The Integumentary System

Photo A shows a person getting a tattoo on the foot. Photo B shows a woman getting her eyebrows groomed. Photo C shows a person’s ear, with five earrings in the upper part and one in the lobe. Photo D shows a man and a boy shaving their faces.
Figure 5.1. 
Your skin is a vital part of your life and appearance (a–d). Some people choose to embellish it with tattoos (a), makeup (b), and even piercings (c). (credit a: Steve Teo; credit b: “spaceodissey”/flickr; credit c: Mark/flickr; credit d: Lisa Schaffer)
 

Learning Objectives

  • Describe the integumentary system and the role it plays in homeostasis
  • Describe the layers of the skin and the functions of each layer
  • Describe the accessory structures of the skin and the functions of each
  • Describe the changes that occur in the integumentary system during the aging process
  • Discuss several common diseases, disorders, and injuries that affect the integumentary system
  • Explain treatments for some common diseases, disorders, and injuries of the integumentary system

What do you think when you look at your skin in the mirror? Do you think about covering it with makeup, adding a tattoo, or maybe a body piercing? Or do you think about the fact that the skin belongs to one of the body’s most essential and dynamic systems: the integumentary system? The integumentary system refers to the skin and its accessory structures, and it is responsible for much more than simply lending to your outward appearance. In the adult human body, the skin makes up about 16 percent of body weight and covers an area of 1.5 to 2 m2. In fact, the skin and accessory structures are the largest organ system in the human body. As such, the skin protects your inner organs and it is in need of daily care and protection to maintain its health. This chapter will introduce the structure and functions of the integumentary system, as well as some of the diseases, disorders, and injuries that can affect this system.

Layers of the Skin

Learning Objectives

  • Identify the components of the integumentary system
  • Describe the layers of the skin and the functions of each layer
  • Identify and describe the hypodermis and deep fascia
  • Describe the role of keratinocytes and their life cycle
  • Describe the role of melanocytes in skin pigmentation

Although you may not typically think of the skin as an organ, it is in fact made of tissues that work together as a single structure to perform unique and critical functions. The skin and its accessory structures make up the integumentary system, which provides the body with overall protection. The skin is made of multiple layers of cells and tissues, which are held to underlying structures by connective tissue (Figure 5.2). The deeper layer of skin is well vascularized (has numerous blood vessels). It also has numerous sensory, and autonomic and sympathetic nerve fibers ensuring communication to and from the brain.

This illustration shows a cross section of skin tissue. The outermost layer is called the epidermis, and occupies one fifth of the cross section. Several hairs are emerging from the surface. The epidermis dives around one of the hairs, forming a follicle. The middle layer is called the dermis, which occupies four fifths of the cross section. The dermis contains an erector pilli muscle connected to one of the follicles. The dermis also contains an eccrine sweat gland, composed of a bunch of tubules. One tubule travels up from the bunch, through the epidermis, opening onto the surface a pore. There are two string-like nerves travelling vertically through the dermis. The right nerve is attached to a Pacinian corpuscle, which is a yellow structure consisting of concentric ovals similar to an onion. The lowest level of the skin, the hypodermis, contains fatty tissue, arteries, and veins. Blood vessels travel from the hypodermis and connect to hair follicles and erector pilli muscle in the dermis.
Figure 5.2. Layers of Skin
The skin is composed of two main layers: the epidermis, made of closely packed epithelial cells, and the dermis, made of dense, irregular connective tissue that houses blood vessels, hair follicles, sweat glands, and other structures. Beneath the dermis lies the hypodermis, which is composed mainly of loose connective and fatty tissues.
 

The skin consists of two main layers and a closely associated layer. View this animation to learn more about layers of the skin. What are the basic functions of each of these layers?

The Epidermis

The epidermis is composed of keratinized, stratified squamous epithelium. It is made of four or five layers of epithelial cells, depending on its location in the body. It does not have any blood vessels within it (i.e., it is avascular). Skin that has four layers of cells is referred to as “thin skin.” From deep to superficial, these layers are the stratum basale, stratum spinosum, stratum granulosum, and stratum corneum. Most of the skin can be classified as thin skin. “Thick skin” is found only on the palms of the hands and the soles of the feet. It has a fifth layer, called the stratum lucidum, located between the stratum corneum and the stratum granulosum (Figure 5.3).

