SKIN

Outer covering of body which provides the dynamic

interphase between the body and external environment.
The skin is considered as an organ because it consists of
several kind of tissues that are structurally arranged to
function together. Skin is largest organ of the body
covering about 3000 sq. inch area in an average adult and
accounts for approx. 7% of body wt. The skin reflects
our general health. A healthy skin indicates a healthy
body.

Skin - 2 principal layers

1. Epidermis – It is keratinized stratified squamous

variety. The various appendages of skin i.e. sweat
gland seba gland, sebaceous glands, hair & nails.

Layers of Epidermis :
Depending on the skin type –thick or thin – skin is made
up of either four or five layers.
1. Stratum corneum : It is the most superficial layer of
teh skin. It consists of many (25-30) layers of fully
keratinized flattened scale like dead cells.
2. Stratum lucidum (clear layer) : It is a thin clear
homogeneous glassy layer. The nucleus, organelles
and membrane of cells are not visible under a
microscope.
3. Stratum granulosum (granular layer) : It consists of
three or four rows of flattened cells with pyknotic
nuclei showing signs of degenation.
4. Stratum spinosum (spiny layer) : It consists of
several layers of polygonal cells, each with a
centrally located large oval nucleus.
5. Stratum basale/stratum germinatum : It consists of a
single layer of cuboidal or columnar cells.

2. Dermis : Deeper layer is dermis – consists mainly of

bundles of collagen fiber with some elastic tissue
blood vessels, lymphatics and nerve fibers.
Layer of Dermis :
The dermis is usually divided into two layers :
1. A superficial papillary layer
2. Deep reticular layer

Papillary layer : This is in contact with epidermis and

accounts for about one-fifth of the entire thickness of the
dermis.

Reticular layer : It is chiefly composed of collagen fibers

arranged mostly in parallel bundles. This layer is quite
distensible.

COLOR OF SKIN
The colour of the skin is caused by combination of three
pigments :
1. Melanin is a black brown pigment produced by
melanocytes.
2. Carotene is a yellow orange pigment It is
exogenous pigment taken up from the food. It is
present in stratum corneum and fat cells.
3. Hemoglobin The purple hemoglobin and red
oxyhemoglobin present in cutaneous blood vessels
is reponsible for the pink of the skin.

TYPES OF SKIN
The skin varies in thickness. It is thickest in palm and
sole.
There are two types :
1. Thin
2. Thick
 Thin skin is present all over the body except palms and
soles.

Thick skin is present only in the palm and soles.

Differences between the thin and thick skin.

Thin skin Thick Skin

Epidermis Thin (0.10-0.15mm) Thick (0.6-4.5mm)
Stratum corneum Stratum corneum
thin , Stratum thick , strateum
lucidum absent, lucidum present,
Epidermal ridges epidermal ridges
absent present
Hair follicles Present Absent
Sebaceous glands Present Absent
Sweat glands Few more
Sensory nerve Few More
endings
NAILS :
There are hardened plates of keratinized epithelial cells
of stratum corneum.

Parts of the nails :

Each nail consists of the following parts. :
1. Root
2. Body
3. Free border
4. Hidden border

HAIR
These are thin elongated keratinized structures present
over almost of the body.
Part of hair
1. Shaft
2. Root
3. Bulb
Structure of hair
The hair consists of three layers
1. Medulla consists of moderately keratinized and
loosely arranged cells.
2. Cortex consists of a heavily keratinized grouped
cells.
3. Cutile consists of a single layer of cells

SWEAT GLANDS :
The sweat glands are long coiled tubular glands. It
consists of two parts : a secretory portion and excretory
portion

The secretory portion is located in the deep dermis in the

form of a twisted coil.
The excretory duct is long and extends from secretory
position to the surface of the skin.

Types of Sweat Glands :

1. Eccrine
2. Apocrine

Difference are
Eccrine sweat Apcrine sweat
glands gland
Nature of secretion Watery, containing Viscid, containing
sodium chloride, proteins and lipids.
potassium, urea and
ammonia
Site of discharge of On the skin surface Into the
secretion on sweat pores pilosebaceous canal
around the hair
shaft
Distribution Widely distributed Found in skills,
throughout the mons pubis and
body anal regions.
Function Regulated body provide
temperature characteristics body
odor
Age of activity Active thoughout Active at puberty
life
Endocrine control Absent Present

FUNCTIONS OF SKIN

The skin is dynamic organ. It not only protects the body

from pathogens and external injury, but it also plays a
major role in maintaining body homeostasis.
The major functions of the skin include :
1. Protection
 2. Hydroregulation
3. Thermoregulation
4. Sensory reception
5. Absorption of lipid soluble substances
6. Synthesis of Vitamin D
7. Excretion of waste material
8. Communication of emotions

BLOOD SUPPLY TO THE SKIN

The epidermis of the skin is avascular. A special feature
of the blood supply to the skin is the presence of
numerous arteriovenous anastomoses which regulate
blood flow.

NERVE SUPPLY TO THE SKIN

The nerves that supplying to the skin are –
1. Motor nerves – These are autonomic nerve fibers
which activates glands and control blood flow.
2. Sensory nerves – These are somatic nerve fibers
which innervate the skin in the form of large
number of sensory nerve endings which carry
different types of sensation from the skin.

