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CHAPTER 4 the Integumentary System

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CHAPTER 4 the Integumentary System CHAPTER 4 The Integumentary System LEARNING OBJECTIVES Upon completion of this chapter, you should be able to: • Name the two layers of the skin. • Name the accessory structures of the integumentary system. • Build and pronounce medical terms of the integumentary system. • Name the disorders and treatments relating to the integumentary system. • Name the major classifi cations of pharmacologic agents used to treat skin disorders. • Analyze and defi ne the new terms introduced in this chapter. • Interpret abbreviations associated with the integumentary system. 53 54 PART TWO • BODY SYSTEMS Introduction The largest organ of the body is the skin. The skin covers the entire body—more than 20 square feet on average—and weighs about 24 pounds. It is part of the integumentary system, which also includes the accessory structures: hair, nails, and sebaceous (oil) and sudoriferous (sweat) glands. Integumentum is Latin for “covering” or “shelter.” The physician who specializes in the diag- nosis and treatment of skin disorders is called a dermatologist (dermat/o being one of the com- bining forms for skin). Coupling the root dermat/o with the previously learned suffi x -logy gives us the term dermatology , which is the term for the specialty practice that deals with the skin. Word Elements The major word elements that relate to the integumentary system consist of various anatomical components, accessory structures, colors of the skin, and abnormal conditions. The Word Ele- ments table lists many of the roots, their meanings, and examples associated with the integu- mentary system. Word Elements • Integumentary System WORD ELEMENT MEANING EXAMPLE albin/o white albinism cirrh/o, jaund/o, xanth/o yellow cirrhosis, jaundice, xanthoderma cutane/o skin cutaneous cyan/o blue cyanosis -cyte, cyt/o cell melanocyte derm/o, dermat/o skin dermatitis epi- upon epidermal erythr/o red erythema ichthy/o dry, scaly (fi sh-like) ichthyosis kerat/o horn-like keratosis leuk/o white leukoderma melan/o black melanoma myc/o fungus dermatomycosis onych/o nail onychophagia pil/o hair pilonidal scler/o hardening scleroderma seb/o sebum seborrhea sub- below subcutaneous sudor/i sweat sudoriferous xer/o dry xeroderma CHAPTER 4 • THE INTEGUMENTARY SYSTEM 55 Structure and Function The skin consists of two layers, the epidermis (epi- is a prefi x meaning “on” or “over”) and dermis . Beneath the skin (epidermis and dermis) is a layer of connective tissue called the sub- cutaneous layer. (Sub- is a prefi x meaning “beneath” or “under”; cutane/o is another root for skin; and -ous is an adjective suffi x meaning “pertaining to.”) This layer is composed of adipose or fatty tissue. The subcutaneous layer is important because it connects the dermis to the muscles and organs beneath it (Fig. 4-1). The epidermis is composed of several thin sublayers of epithelial (adjective form of epithelium ) tissues. There are no blood vessels or nerves in epithelial tissues. The epidermis provides a protective covering for the entire body. The deepest layer of the epidermis contains special cells called melanocytes (melan/o is a root word meaning “pigment,” and -cyte is a suf- fi x meaning “cell”). These cells produce a pigment called melanin , which gives the skin its color and also protects against sunlight. The dermis or corium (another term for dermis) is the thick layer of tissue just below the epidermis. It contains blood vessels, nerves, and a few of the accessory structures: hair follicles and sebaceous and sudoriferous glands. The blood vessels in the dermis provide nourishment to the skin and help maintain temperature control. The nerves in this layer receive sensory impulses that enable the body to recognize pain, touch, heat, cold, and pressure. Nerve endings Hair Epidermis Dermis (corium) Sebaceous (oil) gland Sudoriferous (sweat) gland Subcutaneous layer Artery Nerve Vein Adipose Hair follicle tissue FIGURE 4-1 Cross-section of the skin. The three layers of the skin: epidermis (epi- is a prefi x meaning “upon” or “on top”; dermis is a root for skin), dermis or corium, and the subcutaneous layer (sub- is a prefi x meaning “under”; cutane is a root meaning “skin”). Modifi ed from Cohen BJ, Taylor J. Memmler’s Structure and Function of the Human Body, 8th Ed. Baltimore: Lippincott Williams & Wilkins, 2005. 