Part A is a micrograph showing a cross section of thin skin. The topmost layer is a thin, translucent layer with irregular texture and areas where cells are sloughing off. The deepest layer is dark purple and extends into the third layer with finger like projections. The third light purple layer contains thin bands of fibers and small, dark cells. The fourth, and deepest layer, is darker than the third layer, but is still light purple. It contains thick fiber bands that are loosely packed. Part B is a magnified view of the epidermis of thick skin. It shows the topmost layer is five times thicker than the topmost layer of thin skin. The topmost layer of thick skin is also denser and less translucent than the topmost layer of thin skin.
Figure 5.3. Thin Skin versus Thick Skin
These slides show cross-sections of the epidermis and dermis of (a) thin and (b) thick skin. Note the significant difference in the thickness of the epithelial layer of the thick skin. From top, LM × 40, LM × 40. (Micrographs provided by the Regents of University of Michigan Medical School © 2012)
 

The cells in all of the layers except the stratum basale are called keratinocytes. A keratinocyte is a cell that manufactures and stores the protein keratin. Keratin is an intracellular fibrous protein that gives hair, nails, and skin their hardness and water-resistant properties. The keratinocytes in the stratum corneum are dead and regularly slough away, being replaced by cells from the deeper layers (Figure 5.4).

The outer layer of cells in this micrograph is the thinnest layer and stained deep purple due to full keratinization of dead cells. The next layer occupies one quarter of the micrograph, is lightly stained, and is a dense collection of cells. The third layer from the top is mostly white, with lightly stained, loosely-packed strands radiating in random directions. The bottom-most layer is densely-packed, with thick bands of highly organized muscle tissue that are darkly stained.
Figure 5.4. Epidermis
The epidermis is epithelium composed of multiple layers of cells. The basal layer consists of cuboidal cells, whereas the outer layers are squamous, keratinized cells, so the whole epithelium is often described as being keratinized stratified squamous epithelium. LM × 40. (Micrograph provided by the Regents of University of Michigan Medical School © 2012)
 

Interactive Link

View the University of Michigan WebScope at http://virtualslides.med_umich.edu/Histology/Basic%20Tissues/Epithelium%20and%20CT/106_HISTO_40X.svs/view.apml? to explore the tissue sample in greater detail. If you zoom on the cells at the outermost layer of this section of skin, what do you notice about the cells?

 

Stratum Basale

The stratum basale (also called the stratum germinativum) is the deepest epidermal layer and attaches the epidermis to the basal lamina, below which lie the layers of the dermis. The cells in the stratum basale bond to the dermis via intertwining collagen fibers, referred to as the basement membrane. A finger-like projection, or fold, known as the dermal papilla (plural = dermal papillae) is found in the superficial portion of the dermis. Dermal papillae increase the strength of the connection between the epidermis and dermis; the greater the folding, the stronger the connections made (Figure 5.5).

This illustration shows a cross section of the epidermis. The cells of the innermost layer, the stratum basale, are large and have a purple nucleus. The stratum basale curls around the dermis, which projects into the epidermis. The stratum basale contains four layers of large, triangle-shaped keratinocytes. Fibers are visible within the spaces between keratinocytes in the stratum basale. A melanocyte is also present in this layer. The melanocyte possesses finger-like projections extending from its main cell body. The projections branch through the extracellular spaces between nearby keratinocytes. Above the stratum basale is the stratum spinosum which consists of 8 layers of oval-shaped keratinocytes. The nucleus is present in these keratinocytes, but has faded to a lighter purple. The stratum granulosum contains five layers of keratinocytes, each containing spots in its cytoplasm, labeled the lamellar granules. The stratum lucidium contains 4 layers of diamond-shaped cells with no nucleus. The stratum corneum contains 9 layers of keratinocytes with no nucleus , nor cytoplasm. A few of the cells in the topmost layer of the stratum corneum are flaking off from the skin.
Figure 5.5. Layers of the Epidermis
The epidermis of thick skin has five layers: stratum basale, stratum spinosum, stratum granulosum, stratum lucidum, and stratum corneum.
 

