The skin is an organ that provides the outer protective envelope for all parts of the body.
The skin is the largest organ in the body. It is a waterproof, airtight and flexible barrier between the environment and internal organs.
It is a mosaic of cells stuck together and its thickness depends on its location in the body. The skin is divided into 3 layers, the epidermis, the dermis and the subcutaneous layer .
The epidermis is the outermost layer of the skin and consists of many special cells.
The epidermis is an elastic layer on the outside that is continuously regenerated, this layer is shed and replaced continuously, every 15 to 30 days.
Structurally, the epidermis is only about a tenth of a millimeter thick, but it is made up of 40 to 50 rows of stacked squamous epithelial cells.
The epidermis does not have blood or blood vessels, it is an avascular region of the human body.
The cells present in the epidermis absorb all the nutrients through the diffusion of fluids from the dermis.
In most of the body, the epidermis is arranged in 4 different layers.
There is a fifth layer of epidermis that is present on the surface of the palms of the hands and the surface of the soles of the feet, where the skin is thicker than on the rest of the body.
The skin begins to develop in the fourth week of fetal life.
It begins initially as a thick layer of single cell ectoderm, under which the cells of the mesoderm proliferate and divide.
Fingernails and toenails are keratinous structures and arise only from the ectoderm.
Specialized structures such as sweat glands (apocrine and eccrine), hair follicles, and sebaceous glands develop from the epidermis and grow downward as invaginations penetrate the dermis.
Males have thicker skin all over their bodies than females.
The skin on the soles of the feet and the palms of the hands are thickest, and the eyelids and post-auricular skin are the thinnest.
Variations in thickness depend on dermal thickness, as epidermal thickness remains relatively constant throughout the body.
The epidermis is a layer that arises from the superficial ectoderm and is colonized by melanocytes, Langerhans cells (dendritic cells), and Merkel cells (pressure sensing receptors).
It is devoid of blood vessels and relies on the dermis below to draw blood, nutrients, and remove waste.
The epidermis plays an important role in protecting the skin. Among the main functions are:
The skin helps maintain body temperature.
When the body is hot, there is vasodilation (widening of the blood vessels) on the surface of the skin. This cools the skin by allowing heat to escape.
When it is cold, there is constriction (narrowing of the blood vessels). This allows less heat to escape, helping to conserve temperature.
When it’s hot or you exercise, your skin’s sweat glands excrete salts and proteins into the water.
Once on the surface of the skin, sweat evaporates into the air.
This cools the skin and helps control body temperature.
There are many nerve endings and receptors that detect changes in the skin.
This allows you to feel everyday objects, feel pain, differentiate heat from cold, and also feel pressure.
As the skin covers the entire body and is a continuous layer, it acts as a barrier and protects the body from mechanical and chemical injury and protects against bacteria, viruses, and parasitic infections.
The pigment in the epidermis also plays an important role in protecting the skin against ultraviolet radiation and preventing it from drying out.
It also prevents the loss of water and body fluids. It keeps the internal environment of our body stable.
Synthesis of vitamin D
When exposed to the sun’s rays, the skin produces vitamin D3. This is essential for building strong, well-formed bones.
Layers of the epidermis
The epidermis is subdivided into 5 layers.
The outermost layer of the skin is the stratum corneum. The stratum corneum is made up of many rows of cells.
The cells in the stratum corneum layer are known as corneocytes (or horny cells) which are thin, flat, dead cells without nuclei, whose protoplasm has changed to keratin (horny substance).
Corneocytes are composed primarily of keratin proteins, which provide structural strength to the stratum corneum and allow water absorption.
The cells lie flattened on top of each other like fish scales, protecting the underlying layers.
Dead keratinocytes are constantly shed from the surface of the stratum corneum and are replaced by cells that come from the deeper layers.
The corneocytes (mature keratinocytes) of the stratum corneum are surrounded by a protein envelope.
They are arranged in layers about 20 cells thick (the number of cells in this layer varies by location), which remain attached due to the corneodesmosomes and surrounding lipids.
The total lifespan of epidermal cells is about 40 days.
There are many cells that are tightly packed together, this allows the skin to be tough and waterproof.
This layer is important as they serve as an effective barrier against any chemicals, insects, and bacteria that can damage the living cells just below them.
The structure of the stratum corneum may seem simple, but it plays a key role in maintaining the structural integrity and hydration of the skin.
This layer not only ensures the continuous production of new skin cells, but also provides the body with vital protections against viruses, bacteria, parasites, and any other form of pathogen or toxin.
