Medical college of Zhengzhou Universituy

Dermatology &
Venereology
ZHANG Jiang-an ( 张江安 )
Dept. Of Dermatology Zhenzhou University
Skin Diseases
Skin diseases are very common
7% of outpatient visits are for dermatologic complaints
Thousands of skin disorders have been described
But only a small number account for the vast majority of patient
visits
Skin diseases are divided into two large groups
Growths: represents a neoplastic change, squamous cell
cacinoma, et al.
Rashes: an inflammatory reaction in the skin, psoriasis, et al.
Sexually Transmitted Diseases, STD

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 Dermatology & Venereology

Part I: Introduction
Part II: Clinical Dermatology

Part III: Sexually Transmitted Diseases

Exam

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 Introduction

the Skin: Basic Structure & Function

 Skin
The skin is the largest organ in the body
 weighting an average of 4 Kg and making up
about 16% of body weight
 covering an area of 2 m2

Its major function is to act as a barrier

 against an inhospitable environment
 to protect the body from the influences of the
outside world
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Anatomy of normal skin

Components of skin
 Epidermis: the outermost
layer, the major protective
layer
 Dermis: the middle layer,
the major support layer
 Subcutaneous tissue
(fat): the innermost layer of
the skin

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Cell types seen in the epidermis
 Keratinocytes
– principal cell of the
epidermis
 Melanocytes
– found in the basal cell layer
– the pigment-producing cell
 Langerhans' cells
– An important
immunologically competent
cell
 Merkel cells
– present in small numbers in
the basal cell layer

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 Keratinocyte
 principal cell of the epidermis

– originates from ectodermal

– has the specialized function of producing keratin

– plays a role in the immune function of the skin

– while differentiating and moving upward through the
epidermis, it changes morphologically
 It flattens out, and eventually the nucleus disappears

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the Layers of the Epidermis

horny layer
granular
layer

prickle cell
layer

basal layer

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 the Layers of the epidermis
basal layer (basal cell layer)
– the only keratinocytes in normal epidermis
which undergo cell division
 prickle cell layer (stratum spinosum)
– the bulk of the living epidermal keratinocytes
 granular layer (stratum granulosum)
– contains distinctive dark granules that are
composed of keratohyalin
 horny layer (cornified layer, stratum corneum)
– outer non-nucleated barrier layer
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 I. Basal Cell Layer

the innermost layer of epidermis

cell division occurs only in this layer

– a proportion of the basal cells proliferate,
differentiate, and move in a stepwise fashion
through the full thickness of the epidermis
– It can be considered the “stem cell” of the
epidermis

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Basement membrane zone, BMZ

epidermis

BMZ
Stained by PAS
dermis
 isa complex multilayered structure, four layers
 divides the epidermis from the dermis
 can be observed through PAS stain
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Transit time
 It is calculated that the
‘transit time’ for a daughter
keratinocyte in the basal cell
layer of normal skin to reach
the outer surface
 It is around 50 –75 days in
normal skin
 In psoriasis this is reduced to
8-10 days
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 II. Prickle cell layer (Stratum spinosum)

lies above the basal cell layer

Keratinization begins in this layer

– The keratinocytes produce keratin, a fibrous protein
that is the major component of the horny layer

derives its name from the “spines”

( intercellular bridges/ desmosomes)
– are extensions from keratin within the keratinocytes
– functionally they hold the cells together
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 intercellular bridges

Desmosomes is a special cellular

bridges that connect keratinocytes
each other.
no desmosomes between keratinocytes
and melanocytes, or Langerhans’ cells,
or Merkel cells
desmosomes 15
Pemphigus vulgaris
epidermis

dermis ancantholysis

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II. Prickle cell layer (Stratum spinosum)

lamellar granules

are the special structure in the epidermis
 are visualized with electron microscopy

 extrude into the intercellular space and

ultimately are thought to help form the
“cement” that holds together the stratum
corneum
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 lamellar granules

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Ultrastructure of the epidermis
Lamellar granules
in keratinocyte
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III. Granular layer (Stratum granulosum)

The process of differentiation


continues in this layer
granular cells
– acquire additional keratin
– become more flattened
– contain distinctive dark granules that
are composed of keratohyalin
– also contain lamellar granules
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 keratohyalin

Cell in granular layer

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Ultrastructure of the epidermis
Keratohyalin
constitutes dark granules, which are
easily seen on light microscope
contains
– Profilaggrin
 the precursor to filaggrin, the latter plays
an important role in the aggregation of
keratin filaments in the stratum corneum
– involucrin
 Play a role in the formation of the cell

envelope of the cells in the stratum corneum

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 IV. Horny Layer (Stratum
Corneum)
 The cells in the stratum corneum
– are dead
– are large, flat, polyhedral, plate-like envelops
filled with keratin
 They are stacked in vertical layers that range in
thickness from 15 to 25 layers on most body surfaces
to as many as 100 layers on the palms and soles.
 The cells are held together by a lipid-rich cement in
a fashion similar to “bricks and mortar”, and
constitute the major physical barrier of the skin
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 horny layer

granular
layer

High-power view of granular layer, showing sharp

transition from the living but non-dividing epidermal
cells and the dead anucleate cornified layer
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 Melanocytes
 dendritic, pigment-producing cells located in the basal cell layer
 epidermal melanin unit
– The dendrites of melanocytes extend for long distances within the epidermis, and any
one melanocyte is therefore in contact with a great number of keratinocytes
– The dendrites serves as conducts through which pigment granules(melanosomes) are
transferred to their neighboring keratinocytes.
 protect the skin from ultraviolet radiation