The stratum basale is a single layer of cells primarily made of basal cells. A basal cell is a cuboidal-shaped stem cell that is a precursor of the keratinocytes of the epidermis. All of the keratinocytes are produced from this single layer of cells, which are constantly going through mitosis to produce new cells. As new cells are formed, the existing cells are pushed superficially away from the stratum basale. Two other cell types are found dispersed among the basal cells in the stratum basale. The first is a Merkel cell, which functions as a receptor and is responsible for stimulating sensory nerves that the brain perceives as touch. These cells are especially abundant on the surfaces of the hands and feet. The second is amelanocyte, a cell that produces the pigment melanin. Melanin gives hair and skin its color, and also helps protect the living cells of the epidermis from ultraviolet (UV) radiation damage.

In a growing fetus, fingerprints form where the cells of the stratum basale meet the papillae of the underlying dermal layer (papillary layer), resulting in the formation of the ridges on your fingers that you recognize as fingerprints. Fingerprints are unique to each individual and are used for forensic analyses because the patterns do not change with the growth and aging processes.

Stratum Spinosum

As the name suggests, the stratum spinosum is spiny in appearance due to the protruding cell processes that join the cells via a structure called a desmosome. The desmosomes interlock with each other and strengthen the bond between the cells. It is interesting to note that the “spiny” nature of this layer is an artifact of the staining process. Unstained epidermis samples do not exhibit this characteristic appearance. The stratum spinosum is composed of eight to 10 layers of keratinocytes, formed as a result of cell division in the stratum basale (Figure 5.6). Interspersed among the keratinocytes of this layer is a type of dendritic cell called the Langerhans cell, which functions as a macrophage by engulfing bacteria, foreign particles, and damaged cells that occur in this layer.

This micrograph of the epidermis shows stratum corneum as a rough, darkened layer. The next layer, the stratum granulosum, contains white cells with areas of black in their cytoplasm, equal in thickness to the stratum corneum. The third layer, the stratum spinosum, contains large, grayish cells. The stratum spinosum is the thickest layer, occupying half of the micrograph. A hair follicle is embedded in this layer, which is a round structure with black, concentric spots. The fourth layer is the stratum basalis, which contains grayish cells with clear, dark nuclei, similar in thickness to the stratum corneum. The dermis is the deepest layer, and is lightly-colored with interspersed gray cells. A cross-section of a capillary is visible within the dermis.
Figure 5.6. Cells of the Epidermis
The cells in the different layers of the epidermis originate from basal cells located in the stratum basale, yet the cells of each layer are distinctively different. EM × 2700. (Micrograph provided by the Regents of University of Michigan Medical School © 2012)
 

Interactive Link

View the University of Michigan WebScope athttp://virtualslides.med.umich.edu/Histology/EMsmallCharts/3%20Image%20Scope%20finals/065%20-%20Epidermis_001.svs/view.apml to explore the tissue sample in greater detail. If you zoom on the cells at the outermost layer of this section of skin, what do you notice about the cells?

The keratinocytes in the stratum spinosum begin the synthesis of keratin and release a water-repelling glycolipid that helps prevent water loss from the body, making the skin relatively waterproof. As new keratinocytes are produced atop the stratum basale, the keratinocytes of the stratum spinosum are pushed into the stratum granulosum.

Stratum Granulosum

The stratum granulosum has a grainy appearance due to further changes to the keratinocytes as they are pushed from the stratum spinosum. The cells (three to five layers deep) become flatter, their cell membranes thicken, and they generate large amounts of the proteins keratin, which is fibrous, and keratohyalin, which accumulates as lamellar granules within the cells (see Figure 5.5). These two proteins make up the bulk of the keratinocyte mass in the stratum granulosum and give the layer its grainy appearance. The nuclei and other cell organelles disintegrate as the cells die, leaving behind the keratin, keratohyalin, and cell membranes that will form the stratum lucidum, the stratum corneum, and the accessory structures of hair and nails.

