Module 20: The Integumentary System

Lesson 1: Layers of the Skin

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Dưới đây là danh sách những thuật ngữ Y khoa của module The Integumentary System.
Khái quát được số lượng thuật ngữ sẽ xuất hiện trong bài đọc và nghe sẽ giúp bạn thoải mái tiêu thụ nội dung hơn. Sau khi hoàn thành nội dung đọc và nghe, bạn hãy quay lại đây và luyện tập (practice) để quen dần các thuật ngữ này. Đừng ép bản thân phải nhớ các thuật ngữ này vội vì bạn sẽ gặp và ôn lại danh sách này trong những bài học (lesson) khác của cùng một module.

Medical Terminology: The Integumentary System

acne
skin condition due to infected sebaceous glands
albinism
genetic disorder that affects the skin, in which there is no melanin production
anagen
active phase of the hair growth cycle
apocrine sweat gland
type of sweat gland that is associated with hair follicles in the armpits and genital regions
arrector pili
smooth muscle that is activated in response to external stimuli that pull on hair follicles and make the hair “stand up”
basal cell
type of stem cell found in the stratum basale and in the hair matrix that continually undergoes cell division, producing the keratinocytes of the epidermis
basal cell carcinoma
cancer that originates from basal cells in the epidermis of the skin
bedsore
sore on the skin that develops when regions of the body start necrotizing due to constant pressure and lack of blood supply; also called decubitis ulcers
callus
thickened area of skin that arises due to constant abrasion
catagen
transitional phase marking the end of the anagen phase of the hair growth cycle
corn
type of callus that is named for its shape and the elliptical motion of the abrasive force
cortex
in hair, the second or middle layer of keratinocytes originating from the hair matrix, as seen in a cross-section of the hair bulb
cuticle
in hair, the outermost layer of keratinocytes originating from the hair matrix, as seen in a cross-section of the hair bulb
dermal papilla
(plural = dermal papillae) extension of the papillary layer of the dermis that increases surface contact between the epidermis and dermis
dermis
layer of skin between the epidermis and hypodermis, composed mainly of connective tissue and containing blood vessels, hair follicles, sweat glands, and other structures
desmosome
structure that forms an impermeable junction between cells
eccrine sweat gland
type of sweat gland that is common throughout the skin surface; it produces a hypotonic sweat for thermoregulation
eczema
skin condition due to an allergic reaction, which resembles a rash
elastin fibers
fibers made of the protein elastin that increase the elasticity of the dermis
eleiden
clear protein-bound lipid found in the stratum lucidum that is derived from keratohyalin and helps to prevent water loss
epidermis
outermost tissue layer of the skin
eponychium
nail fold that meets the proximal end of the nail body, also called the cuticle
external root sheath
outer layer of the hair follicle that is an extension of the epidermis, which encloses the hair root
first-degree burn
superficial burn that injures only the epidermis
fourth-degree burn
burn in which full thickness of the skin and underlying muscle and bone is damaged
glassy membrane
layer of connective tissue that surrounds the base of the hair follicle, connecting it to the dermis
hair
keratinous filament growing out of the epidermis
hair bulb
structure at the base of the hair root that surrounds the dermal papilla
hair follicle
cavity or sac from which hair originates
hair matrix
layer of basal cells from which a strand of hair grows
hair papilla
mass of connective tissue, blood capillaries, and nerve endings at the base of the hair follicle
hair root
part of hair that is below the epidermis anchored to the follicle
hair shaft
part of hair that is above the epidermis but is not anchored to the follicle
hypodermis
connective tissue connecting the integument to the underlying bone and muscle
hyponychium
thickened layer of stratum corneum that lies below the free edge of the nail
integumentary system
skin and its accessory structures
internal root sheath
innermost layer of keratinocytes in the hair follicle that surround the hair root up to the hair shaft
keloid
type of scar that has layers raised above the skin surface
keratin
type of structural protein that gives skin, hair, and nails its hard, water-resistant properties
keratinocyte
cell that produces keratin and is the most predominant type of cell found in the epidermis
keratohyalin
granulated protein found in the stratum granulosum
Langerhans cell
specialized dendritic cell found in the stratum spinosum that functions as a macrophage
lunula
basal part of the nail body that consists of a crescent-shaped layer of thick epithelium
medulla
in hair, the innermost layer of keratinocytes originating from the hair matrix
Meissner corpuscle
(also, tactile corpuscle) receptor in the skin that responds to light touch
melanin
pigment that determines the color of hair and skin
melanocyte
cell found in the stratum basale of the epidermis that produces the pigment melanin
melanoma
type of skin cancer that originates from the melanocytes of the skin
melanosome
intercellular vesicle that transfers melanin from melanocytes into keratinocytes of the epidermis
Merkel cell
receptor cell in the stratum basale of the epidermis that responds to the sense of touch
metastasis
spread of cancer cells from a source to other parts of the body
nail bed
layer of epidermis upon which the nail body forms
nail body
main keratinous plate that forms the nail
nail cuticle
fold of epithelium that extends over the nail bed, also called the eponychium
nail fold
fold of epithelium at that extend over the sides of the nail body, holding it in place
nail root
part of the nail that is lodged deep in the epidermis from which the nail grows
Pacinian corpuscle
(also, lamellated corpuscle) receptor in the skin that responds to vibration
papillary layer
superficial layer of the dermis, made of loose, areolar connective tissue
reticular layer
deeper layer of the dermis; it has a reticulated appearance due to the presence of abundant collagen and elastin fibers
rickets
disease in children caused by vitamin D deficiency, which leads to the weakening of bones
scar
collagen-rich skin formed after the process of wound healing that is different from normal skin
sebaceous gland
type of oil gland found in the dermis all over the body and helps to lubricate and waterproof the skin and hair by secreting sebum
sebum
oily substance that is composed of a mixture of lipids that lubricates the skin and hair
second-degree burn
partial-thickness burn that injures the epidermis and a portion of the dermis
squamous cell carcinoma
type of skin cancer that originates from the stratum spinosum of the epidermis
stratum basale
deepest layer of the epidermis, made of epidermal stem cells
stratum corneum
most superficial layer of the epidermis
stratum granulosum
layer of the epidermis superficial to the stratum spinosum
stratum lucidum
layer of the epidermis between the stratum granulosum and stratum corneum, found only in thick skin covering the palms, soles of the feet, and digits
stratum spinosum
layer of the epidermis superficial to the stratum basale, characterized by the presence of desmosomes
stretch mark
mark formed on the skin due to a sudden growth spurt and expansion of the dermis beyond its elastic limits
sudoriferous gland
sweat gland
telogen
resting phase of the hair growth cycle initiated with catagen and terminated by the beginning of a new anagen phase of hair growth
third-degree burn
burn that penetrates and destroys the full thickness of the skin (epidermis and dermis)
vitamin D
compound that aids absorption of calcium and phosphates in the intestine to improve bone health
vitiligo
skin condition in which melanocytes in certain areas lose the ability to produce melanin, possibly due an autoimmune reaction that leads to loss of color in patches
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Dưới đây là các bài văn nằm ở bên trái. Ở bên phải là các bài luyện tập (practice) để đánh giá khả năng đọc hiểu của bạn. Sẽ khó khăn trong thời gian đầu nếu vốn từ vựng của bạn còn hạn chế, đặc biệt là từ vựng Y khoa. Hãy kiên nhẫn và đọc nhiều nhất có kể, lượng kiến thức tích tụ dần sẽ giúp bạn đọc thoải mái hơn.
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 1). 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.
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 2).

