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  • ● Integumentary simply means “covering” or “enclosing.”
  • ● The epidermis can absorb fat-soluble substances. ● Only substances that are soluble in both lipids and water can penetrate both the epidermis and dermis. ● Common chemicals that meet this criterion include organic (i.e., carbon-containing) solvents such as paint thinner; benzene, a carcinogenic component of gasoline; mercury, which is no longer permitted in nonprescription thermometers; and nicotine, a culprit in many throat, mouth, and tongue cancers.
  • ● A dermal-epidermal junction helps glue these two regions together.
  • ● How do skin cells die naturally? The formation of new layers of cells pushes existing cells of the epidermis upward. As the cells move further away from their source of nutrition, they starve and die.
  • ● What is the dual purpose of the waterproofing properties of the keratinocytes? Their purpose is to keep water in and to keep water out.
  • ● Vitiligo can be genetic or the result of trauma, such as a burn or scar, that has damaged the melanocytes. Vitiligo is the disease that Michael Jackson is said to have. ● The hair that grows in areas affected by vitiligo usually turns white also.
  • ● What is another name for the layers of the epidermis? The layers of the epidermis are also known as strata. ● The cells of the stratum corneum become rehydrated and swell when immersed in water for long periods, resulting in wrinkled “prune” skin. Warm, soapy water enhances this effect by stripping the cells of their natural oils. This effect does not appear as dramatically in salt water.
  • ● How do collagen and elastin change as we age? As we age, we lose collagen and elastin under the skin, which gives rise to wrinkles and flabby skin. UV exposure, poor nutrition, dehydration, and poor skin care accelerate this process.
  • ● What is cyanosis? Cyanosis results from excessive amounts of deoxygenated blood. Too much bilirubin-Jaundice
  • ● What causes white hair? Gray hair? White hair is often the result of air in the hair follicle. Gray hair occurs when the amount of melanin deposited in the hair decreases or is absent. Both of these processes are part of natural aging. ● Alopecia areata, an autoimmune disorder of unknown cause, can also make hair appear gray in a short time. In the early stages of alopecia, the darker, thicker hairs stop growing. Later, round bald patches may appear.
  • ● There are two types of sudoriferous glands.
  • ● How can the nails help the massage therapist understand the health of his or her client? According to the American Academy of Dermatology, nails are a barometer of health: White nails can indicate liver disease. Half-pink, half-white nails can indicate kidney disease. Red nail beds can accompany heart conditions. Thick, yellow nails and slow growth rate can be signs of lung disease. Pale nail beds might indicate anemia. People with diabetes might have yellowish nails with a pink or red tinge at the base.
  • ● Fingernails grow three to four times faster than toenails, and the nails on a person’s dominant hand grow faster than those on the other hand.
  • ● In which layer(s) of skin are each of these receptors located? Meissner corpuscles are located in the dermis, just below the epidermis. Ruffini’s corpuscles are located in the dermis. Pacinian corpuscles are located deep in the dermis, primarily in the hands and feet and in many joint capsules.
  • ● In which layer(s) of skin are each of these receptors located? Krause end bulbs are found in mucous membranes. Merkel disks are located in the epidermis. Hair-follicle receptors are located in the dermis.
  • ● Observing and reporting changes in moles is an added service of the massage therapist. ● Using the ABCDEF method will help you detect changing moles as they occur.
  • ● Have students discuss the massage implications for each of the pathologies listed on these slides. ● Remind students to use standard precautions to clean up any body fluids or substances, such as from a boil (furuncle).
  • ● What is a herpes simplex lesion commonly called when it appears near the mouth? Cold sore or fever blister ● Usually, herpes simplex type I is the virus responsible for oral and facial herpetic lesions, and herpes simplex type II causes genital herpes lesions, but either type can affect any location.
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    1. 1. 1Chapter 12Integumentary System________________________________________________________________________________________ __ Susan G. Salvo Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    2. 2. 2Introduction The integumentary system consists of the skin, hair, nails, and related glands Skin:  Defines our parameters by covering our body  Is the largest organ in the body  Forms natural openings, such as the mouth, nose, ears, urethra, vagina, and anus  Receives stimuli—heat, cold, movement, touch, pressure, pain Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    3. 3. 3PhysiologyProtection  Physical, biological, and chemical barrier  Protects from infection, UV irradiation,  Waterproofs Absorption  Absorbs fat, vitamins, salts Sensation  Pressure, pain, temperature, touch Body temperature regulation  Blood circulation through skin is a major component of temperature regulation  Evaporation of sweat helps cool body Waste elimination  Perspiration is 98% water and 2% solids Vitamin D synthesis  Sunlight converts molecules to active vitamin D for calcium absorption Immunity  Specialized cells in the skin attach to and destroy pathogens Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    4. 4. 4Regions of the Skin Epidermis  Four or five layers containing unique cells Dermis  Located under the epidermis  Contains blood vessels, nerve receptors, hair follicles, and skin glands Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    5. 5. 5Epidermis Derived from ectoderm (same embryonic layer that gives us brain, spinal cord, and special senses) Contains melanocytes Pores allow passage of oxygen and nutrients Composed of epithelial tissue; relatively avascular Life cycle of skin is 21–27 days Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    6. 6. 6 Specialized Epidermal Cells Keratinocytes  Produce keratin—tough, fibrous  Protect skin by waterproofing surface  Form principal structures of outer skin Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    7. 7. 7Specialized Epidermal Cells Melanocytes  Produce melanin, or skin pigment  Contribute to color of skin, hair, and iris of eye  UV protection Langerhans cells  Originate in bone marrow but migrate to deeper layers of epidermis in early life  With helper T cells trigger immune reactions Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    8. 