Stratum Lucidum

The stratum lucidum is a smooth, seemingly translucent layer of the epidermis located just above the stratum granulosum and below the stratum corneum. This thin layer of cells is found only in the thick skin of the palms, soles, and digits. The keratinocytes that compose the stratum lucidum are dead and flattened (see Figure 5.5). These cells are densely packed with eleiden, a clear protein rich in lipids, derived from keratohyalin, which gives these cells their transparent (i.e., lucid) appearance and provides a barrier to water.

Stratum Corneum

The stratum corneum is the most superficial layer of the epidermis and is the layer exposed to the outside environment (see Figure 5.5). The increased keratinization (also called cornification) of the cells in this layer gives it its name. There are usually 15 to 30 layers of cells in the stratum corneum. This dry, dead layer helps prevent the penetration of microbes and the dehydration of underlying tissues, and provides a mechanical protection against abrasion for the more delicate, underlying layers. Cells in this layer are shed periodically and are replaced by cells pushed up from the stratum granulosum (or stratum lucidum in the case of the palms and soles of feet). The entire layer is replaced during a period of about 4 weeks. Cosmetic procedures, such as microdermabrasion, help remove some of the dry, upper layer and aim to keep the skin looking “fresh” and healthy.

Dermis

The dermis might be considered the “core” of the integumentary system (derma- = “skin”), as distinct from the epidermis (epi- = “upon” or “over”) and hypodermis (hypo- = “below”). It contains blood and lymph vessels, nerves, and other structures, such as hair follicles and sweat glands. The dermis is made of two layers of connective tissue that compose an interconnected mesh of elastin and collagenous fibers, produced by fibroblasts (Figure 5.7).

This micrograph shows layers of skin in a cross section. The papillary layer of the dermis extends between the downward fingers of the darkly stained epidermis. The papillary layer appears finer than the reticular layer, consisting of smaller, densely-packed fibers. The reticular layer is three times thicker than the papillary layer and contains larger, thicker fibers. The fibers seem more loosely packed than those of the papillary layer, with some separated by empty spaces. Both layers of the dermis contain cells with darkly stained nuclei.
Figure 5.7. Layers of the Dermis
This stained slide shows the two components of the dermis—the papillary layer and the reticular layer. Both are made of connective tissue with fibers of collagen extending from one to the other, making the border between the two somewhat indistinct. The dermal papillae extending into the epidermis belong to the papillary layer, whereas the dense collagen fiber bundles below belong to the reticular layer. LM × 10. (credit: modification of work by “kilbad”/Wikimedia Commons)
 

Papillary Layer

The papillary layer is made of loose, areolar connective tissue, which means the collagen and elastin fibers of this layer form a loose mesh. This superficial layer of the dermis projects into the stratum basale of the epidermis to form finger-like dermal papillae (see Figure 5.7). Within the papillary layer are fibroblasts, a small number of fat cells (adipocytes), and an abundance of small blood vessels. In addition, the papillary layer contains phagocytes, defensive cells that help fight bacteria or other infections that have breached the skin. This layer also contains lymphatic capillaries, nerve fibers, and touch receptors called the Meissner corpuscles.

Reticular Layer

Underlying the papillary layer is the much thicker reticular layer, composed of dense, irregular connective tissue. This layer is well vascularized and has a rich sensory and sympathetic nerve supply. The reticular layer appears reticulated (net-like) due to a tight meshwork of fibers. Elastin fibers provide some elasticity to the skin, enabling movement. Collagen fibers provide structure and tensile strength, with strands of collagen extending into both the papillary layer and the hypodermis. In addition, collagen binds water to keep the skin hydrated. Collagen injections and Retin-A creams help restore skin turgor by either introducing collagen externally or stimulating blood flow and repair of the dermis, respectively.