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Epidermal Melanin Unit

Keratinocyte

melanosome

melanocyte

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 Langerhans' Cells
 are dendritic cells among keratinocytes of the
prickle cell layer, they constitute 3% to 5% of
the cells in this layer
 at the light-microscopic level, they are difficult
to detect in routinely stained sections
 ultrastructurally they are characterized by a
folded nucleus and distinct intracytoplasmic
organelles called Birbeck granules
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 Light Micrograph of Langerhans Cells

Revealed by gold chloride Stained by ATPase method, in

staining, in a vertical section of an isolated epidermal sheet
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the epidermis viewed from the dermal side
 Langerhans' cell lysosomes

Note
1.indented
Birbeck
nucleus granules

2. Birbeck
granules
rod, and
racquet-shaped 29
 Langerhans' Cells

 are of the monocyte-macrophage lineage and

originate in bone marrow.
 areimmunologically competent and may act as
antigen presenting cells
 are the first line of immunologic defense in the
skin, and function primarily in the afferent limb
of the immune response

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Horny Layer
Granular Layer

Epidermis
Prickle Layer

basal cell layer

Dermis
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 Components of Dermis
fibers
– collagen
– elastic fibers
ground substance
cells
– the fibroblast
– the macrophage
– the mast cell
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 Dermis
The dermis is a tough but elastic
support structure that contains:
– blood vessels
 to supply nutrition
 to regulate temperature

– lymphatics
– free nerve endings
 the most important sensory receptors
– cutaneous appendages 33
 Skin Appendages

eccrine sweet glands

apocrine sweet glands
hair follicle
sebaceous glands
nails
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Diagramatic Cross Section of the Skin

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 Skin Appendages

Eccrine Sweet Glands

 distributed over the entire body surface

 are most abundant on the palms, soles, forehead, and

axillae.
 Secretion of sweat occurs as a result of many factors
– heat is a prime stimulus to increased sweating
– other physiologic stimuli, including emotional stress, are
important as well.
 to help regulate temperature by excreting sweet onto
the surface of the skin

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Diagramatic Cross Section of the Skin

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Skin Appendages

Apocrine Sweet Glands

 are generally confined to the following sites:
axillae, areolae , the anogenital region
 do not begin to function until puberty.

 serve no known useful function in humans

 they are responsible for body odor, bacterial action

on apocrine sweet causes body odor

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High-power view of secretory cells in apocrine
glands showing decapitation pattern of secretion
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Diagramatic Cross Section of the Skin

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Skin Appendages
Hair Follicle
 are distributed over the entire body surface except
for the palms and soles
 Types of hair
– vellus hairs (short, fine, light colored)
– terminal hairs (long, thick, dark colored)
 Hair growth cycles
– anagen (growing phase )
– catagen (transitional phase )
– telogen (resting phase )

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Phases of the Growth Cycle of a
Hair

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Diagramatic Cross Section of the Skin

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 Skin Appendages
Sebaceous Glands
 are part of the pilosebaceous unit and so are found
wherever hair follicles are located.
 produce an oily substance termed sebum, which
may be useful as a skin moisturizer
 from the sebaceous glands, sebum drains into the
hair follicle, from which it exits onto the surface of
the skin
 the size and secretory activity of these glands are
under androgen control 

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The pilosebaceous
unit, showing the
sebaceous gland
draining into the
hair follicle canal
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 Nails

Nails are made of keratin produced

in the matrix
Nails facilitate fine grasping and
pinching maneuvers

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normal nail

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 Subcutaneous Tissue

Insulates the body from cold

Cushions deep tissues from blunt

trauma
Is a reserve food

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Function of skin
SKIN FUNCTIONS
 Protects from external injury
 Literally holds all other organs together
 Plays a part in fluid balance. Mainly excretes but can also
absorb fluid
 Temperature control
 An important organ of sensation
 Absorb ultraviolet radiation
 Metabolizes vitamin D
 Synthesizes epidermal lipids which are an important
protective barrier
 Cosmetic function

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 Key points
 Three components of skin
– Epidermis, dermis and subcutaneous tissue
 Cell types seen in the epidermis
– Keratinocytes, Melanocytes, Langerhans' cells, Merkel cells
 The Layers of the epidermis
– basal layer, prickle cell layer, granular layer, horny layer
 Basement membrane zone
 Skin Appendages include ?
– eccrine sweet glands, apocrine sweet glands, hair follicle,
sebaceous glands, nails

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 Thank you
for your attention!