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 3).

A. 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 4).

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 a melanocyte, 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.

B. 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). 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.

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.

C. 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 4). 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.

D. 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 4). These cells are densely packed with eleidin, a clear protein, derived from keratohyalin, which gives these cells their transparent (i.e., lucid) appearance.

E. Stratum Corneum

The stratum corneum is the most superficial layer of the epidermis and is the layer exposed to the outside environment (See Figure 4). 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.
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 (See Figure 6).

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 6). 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.

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.
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.
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 (See Figure 7).

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 (See Figure 8).

OpenStax. (2022). Anatomy and Physiology 2e. Rice University. Retrieved June 15, 2023. ISBN-13: 978-1-711494-06-7 (Hardcover) ISBN-13: 978-1-711494-05-0 (Paperback) ISBN-13: 978-1-951693-42-8 (Digital). License: Attribution 4.0 International (CC BY 4.0). Access for free at openstax.org.

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.

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 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)

The epidermis of thick skin has five layers: stratum basale, stratum spinosum, stratum granulosum, stratum lucidum, and stratum corneum.

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)

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)

The relative coloration of the skin depends on the amount of melanin produced by melanocytes in the stratum basale and taken up by keratinocytes.

Moles range from benign accumulations of melanocytes to melanomas. These structures populate the landscape of our skin. (credit: the National Cancer Institute)

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Script:
  1. The skin is made up of two main layers: the outer layer called the epidermis and the inner layer known as the dermis.
  2. Let’s start with the epidermis, which has several layers.
  3. The innermost layer is called the stratum basale (or germinatum), followed by the stratum spinosum, stratum granulosum, and, if present, the stratum lucidum.
  4. Finally, the outermost layer is the stratum corneum, made up of dead cells that regularly shed and are replaced by cells from the basal layer.
  5. The stratum basale also houses melanocytes, responsible for producing melanin, the pigment that gives color to the skin.
  6. Melanin is transferred to keratinocytes in the stratum spinosum to protect cells from UV rays.
  7. Moving on to the dermis, it connects the epidermis to the hypodermis and provides strength and elasticity, thanks to collagen and elastin fibers.
  8. The dermis consists of two layers: the papillary layer with papillae extending into the epidermis, and the lower reticular layer made of loose connective tissue.
  9. Beyond the dermis lies the hypodermis, which connects the dermis to underlying structures.
  10. It also contains adipose tissue for fat storage and protection.
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