst

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 SCALE

Epidermal particles, dry/greasy, thin and

covered with keratin mass
Various color, whitish grey, yellow/brown
Occurrence caused by inflammation
disease with parakeratosis

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 SCALE

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 SCALE

Psoriasis Vulgaris
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 CICATRIX (SCARS)
Formation of new tissue that contains
fibrous tissue replacing wounded/broken
tissue caused by disease or trauma in
deeper dermis
May resolve / dissappear  atrophy
cicatrix
Larger  hypertrophy cicatrix

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 CICATRIX

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 CICATRIX

Hyperthropic Scars
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 ATROPHY

Cicatrix athropicans

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 CYST

Cyst contains fluid or semisolid

material ( fluid, cells and or cells
product)
Form  spheris / oval / papule

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 CYST

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 CYST

Cystic hydradenoma
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 CRUST
Drying of body fluid mix with debris,
bacterial epithelial
Color, thickness, size depends on origin
composition and amount of body fluid
Color:
– Yellow  serum
– Grees  pus
– Black  blood

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 CRUST

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 CRUST

Impetigo
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 EROSION

Lost of skin surface limited to

epidermis and healed without
leaving scar

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 EROSION

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 EROSION
Toxic Epidermal Necrolysis

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 ULCER
lost of tissue continuity in dermis or
even deeper
Size differ from small until large
Healed by leaving scar / cicatrix

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 ULCER

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 ULCER

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 GANGRENE
Severe necrosis process caused by
artery occlusion, with bluish black
color

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 POIKILODERMA
A condition of atrophy, telangiectasia,
and pigment alteration ( hypo / hyper)

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 EXAMINATION AND DIAGNOSIS
OF SKIN DISEASE
Skin examination is ideally performed:
– In distinct room
– Sufficient light
– If possible, exposed by sun light
In particular disease using fluorescent light
such as wood’s light to examine vitiligo,
melasma, tinea, eritrasma
Magnifying glass
Scrapping
Palpation
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 EXAMINATION AND DIAGNOSIS OF SKIN DISEASE

Beside various things mentioned above,

attention is needed:
– Lesions distributions
– Lesions evolution
– Lesions involution
– Grouping of lesions
– Lesions configuration
– Lesions color

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 SKIN FINDINGS IN SYSTEMIC DISEASE

Pruritus
Hirsutisme
Alopecia
etc

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 DIAGNOSIS OF SKIN DISEASE
Diagnosis of skin disease only based on clinical
examination sometimes is difficult, because of :
similar clinical manifestation may occur by different
cause, on the other hand in different clinical
manifestation sometimes occur from the same cause
In this case, need supportive examination
– Scrapping or culture
– Biopsy for histopathology
History of disease
– Need to obtain information about age, healthy,
occupation, hobby, living environment, onset,
course of disease and history of previous treatment
or disease

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 Same cause with different
clinical manifestation

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 Same clinical
manifestation with
different cause

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