The Skin As An Organ at CBC

DR IBEZIM CHIBUCHI PEARL
THE SKIN AS AN ORGAN;

Its primary & secondary lesions
OUTLINE
 Introduction
 Anatomy
 Functions
 Primary Lesions
 Secondary Lesions
 Conclusion
INTRODUCTION
 An organ is a collection of tissues that
structurally form a functional unit specialized to

perform a particular function. Eg. heart,
kidneys, lungs, skin.
 It is made of several types of tissue and
therefore several types of cells.

INTRODUCTION
 The skin is the largest organ of the body, with a
total area of about 20 square feet.

 It is varied in its composition and function.
 Skin lesions are like a stamp with implications of
both cutaneous and systemic

conditions/illnesses.
GROSS ANATOMY
ANATOMY
 Skin has three major layers:
EPIDERMIS
DERMIS
SUBCUTANEOUS LAYER
EPIDERMIS
 The outermost layer of skin.
 Provides a waterproof barrier and creates our skin
tone.
 Varies in thickness depending on the part of the
body.
 Consists of 5 layers – in its order from outermost to
innermost:
EPIDERMIS
1. Stratum corneum: Composed of multiple layers of

dead, highly compacted cells. The cornified layer is
replenished as the oldest or most superficial layer
is shed in a highly regulated process which takes
28 days (from basal cell to shedding of cornified
layer).
EPIDERMIS
2. Stratum lucidium
3. Stratum granulosum: Granular cells contain
keratohyalin and lamellar granules,
containing the protein and lipid components
that make up the cornified layer.
EPIDERMIS
3. Stratum spinosum. composed of 3-4 layers of

spinous cells network which function to synthesize
keratin.
4. Stratum basalis. Serves as a continuing supply of
keratinocytes for the normally differentiating
epidermis and a reservoir of cells to repair
epidermal damage.
CELLS OF THE EPIDERMIS
 Keratinocytes : produce keratin for strength. The
most abundant cell type.

 Melanocyets : contribute to skin colour and
protection from uv radiation. They are derived

from the neural crest and migrate to the skin
during embryonic life
 Langerhan cells: They are dendritic cells of the
mononuclear phagocyte system and are

recognized on electron microscopy by the Birbeck
granule. They are produced in the bone marrow
and participate in immune reactions in the skin.
 Merkel cells: detect light touch and pressure.
They are type I slow-adapting

mechanosensory receptors for touch that
differentiate within the epidermis.
DERMIS
 Lies deep to (beneath) the epidermis.
 It is larger than the epidermis and is made of 2
layers: - Outer papillary layer.

- Inner reticular layer
 The elastin and collagen fibres of the dermis
produce structural strength, the cleavage lines and

stretch marks (striae).
DERMIS
 Within the dermis are blood vessels, lymphatics,
neural structures,eccrine and apocrine sweat

glands, hair follicles, sebaceous glands, and
smooth muscle.
CELLS OF THE DERMIS
 The fibroblasts: predominant dermal cell. It is
spindle-shaped and is responsible for the synthesis

of collagen, elastic fibers, and mucopolysaccharides.
 Phagocytic histiocytes
 Mast cells
 Motile leukocytes
SUBCUTANEOUS LAYER
 Also called hypodermis and is the thickest
layer of the skin.

 Found directly under the dermis.
 It is composed of fat cells and connective
tissue.
 Functions for insulation and storage of energy.
SKIN APPENDAGES
 Glands: - sebaceous
- sudoriferous (sweat)
- ceruminous
- mammary
 Hair: Absent on palms, soles, lips, nipples, parts of
external genitalia and distal segments of fingers &

toes.

FUNCTIONS
 Protection from physical and chemical injury,
microbes and the elements (eg sunlight)

 Sensations of touch, heat, and cold.
 Protection from water loss.
 Preservation of human shape and contour.

