Integumentary System
The Skin
Introduction
Called a membrane because it covers
the body
Also called organ because it contains
several kinds of tissues
Most studies call it a system because
it has organs and other parts that
work together for a particular
function
Did you know?
 On an average adult the skin covers more than 3000
square inches of surface area and accounts for about
15% of total body weight
 1 square centimeter of skin contains: 15 sebaceous
glands, 1 yard of blood vessels, 700 sweat glands, 3000
sensory cells at the end of nerve fibers, 4 yards of
nerves, 25 pressure apparatus for the perception of
tactile stimuli, 200 nerve endings to record pain, 2
sensory apparatuses for cold, 12 sensory apparatuses
for heat, 3,000,000 cells, and 10 hairs.
Layers of the Skin
 Epidermis: Outermost layer of skin, made of 5-6
smaller layers; epithelial cells
 Two main layers: Stratum corneum: outermost
layer where cells constantly shed; cells have keratin
which makes them waterproof; first line of defense
against bacteria; thickest on palms and soles
 Stratum germinativum: (reproductive layer)
provides cells to replace cells in strata corneum
 Contains no blood vessels or nerve cells (avascular)
 Contains melanocytes that contain melanin
 Contains Keratin, a fibrous water repellent protein
Dermis
Also call dorium or true skin
Has framework of elastic connective
tissue
Contains blood vessels (vascular),
blood and lymph vessels, nerves,
involuntary muscle, sweat and oil
glands and hair follicles
Top of the Dermis
Covered with papillae
Fit into ridges on the stratum
germinativum of the epidermis
Ridges form lines or striations on the skin
Pattern of ridges is unique for each
individual- pattern is used for
finger/footprints, used for identification
Glands of skin
 Sebaceous glands: Oil glands
 Usually open onto hair follicle
 Produce oil called sebum, which keeps hair from
becoming dry and brittle, pimples occur when
clogged with dirt and oil
 Antibacterial and antifungal properties due to
slight acidity of sebum
 Arrector pili muscle – smooth muscle attached to
follicle; causes “goosebumps”
Glands of skin
Sudoriferous glands: Sweat glands
Coiled tubes that extend through dermis
Open on surface of the skin at an opening called
a pore
Sweat contains water, salt, and some body
wastes
Sweat is odorless, body odor occurs when the
sweat interacts with bacteria on the skin
Subcutaneous fascia or
hypodermis
Innermost layer of skin
Made of elastic and fibrous
connective tissue and adipose
(fatty tissue)
Connects skin to underlying
muscles
Other parts of the skin
Hair: consists of a root that grows in a
hollow tube called a follicle, and a hair
shaft, helps protect the body, covers all
body surfaces except for the palms of the
hands and soles of the feet
Alopecia or baldness: permanent loss of
hair on the scalp, genetic condition,
usually in men
Nails
Protect the fingers and toes from injury
Made of dead keratinized epidermal
epithelial cells, which are packed closely
together to form a thick dense surface
Cells formed in nail bed
Cells can be replaced if lost if nail bed is
not damaged
Functions of the
Integumentary System
Protection
Sensory perception
Regulation of body temperature
Storage
Absorption
Excretion
Production
Protection:
Barrier for sun’s ultraviolet rays
Protects against invasion of
pathogens or germs
Holds moisture in and prevents
deeper tissues from drying out
Sensory perception:
Nerves present in skin
Respond to pain, pressure,
temperature (heat and cold), and
touch sensations
Regulation of body
temperature :
Blood vessels in skin help body retain or
lose heat
Dilate: blood vessels get larger and allow
excess heat to escape through the skin
Constrict: blood vessels get smaller and
retain heat
Sudoriferous (sweat) glands also help cool
body through evaporation of perspiration
Storage:
Skin has tissues for temporary
storage of fat, glucose (sugar),
water, vitamins, and salts
Stores adipose tissue in the
subcutaneous fascia, which is a
source of energy
Absorption:
Certain substances absorbed through
skin, but limited
Examples: medication for motion
sickness (gel), ointments and creams,
and heart patches, nicotine patches
to stop smoking, pain medicine
patches. Transdermal medications
are sticky patches placed on the skin
Excretion:
Helps body eliminate salt, a
minute amount of waste, and
excess water
Done through perspiration or
sweat
Production:
Skin helps produce vitamin D
Uses ultraviolet rays from the
sun to form an initial molecule of
vitamin D that matures in the
liver
Pigmentation
Melanin and Carotene determine skin color
Melanin – brownish-black pigment; leads to a
black, brown, or yellow skin tint, depending on
racial origin; absorbs UV rays to tan the skin;
small concentrated areas form freckles
Carotene – yellowish-red pigment; helps
determine skin color
Albino- lack of pigmentation; skin has pinkish
tint and hair is pale yellow or white; eyes also
lack pigment and are red in color and very
sensitive to light
Abnormal colors of the skin can indicate disease
 Erythema – reddish color of skin; causes can be
burns, congestion of blood in the vellels
 Jaundice – yellow discoloration of the skin; causes
can be bile in the blood from liver or gallbladder
disease, also associated with diseases that involve
the destruction of red blood cells
 Cyanosis – bluish discoloration of the skin; caused
by insufficient oxygen; may be associated with
heart lung, circulatory diseases
 Chronic poisoning may cause a gray or brown skin
discoloration
REVIEW
Epidermis:
Dermis:
Hypodermis:
Functions
 1.