56 PART TWO • BODY SYSTEMS The hair follicles produce hair that is dis- Free edge Nail plate Lunula Cuticle tributed over much of the body. The fi bers of the hair are composed of a hard protein called keratin (kerat/o means “keratin” or “hard, horn-like”). Like skin, hair color is determined by the pigment melanin, which was described earlier as being produced from special cells called melanocytes. These melanocytes sur- round the hair shaft, and when a small quan- tity of melanin is produced, the hair color is lightly colored or blonde. Production of larger quantities contributes to darker hair. Gray hair, the result of diminished or no production of melanin, frequently occurs as people age. FIGURE 4-2 Superior view of a nail. The cu- ticle is the thin band of tissue that seals the The sebaceous or oil glands are close- nail plate to the skin. From Cohen BJ, Taylor ly associated with the hair follicles. These J. Memmler’s Structure and Function of the glands secrete sebum , an oily fl uid, into the Human Body, 8th Ed. Baltimore: Lippincott hair shaft. The sebum moves along the shaft Williams & Wilkins, 2005. toward the surface of the epidermis and pro- vides lubrication to the skin and hair. The sudoriferous glands are found over most of the body but are most numerous in the palms of the hands, soles of the feet, forehead, and armpits. These glands secrete a watery fl uid that evapo- rates and helps cool the body. The nails, also accessory structures of the integumentary system, are composed of the protein keratin. A nail is a hard plate that covers the dorsal surface of the last bone of each toe and fi nger and offers protection from injury. Besides providing protection, the fi nger- nails aid the fi ngertips in picking up small objects. The free edge of the nail is the part that extends beyond the tip of the fi nger or toe. The nail plate rests on the fi nger; the lunula (which means “half moon”) is the pale half-moon–shaped region at the proximal end of the nail; and the cuticle ( cutis is the Latin word for skin) is the thin band of tissue that seals the nail plate to the skin (Fig. 4-2). Disorders and Treatments DISORDERS The skin is the only system that can be observed in its entirety for abnormalities and disease. It can provide clues to underlying disease in the body and refl ect the state of its own health. Such clues consist of changes in skin color, turgor (the distension and displacement of fl uid in the skin), lesions , and eruptions. Skin Lesions A lesion is a wound or other injury to the skin. It can be caused by systemic diseases; underlying infections; exposure to bacteria, fungi, viruses, and parasites; or an allergic reaction to food or drugs. Lesions can be categorized as fl at, elevated, or depressed. There are numerous types of lesions, each having its own medical term, as shown in the following list: Flat lesions: • Macule: Flat, colored spot less than 1 cm in diameter (e.g., freckle). • Plaque: Flat or lightly raised lesion more than 1 cm in diameter. Elevated lesions: • Bulla: Raised, fl uid-fi lled lesion or blister greater than 1 cm (e.g., severe poison oak). • Nodule: Solid, raised lesion larger than a papule, 0.6 to 2 cm in diameter (e.g., small tumor). • Papule: Small, circular, solid elevation of the skin less than 1 cm in diameter (e.g., wart, pimple). CHAPTER 4 • THE INTEGUMENTARY SYSTEM 57 • Pustule: Small, circular, pus-fi lled el- evation of the skin, usually less than 1 cm in diameter (e.g., pustular psoria- sis or scabies) . • Vesicle: Small, circular, fl uid-fi lled el- evation of the skin less than 1 cm (e.g., Bulla Fissure poison ivy, chickenpox) . • Wheal: Smooth, rounded, slightly raised area often associated with itching (e.g., hives, insect bites) . Depressed lesions: • Fissure: Crack or break in the skin; a slit of any size . • Ulcer: An open sore or crater that Macule Nodule extends to the dermis resulting from de- struction of the skin; usually heals with scarring (e.g., pressure or bed sore) . These common types of lesions are illus- trated in Figure 4-3. Infl ammatory Disorders Papule Plaque There are numerous types of skin disorders that are characterized by the infl ammatory process. Contact dermatitis (dermat/o means “skin”; -itis means “infl ammation”) can be caused by exposure to an allergen or by direct contact with a chemical or plant. Poison ivy, for example, may be the diagnosis when the skin becomes Pustule Ulcer erythematous (erythemat/o means “redness”; -ous means “pertaining to”), is covered with tiny vesicles, and is often itchy or pruritic (prurit/o means “to itch”; -ic is the adjective suffi x that means “pertaining to”; the noun is pruritus ; the suffi x -us means “condition”). Eczema is a type of chronic dermatitis that may begin in childhood and progress through Vesicle Wheal adulthood (Fig. 4-4). This disorder is character- FIGURE 4-3 Skin lesions. Illustrations of some of ized by red, vesicular lesions that are crusted and the more common skin lesions. From Cohen BJ. Medical Terminology: An Illustrated Guide, 5th Ed. pruritic. Another common chronic infl ammatory Philadelphia: Lippincott Williams & Wilkins, 2007. condition is psoriasis ( psor is French meaning “to itch”; -iasis means “a condition or process”) (Fig.
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