FUNCTIONS OF THE SKIN
 Metabolism
-Temperature regulation
-Vitamin D production
-Excretion
-Regulation of pH
-Absorption
-Secretion
-Storage
SKIN LESIONS
 They could be primary or secondary lesions.
 Hence skin lesions should be palpated, inspected,
and classified on the bases of morphology, size,

color, texture, firmness, configuration, location,
and distribution to distinguish them.
SKIN LESIONS
 Secondary lesions are those whose
morphology has been altered by factors like

infection, trauma or treatment.
 Primary lesions may change into secondary
lesions, or secondary lesions may develop over

time where no primary lesion existed
PRIMARY LESIONS
 MACULE is an alteration in skin color but cannot

be felt. It is not raised. When the
 PATCH is a macular lesion which is >1 cm in
dimension.
 PAPULES are palpable (raised) solid lesions <1
cm.
PRIMARY LESIONS
 PLAQUES are palpable lesions >1 cm in size
and have a flat surface.

 NODULES are palpable lesions, >1 cm with a
rounded surface.
 PUSTULES contain purulent material.
PRIMARY LESIONS
 TUMOR may be used for a large nodule that is
suspected to be neoplastic in origin.

 VESICLES are raised, fluid-filled lesions <1 cm in
diameter.
 BULLAE is used when the raised lesion is >1cm
Vessicles/ bullae
PRIMARY LESIONS
 WHEALS are flat-topped, palpable lesions of
variable size, duration, and configuration that

represent dermal collections of edema fluid.
 CYSTS are circumscribed, thick-walled lesions that
are covered by a normal epidermis and contain

fluid or semisolid.
SECONDARY LESIONS
 SCALES consist of compressed layers of stratum
corneum cells that are retained on the skin

surface.
 PURPURA are the result of bleeding into the
skin and have a red-purple color. They may be

flat or palpable.
SECONDARY LESIONS
 PETECHIAE are small purpura <2-3 mm.
 EROSIONS involve focal loss of the epidermis.
They heal without scarring.

 ULCERS extend into the dermis and tend to heal
with scarring.
 FISSURES are caused by splitting or cracking.
SECONDARY LESIONS
 EXCORIATIONS are ulcerated lesions inflicted by
scratching . They are often linear or angular in

configuration .
 CRUSTS consist of matted, retained
accumulations of blood, serum, pus, and epithelial

debris on the surface of a weeping lesion.
SECONDARY LESIONS
 SCARS are end-stage lesions that can be thin,
depressed, and atrophic; raised and

hypertrophic; or flat and pliable.
 LICHENIFICATION is a thickening of skin with
accentuation of normal skin lines that is caused

by chronic irritation (rubbing, scratching) or
inflammation.
COMMON SKIN CONDITIONS
 Rashes: A general term used for nearly any
change in the skin’s appearance mostly from

simple skin irritation or from medical conditions.
 Dermatitis: A general term for inflammation of
the skin. The most common form is atopic

dermatitis.
 Eczema: Skin inflammation (dermatitis) causing an
itchy rash. Most often, it’s due to an overactive

immune system.
 Psoriasis: An autoimmune condition that can cause
a variety of skin rashes. Silver, scaly plaques on the

skin are the most common form.
 Dandruff: A scaly condition of the scalp may
be caused by seborrheic dermatitis, psoriasis,

or eczema.
 Acne: Occurs when the hair follicle becomes
plugged with oil and dead skin. Most

common among teenagers.
 Cellulitis: Inflammation of the dermis and
subcutaneous tissues, usually due to an infection.

Often resulting to a red, warm, painful skin rash.
 Skin abscess (boil or furuncle): A collection of pus
under the skin resulting from a localised skin

abscess.
 Rosacea: A chronic skin condition causing a red
rash on the face and may look like acne.

 Warts: An excessive growth of skin resulting from a
viral infection of the skin.