 5.
 2.
 6.
 3.
 7.
 4.
Skin Eruptions: Ulcers
Also known as decubitus ulcers,
pressure ulcers, or bed sores.
Localized areas of necrosis that
develop when soft tissue is
compressed between a bony
prominence and an external surface
for a prolonged period of time
Most common pressure
points:
Sacrum
heels
Elbows
Nose, ear and genitalia from
tubes(catheters)
Any shearing force..
Which is the force that stretches the skin
during turning or moving in bed,
decreases blood flow.
Guidelines to prevent:
Adequate nutrition is important. A diet
high in protein with enough calories,
vitamins and minerals.
Frequently turn and position client to
relieve pressure. Turn every 1 to 2 hours.
Use specialized beds and mattresses to
distribute pressure on dependent body
parts
Assessing Damage
Pressure ulcer staging systems are
based on the depth of the tissue
destroyed. If the nurse cannot see
the bottom of the sore, staging
cannot be done.
Four Stages of Pressure
Sores
Stage 1
Stage 2
Nonblanchable
erythema of intact
skin.
May also have
warmth, edema,
induration or
hardness
Partial thickness
skin loss involving
epidermis and/or
dermis
Ulcer is superficial
and presents as a
blister, abrasion or
shallow crater
Stages, cont.
Stage 3
Stage 4
Full thickness skin Full thickness skin
loss involving
loss with extensive
damage of
destruction,
subcutaneous
damage to muscle,
tissue that may
bone, or
extend to fascia
supporting
structures
Presents as a deep
crater
Pictures of pressure ulcers
More pictures…
Risk Assessment
Early identification of at risk patients.
High risk/at risk patients include
clients with neurological impairment,
chronically ill long term care clients,
and orthopedic clients.
Treatment
Stages 1, 2 and 3 : Local treatment:
wound care, saline often used.
Occlusive dressings.
Use clean technique.
Stage 4: May involve surgery
Other skin eruptions:
Macules – ex. freckles (ephelides)
Papules – ex. Pimples
Vesicles- ex. Blisters and Chicken pox
Pustules – ex. Pimples, ant bites
Crusts- ex. “scabs”, made up of dried pus
and blood
Wheals- ex. Hives and insect bites
Nodules – ex. a cyst / a small solid bump
Medical Terminology –
AMelan/o
-cyte
Germin/o
Sudor/I
Seb/o
Hypo
Derm, dermat/o
Lip/o
Adip/o
Tact/i
Diseases and Abnormal
Conditions
 Acne Vulgaris – inflammation of the sebaceous
glands
Cause unknown, but usually occurs at
adolescence. Hormonal changes and increased
secretion of sebum are probably underlying
causes
Symptoms: papules, pustules, and blackheads
Treatment: frequent, thorough washing,
avoidance of creams and heavy makeup,
antibiotic or vitamin A ointments, oral
antibiotics, and/or ultraviolet light treatments
Athlete’s foot- contagious fungal
infection that usually affects the feet
Symptoms: itching, blisters, and cracks
that turn into open sores
Treatment: antifungal medication and
keeping the area clean and dry
Contagious
Athlete’s foot
Skin Cancer- most common type of
cancer. There are 3 main types:
Basal cell- cancer of basal cells in
epidermis of skin. Slow growing and does
not usually spread. Lesions can be pink to
yellow-white. They are usually smooth
with a depressed center and an elevated,
irregular-shaped border
Basal cell
Squamous cell- affects thin cells of the
epithelium but can spread quickly to other
areas of the body. Lesions start as small,
firm, red, flat sores that later scale and
crust. Sores that don’t heal are frequently
squamous cell carcinomas.
Squamous cell
Melanoma- develops in the melanocytes
of the epidermis and is the most
dangerous type of skin cancer. The
lesions can be brown, black, pink, or
multicolored. They are usually flat or
raised slightly, asymmetric and irregular
or notched on the edges.
melanoma
Skin cancer often develops from a mole or
nevus that changes in color, shape, size,
or texture. Bleeding or itching of a mole
can also indicate cancer. Exposure to the
sun, prolonged use of tanning beds,
irritating chemicals, or radiation are the
usual causes of skin cancer. Treatment
involves surgical removal of the cancer,
radiation, and/or chemotherapy.
 Dermatitis- inflammation of the skin. Can be
caused by any substance that irritates the skin
and is frequently an allergic reaction to
detergents, cosmetics, pollen, or certain foods.
Ex. Poison ivy, poison oak, poison sumac
Symptoms: dry skin, erythema, itching, edema,
macular-papular rashes, and scaling
Treatment: eliminating the cause, antiinflammatory ointments, antihistamines, and/or
steroids also used
dermatitis
Eczema- noncontagious, inflammatory
skin disorder caused by an allergen or
irritant. Diet, cosmetics, soaps,
medications, and emotional stress can all
cause eczema.