8. 8 Epidermal Layers Stratum germinativum (basale)  Deepest layer  Generates all other cell layers  Receives superficial pressure via Merkel disks Stratum spinosum  Bonding/transitional layer between stratum granulosum and stratum germinativum Stratum granulosum  Marks beginning of change before tissue dries Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    9. 9. 9Epidermal Layers Stratum lucidum  Present in thick skin (hands and feet)  Absent in thin skin Stratum corneum  Outermost layer  Dead cells, completely keratinized  Ready to be sloughed off and replaced Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    10. 10. 10Dermis Also known as true skin Contains blood vessels, muscles, hair follicles, sweat and oil glands, nerves and nerve endings  Thicker on men than on women  Thicker on posterior than anterior aspect of body  Thickest on palms of hand and soles of feet  Thinnest on eyelids  Elastin provides elasticity Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    11. 11. 11Subcutaneous Layer Also called the hypodermis A layer rich in fat and areolar connective tissue Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    12. 12. 12Skin Color Causes of variations in skin color:  Melanin  Amount of oxygen in capillaries  Presence of bilirubin  Presence of carotene Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    13. 13. 13Skin Appendages Hair Nails Glands Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    14. 14. 14Hair andRelated Structures Hair is made up of keratin filaments arising from hair follicles Hair protects scalp, eyes, nose, and ears Hair follicles can become irritated by excess friction from insufficient lubricant, allergic reaction to massage lubricant, or pulling of hair Arrector pili—muscles that pull hair upright Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    15. 15. 15 Skin Glands Sebaceous glands (oil glands)  Secrete sebum, a mixture of triglycerides, waxes, fatty acids, and cholesterol  Massage stimulates sebum production Sudoriferous glands (sweat glands)  Secrete sweat  Regulate temperature and eliminate waste Ceruminous glands  Secrete waxy cerumen Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    16. 16. 16Sweat Glands Eccrine sweat glands  Most numerous, widespread, important  Produce sweat rich in salts, ammonia, uric acid, urea, and other wastes Apocrine sweat glands  Located in deep subcutaneous layer in axillary regions, areola of breast, pigmented skin around anus  Larger than eccrine glands; join hair follicles Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    17. 17. 17Nails Heavily keratinized distal features of the fingers and toes Protect ends of fingers and toes Digging, scratching, and manipulation of objects Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    18. 18. 18Nails Structures of the nails:  Body—main visible parts of nail  Root—produces nail, about 1 mm per week  Bed—skin beneath nail body  Lateral nail folds—where nail meets skin  Cuticle (eponychium)—ridge of skin growing out over nail’s base  Lunula—whitish half-moon shape at base  Free nail edge—portion that is trimmed Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    19. 19. 19Cross Section of Nail Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    20. 20. 20Nervous System’s Rolein Touch Meissner corpuscles  Also called tactile corpuscles  Discriminates light vs. deep pressure Ruffini’s corpuscle  Deep or continuous pressure  Detects high range of temperatures; also called heat receptors Pacinian corpuscles  Deep pressure and vibration  Proprioception Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    21. 21. 21Nervous System’s Rolein Touch Krause end bulb  Discriminatory touch, low-frequency vibration, cooler temperatures  Also called cold receptors Merkel disk  Light touch and discriminative touch Hair root plexus  Light-touch receptors of hair movement Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    22. 22. 22Mole Changes Asymmetry  Common moles are symmetrical and round; malignant moles are asymmetrical Border  Common moles have even borders; malignant melanomas have uneven borders Color  Common moles are evenly shaded brown; malignant moles are black or varying shades Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    23. 23. 23Mole Changes Diameter  Common moles are usually less than ¼ inch in diameter; melanomas tend to be larger Elevated  Common moles are smooth; malignant moles are elevated Fast growing  Common moles do not grow fast, if at all; malignant moles change size rapidly Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    24. 24. 24Pathological Conditionsof the Skin Acne  Bacterial infection of hair follicles and sebaceous glands Athlete’s foot  Contagious superficial fungal infection Boils  Staphylococcal bacteria in the dermis or hair follicle Bruise  Injury that does not break the skin Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    25. 25. 25Pathological Conditionsof the Skin Cancer (skin) Cellulitis  Acute infection of subcutaneous tissue Contact dermatitis  Skin irritation due to allergic reaction to contact with an allergen Eczema  Acute or chronic inflammatory disorder of the skin; involved redness, watery discharge, crusting, scaling, itching, and burning Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    26. 26. 26Pathological Conditionsof the Skin Herpes simplex  Highly contagious viral infection; flare-ups involve cold sores on mucous membranes Hives  Inflammatory disorder involving localized edema and wheals Psoriasis  Chronic form of dermatitis; red, flaky skin elevations covered by thick, dry silvery scales Shingles  Acute infection of peripheral nervous system caused by reactivation of herpes zoster virus Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    27. 27. 27Pathological Conditionsof the Skin Skin tags  Tiny flaps of skin usually located around the neck, upper chest, armpit, and groin Stretch marks  Tearing, thinning, or overstretching of skin Warts  Thickening of epidermis resulting in a mass of cutaneous elevations caused by papillomavirus; contagious Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.
    28. 28. 28Summary The skin is much more than a covering Offers protection, heat exchange, vitamin synthesis, waste removal Regions of skin include epidermis and dermis; subcutaneous layer lies below dermis Skin appendages include hair, nails, and glands Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.

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