 Herpes: The herpes viruses HSV-1 and HSV-2 can
cause periodic blisters or skin irritation around the

lips or genitals.
 Viral exanthem: Many viral infections can
cause a red rash affecting large areas of the

skin especially in children.
 Shingles (herpes zoster): A painful rash that
does not cross the midline caused by

varicella.
Shingles
 Hives: Raised, red, itchy patches on the skin
that arise suddenly usually resulting from an

allergic reaction.
 Tinea versicolor: A benign fungal skin
infection creates pale areas of low

pigmentation on the skin.
 Scabies: An intensely itchy rash in the webs
of fingers, wrists, elbows, and buttocks

caused by tiny mites (sarcoptes scabbi) that
burrow into the skin.
 Ringworm: A fungal skin infection (also called
tinea) that creates characteristic rings.

 Seborrheic keratosis: A benign, often itchy
growth that appears like a “stuck-on” wart.

They can be surgically removed.
 Actinic keratosis: A crusty or scaly bump that
forms on sun-exposed skin and may

sometimes progress to cancer.
 Melanoma: The most dangerous type of skin
cancer, result from sun damage and other causes.

A skin biopsy can identify melanoma.
 Basal cell carcinoma: The most common type of
skin cancer. Basal cell carcinoma is less dangerous

than melanoma because it grows and spreads
more slowly.
 Squamous cell carcinoma: A common form of
skin cancer. May begin as an ulcer that won’t

heal, or an abnormal growth. It usually
develops in sun-exposed areas.
CONCLUSION
 The skin as an organ has quite a complex structure.
 Its numerous functions are indispensible in the
proper function of the human body.

 Understanding of the structure, lesions and
functions of the skin is key to taking good care of

it.
REFERENCES
 Nelson Textbook of Paediatrics, 20th and 21st

edition.
 www.slideshare.net, Skin, by Maj Rishi
Pokhrel.
 www.stanfordchildren.org

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DR IBEZIM CHIBUCHI PEARL

THE SKIN AS AN ORGAN;

 An organ is a collection of tissues that

structurally form a functional unit specialized to

therefore several types of cells.

 The skin is the largest organ of the body, with a

total area of about 20 square feet.

 Skin lesions are like a stamp with implications of

both cutaneous and systemic

 Skin has three major layers:

 Provides a waterproof barrier and creates our skin

1. Stratum corneum: Composed of multiple layers of

3. Stratum spinosum. composed of 3-4 layers of

most abundant cell type.

protection from uv radiation. They are derived

 Langerhan cells: They are dendritic cells of the

mononuclear phagocyte system and are

 Merkel cells: detect light touch and pressure.

They are type I slow-adapting

 It is larger than the epidermis and is made of 2

layers: - Outer papillary layer.

produce structural strength, the cleavage lines and

neural structures,eccrine and apocrine sweat

 The fibroblasts: predominant dermal cell. It is

spindle-shaped and is responsible for the synthesis

 Also called hypodermis and is the thickest

layer of the skin.

 It is composed of fat cells and connective

external genitalia and distal segments of fingers &

 Protection from physical and chemical injury,

microbes and the elements (eg sunlight)

 Protection from water loss.

 Preservation of human shape and contour.

 They could be primary or secondary lesions.

 Hence skin lesions should be palpated, inspected,

and classified on the bases of morphology, size,

 Secondary lesions are those whose

morphology has been altered by factors like

lesions, or secondary lesions may develop over

 MACULE is an alteration in skin color but cannot

 PLAQUES are palpable lesions >1 cm in size

and have a flat surface.

 TUMOR may be used for a large nodule that is

suspected to be neoplastic in origin.

variable size, duration, and configuration that

are covered by a normal epidermis and contain

corneum cells that are retained on the skin

skin and have a red-purple color. They may be

 EROSIONS involve focal loss of the epidermis.

They heal without scarring.

 EXCORIATIONS are ulcerated lesions inflicted by

scratching . They are often linear or angular in

accumulations of blood, serum, pus, and epithelial

depressed, and atrophic; raised and

accentuation of normal skin lines that is caused

 Rashes: A general term used for nearly any

change in the skin’s appearance mostly from

the skin. The most common form is atopic