Symptoms: dryness, erythema, edema,
itching, vesicles, crusts, and scaling
Treatment: removing the irritant,
application of corticosteroids to reduce
the inflammatory response
eczema
Impetigo- highly contagious, skin infection
usually caused by streptococci or
staphylococci organisms
Symptoms: erythema, oozing vesicles,
pustules, and the formation of a yellow
crust
Wash lesions with soap and water and
keep dry.
Treatment: antibiotics (oral and topical)
impetigo
 Psoriasis- chronic, noncontagious skin disease
with periods of exacerbations and remission.
Exact cause unknown, but is an immune
disorder. Scientists believe the immune system
mistakenly activates a reaction in the skin cells,
which speeds up the growth cycle of skin cells.
Stress, cold weather, sunlight, pregnancy, and
endocrine changes tend to cause an
exacerbation of the disease
Symptoms: thick, red areas covered with
white or silver scales
No cure, but treatment includes: coal/tar
or cortisone ointments, ultraviolet light,
and/or scale removal
psoriasis
Ringworm- highly contagious fungal
infection of the skin or scalp
Characteristic symptom- formation of a
flat or raised circular area with a clear
central area surrounded by an itchy, scaly,
or crusty outer ring
Treatment: antifungal medicines, both
oral and topical, are used
ringworm
Verrucae, or warts- viral infection of the
skin
Plantar warts usually occur at pressure
points on the sole of the foot. A rough,
hard, elevated, rounded surface forms on
the skin
Treatment: some may disappear
spontaneously, but others must be
removed with electricity, liquid nitrogen,
acid, chemicals, or laser
Sebaceous cyst
Cyst of a sebaceous (oil) gland that
contains yellow, fatty material
Commonly found on face, neck, and trunk
Benign, can cause problems with become
large; can be painful; can become
infected
Surgically removed, can return if all of
“sac” not removed
Boil
A boil, also known as a furuncle is a skin
abscess, a painful bump that forms under
the skin - it is full of puss. A carbuncle is
collection of boils that develop under the
skin. When bacteria infect hair follicles
they can swell up and turn into boils.
Cause: bacteria infect hair follicles
Treatment: hot packs and lancing
Petechiae
pinpoint, round spots that appear on the
skin as a result of bleeding under the skin
Caused from capillaries bleeding into the
skin
Usually indicate another problem
Possible causes: disruption of blood
clotting mechanisms; thrombocytopenia
(low platelet count); side effect of some
drugs; leukemia; lupus; measles;
mononucleosis; rheumatoid arthritis;
vitamin K deficiency (infants)
Cellulitis
A type of bacterial skin infection; appears
as a swollen, red area of skin that feels
hot and tender, and it may spread rapidly
More commonly affects lower legs
Can spread to blood and lymph systems,
causing systemic life threatening infection
Lupus erythematosus
chronic inflammatory disease that occurs
when your body's immune system attacks
your own tissues and organs
(autoimmune). Inflammation caused by
lupus can affect many different body
systems, including your joints, skin,
kidneys, blood cells, heart and lungs
More common in women
Some people often have a characteristic
butterfly-shaped rash on bridge of nose
and cheeks
Pediculosis (lice)
tiny, wingless, parasitic insects that feed
on your blood. Lice are easily spread
through close personal contact and by
sharing belongings.
Lice can appear on scalp, body, pubic
area
s/s : itching; tingling feeling; small red
bumps; visible lice or eggs
Scabies
a condition of very itchy skin caused by
tiny mites that burrow into your skin
Spread by close contact with someone
who has scabies. Scabies can also be
spread by sharing towels, bed sheets, and
other personal belongings.
Direct skin to skin contact
Treatment: scabicide drug (Elimite
(permethrin)
Keloid
raised growth of fibrous scar tissue that
forms over an area of trauma to the skin
and extends beyond the area of the
original injury.
more common in young women and
African Americans.
Scar tissue normally grows in response to
a wound, but a keloid is an overgrowth of
scar tissue over a healed wound
Chloasma (melasma)
brownish pigmentation on the face that
develops slowly and fades with time. The
pigmentation is due to overproduction of
melanin by the pigment cells,
melanocytes.
Usually seen in women; more common in
people that tan well or have naturally dark
skin
Causes: genetic predisposition;
pregnancy; contraceptives; sun exposure;
unknown
Birthmarks
Port wine stain: large, reddish purple
discoloration of the face or neck; laser
treatment
Strawberry hemangioma: soft, raised
birthmark; dark, reddish purple growth is
a benign tumor of newly formed blood
vessels; usually resolve by 7 yoa but can
be treated; benign but can be disfiguring
Hives (urticaria)
Skin condition characterized by localized
swelling accompanied by itching that is
associated with an allergic reaction
 urtic – rash
Aria – means connected with
Treatment: steroid creams, antihistamines