The barrier functions of the skin are highly dependent on this layer, and include fighting infection, chemical effects, daily wear and tear, and dehydration.
When corneocytes shed this layer due to degradation, the process is known as desquamation.
It takes two weeks for cells to migrate from the stratum basalis to the stratum corneum.
The cells that are present in this layer are the largest and most abundant in the entire epidermis.
In the thick skin of the hands and feet, there is a layer of skin superficial to the stratum granulosa known as the stratum lucid.
The stratum lucid is made up of several rows of clear, dead keratinocytes that protect the underlying layers.
The name stratum lucid comes from the Latin for clear, which is “lucid” or “transparent layer”, which describes the transparency of the cells themselves.
This layer is approximately 4 keratinocytes thick.
It is the second layer from the top, the cells are distinctively closely grouped, some may show flattened nuclei.
Cells are full of eleidin. Eleidin is a clear intracellular protein, a transformation product of the amino acid complex.
Its main function is to reduce the friction between the stratum corneum and the stratum granulosa.
Just superficial to the spinous stratum is the granular stratum is the granular layer.
The stratum granulosa is made up of 3 to 4 layers of cells.
It is the third layer from the top, it consists of living cells of defined shape where mature anucleated keratinocytes reside with their cytoplasmic granules.
Lipids, which are initially polar, are located within the cytoplasm of these cells and extrude to form a barrier on the cell surface, where they become nonpolar.
Cells in the stratum granulosa, or granular layer, have lost their nuclei and appear as flattened cells that contain dark clumps of cytoplasmic material.
There is a lot of activity in this layer as keratin proteins and lipids work together to create many of the cells responsible for the skin’s protective barrier.
In the stratum granulosa, keratinocytes begin to produce waxy lamellar granules to waterproof the skin.
Keratinocytes in the stratum granulosa are so far from the dermis that they begin to die from lack of nutrients.
This is the fourth layer contains cells that transform from columnar to polygonal (multifaceted) and have a spiny appearance (keratinocytes), contain nuclei.
Less developed keratinocytes sit in the stratum spinosum and are connected via desmosomes.
The spiny appearance of this layer is due to cell contraction (fixation artifact for histology slides), resulting in spine-like desmosomes.
Langerhans cells are also found in this layer.
They arise from the bone marrow and are dendritic cells (antigen-presenting cells) that fight infection.
They are found in multiple layers of the skin (basal, spinous, and granular) but are more abundant in the stratum spinosum.
The spinous layer is located just above the basal stratum and is between 5 and 10 cells thick.
Cells that move into the spinous layer (which is also known as the spiny cell or the squamous cell layer).
The cells in this layer are responsible for the manufacture of keratin, the fibrous protein that gives skin, hair, and nails their toughness and waterproof properties.
This is the layer of the stratum spinosum that is superficial to the stratum basalis. Langerhans cells are found here along with many rows of spiny keratinocytes.
The spines found here are cell projections called desmosomes that form between keratinocytes to hold them together and resist friction.
The stratum basalis is the deepest layer of the epidermis. The stratum basalis is where keratinocytes are dividing and growing, where the keratinocytic stem cells responsible for producing all the cells of the epidermis can be found.
Cells of the stratum basalis include cuboidal keratinocytes, melanocytes, and Merkel cells.
Melanocytes arise from neural crest cells and produce melanin (the pigment that gives skin its color).
The epidermal layer consists of a single row of keratinocytes, attached to the underlying dermis by papillae, called basal cells.
These cells are constantly produced in this layer and push the cells that have already formed into the other layers of the epidermis.
When keratinocytes arise from the stratum basalis, they gradually ascend to the stratum corneum in a process that lasts 14 days.
As the basal cells move into the upper layers, they also flatten out, die, and shed to make room for the newer cells.
The stratum basalt is separated from the next layer, the dermis, by a basement membrane, which is a layer made of collagen and proteins.
Keratinocytes are attached to the basement membrane below by hemidesmosomes.
Cells present in the epidermis
The epidermis is made up of several specialized types of cells. There are main groups of cells in the epidermis such as:
They represent about 90% of the cells of the epidermis.
When keratinocytes develop, they begin to produce and store the protein keratin.
Keratin gives it resistance and impermeability to keratinocytes.
They are cuboidal or columnar cells, they contain a nucleus, they carry cholesterol.
They are the main cells of the epidermis formed by cell division in the lower or basal layer and then migrate upwards for a period of approximately four weeks to the outer surface (stratum corneum) where it is shed.
Corneocytes: dead keratinocytes flatten and together form the outermost layer of the epidermis, they are called stratum corneum or horny layer. This protective layer is continually flaking off.