Hypodermis

The hypodermis (also called the subcutaneous layer or superficial fascia) is a layer directly below the dermis and serves to connect the skin to the underlying fascia (fibrous tissue) of the bones and muscles. It is not strictly a part of the skin, although the border between the hypodermis and dermis can be difficult to distinguish. The hypodermis consists of well-vascularized, loose, areolar connective tissue and adipose tissue, which functions as a mode of fat storage and provides insulation and cushioning for the integument.

Everyday Connection: Lipid Storage

The hypodermis is home to most of the fat that concerns people when they are trying to keep their weight under control. Adipose tissue present in the hypodermis consists of fat-storing cells called adipocytes. This stored fat can serve as an energy reserve, insulate the body to prevent heat loss, and act as a cushion to protect underlying structures from trauma.

Where the fat is deposited and accumulates within the hypodermis depends on hormones (testosterone, estrogen, insulin, glucagon, leptin, and others), as well as genetic factors. Fat distribution changes as our bodies mature and age. Men tend to accumulate fat in different areas (neck, arms, lower back, and abdomen) than do women (breasts, hips, thighs, and buttocks). The body mass index (BMI) is often used as a measure of fat, although this measure is, in fact, derived from a mathematical formula that compares body weight (mass) to height. Therefore, its accuracy as a health indicator can be called into question in individuals who are extremely physically fit.

In many animals, there is a pattern of storing excess calories as fat to be used in times when food is not readily available. In much of the developed world, insufficient exercise coupled with the ready availability and consumption of high-calorie foods have resulted in unwanted accumulations of adipose tissue in many people. Although periodic accumulation of excess fat may have provided an evolutionary advantage to our ancestors, who experienced unpredictable bouts of famine, it is now becoming chronic and considered a major health threat. Recent studies indicate that a distressing percentage of our population is overweight and/or clinically obese. Not only is this a problem for the individuals affected, but it also has a severe impact on our healthcare system. Changes in lifestyle, specifically in diet and exercise, are the best ways to control body fat accumulation, especially when it reaches levels that increase the risk of heart disease and diabetes.

Pigmentation

The color of skin is influenced by a number of pigments, including melanin, carotene, and hemoglobin. Recall that melanin is produced by cells called melanocytes, which are found scattered throughout the stratum basale of the epidermis. The melanin is transferred into the keratinocytes via a cellular vesicle called a melanosome (Figure 5.8).

This figure consists of two diagrams side by side. The right diagram shows development of light colored skin; the left shows development of dark-colored skin. In both, a brown melanocyte sits at the border between the dermis and epidermis. The melanocyte has a large nucleus and six finger-like extensions. These reach between cells of the stratum basalis. Sections of the extensions detach and travel through the skins. These are melanosomes. In the left diagram, both the melanocyte and melanosomes contain melanin particles, shown as dark dots. Melanosomes travel upwards to outer skin layers, releasing melanin. As a result, keratinocytes in the left diagram contain several melanin particles that darken skin color. In light colored skin, the melanocyte contains no melanin. It still releases melanosomes into upper layers of the skin; however, these melanosomes contain no melanin. Therefore, the skin does not darken and remains light.
Figure 5.8. Skin Pigmentation
The relative coloration of the skin depends of the amount of melanin produced by melanocytes in the stratum basale and taken up by keratinocytes.

 

Melanin occurs in two primary forms. Eumelanin exists as black and brown, whereas pheomelanin provides a red color. Dark-skinned individuals produce more melanin than those with pale skin. Exposure to the UV rays of the sun or a tanning salon causes melanin to be manufactured and built up in keratinocytes, as sun exposure stimulates keratinocytes to secrete chemicals that stimulate melanocytes. The accumulation of melanin in keratinocytes results in the darkening of the skin, or a tan. This increased melanin accumulation protects the DNA of epidermal cells from UV ray damage and the breakdown of folic acid, a nutrient necessary for our health and well-being. In contrast, too much melanin can interfere with the production of vitamin D, an important nutrient involved in calcium absorption. Thus, the amount of melanin present in our skin is dependent on a balance between available sunlight and folic acid destruction, and protection from UV radiation and vitamin D production.