Sensory nerve endings in the skin

a) Free nerve endings enter the epidermis and carry

pain and temperature sensations.
b) Merkel’s disc or endings terminate on the Merkel
cells of stratum basale and function as
mechanoreceptors.
c) Meissner’s corpuscles function as
mechanonreceptors to detect fine touch. They are
present in dermal papilae.
 d) Pacinian corpuscles present in dermis and functions
as mechanoreceptor to detect deep pressure and
vibrations.
e) Ruffin’s endings are present deep in dermis
function as heat receptor to detect heat.
f) Bulbs of Krause present in superficial dermis and
function as thermoreceptors to detect cold.
g) Root hair plexuses are the plexuses of nerve fibers
around root of hair follicles function as tactile
receptors to detect movement

WOUND HEALING
The healing of wound occurs in 3 steps
1. Inflammation
2. Proliferation
3. Maturation

1. Inflammation : The cut surfaces become

inflamed, blood clots and cell debris fills the
gap between them in the first few hours.
2. Proliferation : The epithelial cells proliferate
across the clot. The epidermis meets and grows
upwards until the full thickness is restored.
Granulation tissue consisting of new capillary
buds, phagocytes and fibroblasts develop. The
fibroblasts continue to secrete collagen fibers
as the clot and any bacteria are removed by
phagocytosis.
3. Maturation : The granulation tissue is replaced
by fibrous scar tissue.
The healing is described to be of two types : a) primary
healing and b) secondary healing. The primary healing
follows minimal destruction of tissue when the damaged
edges of wound are in close opposition The secondary
healing follows destruction of a large amount of tissue.
SKIN BURNS :
The skin burns are generally caused by heat, electricity
or chemicals. The skin burns are classified as first
degree, second degree or third degree based on their
severity.

First degree burns

- Destroys only epidermis
- Presenting symptoms are : redness, pain and
oedema
- shedding of surface layer a few days later
- Heals in 3-4 days.

Second degree burn

- Involves epidermis and part of dermis
- Blisters appear
- Heals completely within few weeks

Third degree burn

- Destroys both epidermis and dermis
completely and frequently some of the
underlying muscle
- Skin appears waxy or charged
- Are insensitive to touch
- Wounds develop
- Heals by forming scar tissue
- Requires skin grafting to promote healing.

Major burns include : a ) third degree burns involving

10% of the body surface, or (b) second degree burns
involving over 25% of the body surface.
ESTIMATION OF SURFACE AREA OF SKIN :

The total surface area of the skin covering the entire

body is 1.5-2.0 sq.m. The estimation of the percentage of
surface area damaged in case of burns is important in
treating the patient with intravenous fluid which replaces
the fluids lost from tissue damage.
Rule of nine : This rule is a quick means of estimating
the surface area affected by burn.

Region of the body % of the surface area

of the skin
1. Head and neck 9 (41/2 + 41/2)
2. Right upper limb 9 (41/2 + 41/2)
3. Left upper limb 9 (41/2 + 41/2)
4. Anterior surface of the trunk 18 (9 x 2)
5. Posterior surface of the trunk 18 (9 x 2)
6. Right lower limb 18 (9 + 9)
7. Left lower limb 18 (9 + 9)
8. Perineum 1
Total 100

SUPERFICIAL FASCIA
It is subcutaneous layer of loose areolar tissue
which unites dermis of skin to the underlying deep
fascia. It is heavily infiltrated with fat. The amount of fat
varies in different parts of body. The supericial fascia
acts as distributing layer in which blood vessels
lympathic and nerves can travel before entering the
dermis. It almost present everywhere in body contains fat
except in the : Superficial fascia in suprapubic
Eyelids region of the anterior abdomen
wall is unique in the sense that it
External ear differenciate in two layers :
Penis -Superficial fatty layer called
Scrotum Camper’s fascia.
- Deep membranous layer called
Scarpa’s fascia
 Flexion creases of the digits
Amount of fat in superficial fascia is more in
females and children. The fat being a bad conductor of
heat, female and children feel less cold, it is main factor
responsible for smooth contours of the females.
Special fat deposit at certains sites in womens form
their secondary sexual characteristics.
These sites are –
4. Gluteal and lumbar region
5. Front of high
6. Anterior abdomen wall below the navel
7. Breasts
8. Post-deltoid region
9. Cervical thoracic region

Functions of Superficial Fascia

10. Forms an insulating layer deep to skin.
11. Responsible for smooth external contours
of females and children
12. Allows mobility of the skin on the
underlying structures.
13. provides easy passage to nerve, vessels
and lymphatics.
14. Acts as cushion at certain sites.

DEEP FASCIA :
The deep fascia is a tough , inelastic membrane of
fibrous tissue which encloses the body deep to
subcutaneous tissue. It keeps the soft tissues in place and
maintains the shape of body.

In the neck it forms 3 layers

 1. General investing layer, which encloses the
structures of neck like a collar
2. Pretacheal fascia, which passes in front of the
trachea.
3. Prevertebral fascia, infront of the cervical part of the
vertebral column.

SITES WHERE DEEP FASCIA IS ABSENT

The deep fascia is absent

1. Face
2. Breast
3. Anterior abdominal wall
4. Penis and scrotum

Nerve supply of Deep fascia

The deep fascia is very sensitive. Its nerve supply is
derived from :

1. Nerves supplying overlapping skin.

2. Nerves supplying enclosed muscles.