They represent about 8% of the cells of the epidermis. They are the second most numerous cell type in the epidermis.
Melanocytes are responsible for producing a pigment called melanin that protects the skin from ultraviolet radiation, from burns caused by the sun and gives the skin its color.
Melanocytes are branched or dendritic structures, and their dendrites are used to transfer pigment granules (melanin) to adjacent epidermal cells.
All humans have the same number of melanocytes.
The difference in skin color occurs because in darker skin the melanocytes produce more pigment.
The melanin pigment protects the cells of the epidermis and the tissues of the dermis from sun damage.
Fair-skinned people are more susceptible to developing sun-damaged skin because their melanocytes produce less melanin (skin pigment).
They represent about 8% of the cells of the epidermis.
Langerhans cells have an immunizing function, detect and fight pathogens that intend to enter the body through the skin.
Langerhan cells are part of the immune system.
In addition to being responsible for the immunity of the skin, they provide responses to allergies.
Merkel cells make up less than 1% of all cells in the epidermis.
Merkel cells make up a disk arranged along the deepest layer of the epidermis.
From there they connect to the nerve endings present in the dermis and detect light touch.
Merkel cells are pressure receptors and are found in this layer, along with sensory nerves for tactile acuity and discrimination.
Meissner corpuscles detect light touch and low-frequency vibrations and are found primarily on the fingertips.
Hair follicles, sweat glands, sebaceous (oil) glands, and apocrine glands develop from epidermal cells, but their deeper parts extend into the dermis.
The glands open to the surface of the skin through small ducts.
Hair grows from the hair follicle, which is found on all skin except the palms and soles.
Nails are specialized plates of hard keratin that develop from the epidermis that lines the small bones at the ends of the fingers and toes.
It is a brown pigment, secreted by melanocytes in the basal layer, part of the amino acid tyrosine, the production is due in part to heredity and, in part due to hormonal secretions, exposure to ultraviolet rays increases production of melanin.
Its main function is to protect the skin against the harmful effects of sunlight.
Melanin is also found in the retina, uveal tract, and hair follicles.
The melanin produced here also accumulates within the organelles (melanosomes), which then anchor the pigment to the surrounding keratinocytes.
They are within keratinocytes and are located within the cytoplasm as granules. Melanoma (a type of skin cancer) arises from these cells.
Adrenocorticotropic hormone, melanocyte-stimulating hormone, and estrogens promote melanin production.
Ethnic differences in skin color arise from the size of the melanosomes rather than the number of cells.
Melanosomes normally reduce in number with age.
Keratization begins in the spinous stratum, ends in the granular stratum.
Moisture is lost from the cells, they begin to lose their nuclei, keratohyalin granules form, and eventually the cells die.
An acceleration of this process is due to age, poor circulation, diseases such as psoriasis and poor nutrition among others.
There are many types of skin cancer, depending on the type of cell and the nature of the cancer.
Basal cell carcinomas are known as rodent ulcers (due to their dark gnawing appearance) and arise from the stratum basalis.
Squamous cell carcinomas arise from squamous cells found in the stratum spinosum.
Melanoma arises from melanocytes and is a malignant cancer. Treatment usually involves a surgical excision.
Moles or moles
These are the result of benign proliferation of melanocytes.
They can be congenital or acquired.
People with whiter skin tend to have more moles.
Surgical skin flaps
Plastic surgeons use the skin in all their operations.
Skin grafts can be used to cover defects at other sites (near or distant) and are transplanted into the vascular bed of the defect.
Split-thickness skin grafts (epidermis and a layer of dermis) can be taken and laid out in a network as a formation for use at a distant site.
The donor site recovers a few weeks later.
This is a collagen disease that usually causes symptoms such as stretchy skin, hypermobile joints, or fragile skin.
Symptoms and type of disease depend on the type of collagen affected.
This is an autoimmune condition that produces pink, scaly plaques throughout the body.
There is a strong genetic component, and treatment includes phototherapy, immunosuppressants, topical agents, and alternative therapies.
This is also known as atopic dermatitis, and it is essentially a dry inflammation of the skin.
The skin develops patchy areas of dryness. The condition is linked to other hypersensitivity conditions, for example asthma and hay fever.
Treatment includes emollients and steroid creams.
Burns vary based on location, depth, and surface area.
Treatment includes fluid replacement (Parkland’s formula for the amount of fluid depends on the surface area of the burn), skin grafts, antibiotics to reduce the risk of wound infection.
Burn patients lose fluid rapidly due to exposed tissue.