It requires about 10 days after initial sun exposure for melanin synthesis to peak, which is why pale-skinned individuals tend to suffer sunburns of the epidermis initially. Dark-skinned individuals can also get sunburns, but are more protected than are pale-skinned individuals. Melanosomes are temporary structures that are eventually destroyed by fusion with lysosomes; this fact, along with melanin-filled keratinocytes in the stratum corneum sloughing off, makes tanning impermanent.

Too much sun exposure can eventually lead to wrinkling due to the destruction of the cellular structure of the skin, and in severe cases, can cause sufficient DNA damage to result in skin cancer. When there is an irregular accumulation of melanocytes in the skin, freckles appear. Moles are larger masses of melanocytes, and although most are benign, they should be monitored for changes that might indicate the presence of cancer (Figure 5.9).

Five photos of moles. The three upper photos show moles that are small, flat, and dark brown. The bottom left photo shows a dark black mole that is raised above the skin. The bottom right photo shows a large, raised, reddish mole with protruding hairs.
Figure 5.9. Moles
Moles range from benign accumulations of melanocytes to melanomas. These structures populate the landscape of our skin. (credit: the National Cancer Institute)
 
 

Disorders of the Integumentary System

The first thing a clinician sees is the skin, and so the examination of the skin should be part of any thorough physical examination. Most skin disorders are relatively benign, but a few, including melanomas, can be fatal if untreated. A couple of the more noticeable disorders, albinism and vitiligo, affect the appearance of the skin and its accessory organs. Although neither is fatal, it would be hard to claim that they are benign, at least to the individuals so afflicted.

Albinism is a genetic disorder that affects (completely or partially) the coloring of skin, hair, and eyes. The defect is primarily due to the inability of melanocytes to produce melanin. Individuals with albinism tend to appear white or very pale due to the lack of melanin in their skin and hair. Recall that melanin helps protect the skin from the harmful effects of UV radiation. Individuals with albinism tend to need more protection from UV radiation, as they are more prone to sunburns and skin cancer. They also tend to be more sensitive to light and have vision problems due to the lack of pigmentation on the retinal wall. Treatment of this disorder usually involves addressing the symptoms, such as limiting UV light exposure to the skin and eyes. In vitiligo, the melanocytes in certain areas lose their ability to produce melanin, possibly due to an autoimmune reaction. This leads to a loss of color in patches (Figure 5.10). Neither albinism nor vitiligo directly affects the lifespan of an individual.

This photo shows the back of a man’s neck. There is a large, discolored patch of skin at the base of his hairline. The discolored area extends over the ears onto the cheeks, toward the front of the face. The man’s head and facial hair are mostly gray, but white patches of hair are seen above the discolored skin.
Figure 5.10. Vitiligo
Individuals with vitiligo experience depigmentation that results in lighter colored patches of skin. The condition is especially noticeable on darker skin. (credit: Klaus D. Peter)
 

Other changes in the appearance of skin coloration can be indicative of diseases associated with other body systems. Liver disease or liver cancer can cause the accumulation of bile and the yellow pigment bilirubin, leading to the skin appearing yellow or jaundiced (jaune is the French word for “yellow”). Tumors of the pituitary gland can result in the secretion of large amounts of melanocyte-stimulating hormone (MSH), which results in a darkening of the skin. Similarly, Addison’s disease can stimulate the release of excess amounts of adrenocorticotropic hormone (ACTH), which can give the skin a deep bronze color. A sudden drop in oxygenation can affect skin color, causing the skin to initially turn ashen (white). With a prolonged reduction in oxygen levels, dark red deoxyhemoglobin becomes dominant in the blood, making the skin appear blue, a condition referred to as cyanosis (kyanos is the Greek word for “blue”). This happens when the oxygen supply is restricted, as when someone is experiencing difficulty in breathing because of asthma or a heart attack. However, in these cases the effect on skin color has nothing do with the skin’s pigmentation.

Interactive Link

This ABC video follows the story of a pair of fraternal African-American twins, one of whom is albino. Watch this video to learn about the challenges these children and their family face. Which ethnicities do you think are exempt from the possibility of albinism?