September 21, 2011, 8:09 pm
Dr. B.J.C.Perera MBBS(Ceylon), DCH(Ceylon), DCH(England), MD(Paediatrics), FRCP(Edinburgh), FRCP(London), FRCPCH(United Kingdom), FSLCPaed, FCCP, FCGP(Sri Lanka) Consultant Paediatrician
* Skin is the largest organ of the body.
* Nails and hair are appendages associated with the skin.
* Skin and its appendages have a predominantly protective role.
* There are several diseases that can affect the skin and its appendages.
It may come as a surprise to many that the skin is the largest organ in the human body. if the skin of a typical 150-pound or 68 kilogram adult male were stretched out flat, it would cover about 2 square yards or 1.7 square meters and weigh about 9 pounds or 4 kilograms. The skin protects the network of muscles, bones, nerves, blood vessels, and everything else inside the body. With regard to the texture of the skin, the eyelids have the thinnest skin and the skin of the soles of the feet is the thickest.
Hair is actually a modified type of skin. Hair grows everywhere on the human body except the palms of the hands, soles of the feet, eyelids, and lips. Hair grows more quickly in temperate climates and more slowly at night than during the day. Like hair, nails are a type of modified skin. Nails protect the sensitive tips of fingers and toes. Human nails aren’t necessary for living, but they do provide support for the tips of the fingers and toes, protect them from injury and aid in picking up small objects. without them, humans would have a hard time scratching an itch or untying a knot. Nails can be an indicator of a person’s general health and illness often affects their growth.
Skin is essential in many ways. it forms a barrier that prevents harmful substances and microorganisms from entering the body. it protects body tissues against injury. it also controls the loss of life-sustaining fluids like blood and water, helps regulate body temperature through perspiration and protects from the sun’s damaging ultraviolet rays. without the nerve cells in skin, people would not feel warmth, cold, touch, superficial pain or other sensations. for instance, goosebumps form when the erector pili muscles contract to make hairs on the skin stand up straight when someone is cold or frightened and the blood vessels keep the body from losing heat by narrowing as much as possible and keeping the warm blood away from the skin’s surface, offering insulation and protection.
Every square inch of skin contains thousands of cells and hundreds of sweat glands, oil glands, nerve endings, and blood vessels. Skin is made up of three layers. these are the epidermis, dermis and the subcutaneous layer of tissues. The upper layer of our skin, the epidermis, is the tough, protective outer layer. it is about as thick as a sheet of paper over most parts of the body. The epidermis has four layers of cells that are constantly flaking off and being renewed. in these four layers are three special types of cells. they are :-
* Melanocytes produce melanin, the pigment that gives skin its colour. All people have roughly the same number of melanocytes but those of dark-skinned people produce more melanin. Exposure to sunlight increases the production of melanin which is the reason why people get suntanned or freckled.
* Keratinocytes produce keratin, a type of protein that is a basic component of hair, skin and nails. on the surface of the skin, kerating produces a tough intact protective barrier.
* Langerhan cells help protect the body against infection.
Because the cells in the epidermis are completely replaced about every 28 days, cuts and scrapes heal quickly. Healing occurs much earlier due to the inherent property of rapid cell turnover in the skin. even surgical incisions in children heal very well in about 5 – 7 days.
Below the epidermis is the next layer of skin, the dermis, which is made up of blood vessels, nerve endings, and connective tissue. The dermis nourishes the epidermis. two types of fibers in the dermis, collagen and elastin, help the skin to stretch when the body bends at joints and repositions itself when straightening up. Collagen is strong and hard to stretch while elastin, as its name suggests, is elastic. in older people, some of the elastin-containing fibers degenerate, which is one reason why the skin looks wrinkled.
The dermis also contains a person’s sebaceous glands. these glands, which surround and empty into hair follicles and pores, produce the oil sebum that lubricates the skin and hair. Sebaceous glands are found mostly in the skin on the face, upper back, shoulders and the chest. Most of the time, the sebaceous glands make the right amount of sebum. as a person’s body begins to mature and develop during the teenage years hormones stimulate the sebaceous glands to make more sebum. when pores become clogged by too much sebum and too many dead skin cells, this contributes to acne or pimples. Later in life, these glands produce less sebum which contributes to dry skin as people age.
The bottom layer of the skin, the subcutaneous tissue, is made up of connective tissue, sweat glands, blood vessels and cells that store fat. This layer helps protect the body from blows and other injuries and helps it hold in body heat. There are two types of sweat glands. The eccrine glands are found everywhere, although they are mostly in the forehead, palms and soles of the feet. By producing sweat, these glands help regulate body temperature and some waste products are also excreted through them. The apocrine sweat glands develop at puberty and are concentrated in the armpits and pubic region. The sweat from the apocrine glands is thicker than that produced by the eccrine glands. although this sweat does not smell, when it mixes with bacteria on the skin’s surface, it can cause body odour. A normal, healthy adult secretes about 1 pint or about half a litre of sweat daily. however, this may be increased by physical activity, fever or a hot environment.
The hair on the head is not just there for looks and beauty. it keeps the body warm by preserving heat. The hair in the nose, ears and around the eyes protects these sensitive areas from dust and other small particles. Eyebrows and eyelashes protect eyes by decreasing the amount of light and particles that go into them. The fine hair that covers the body provides warmth and protects the skin. Hair also cushions the body against injury. Human hair consists of the hair shaft, which projects from the skin’s surface and the root, a soft thickened bulb at the base of the hair embedded in the skin. The root ends in the hair bulb, which sits in a sac-like pit in the skin called the follicle from which the hair grows. at the bottom of the follicle is the papilla, where hair growth actually takes place and growth occurs from the bottom upwards. The papilla contains an artery that nourishes the root of the hair. as cells multiply and produce keratin to harden the structure, they are pushed up the follicle and through the surface of the skin as a shaft of hair. Hair grows by forming new cells at the base of the root. these cells multiply to form a rod of tissue in the skin. The rods of cells move upward through the skin as new cells form beneath them. as they move up, they are cut off from their supply of nourishment and start to form a hard protein called keratin in a process called keratinization. as this process occurs, the hair cells die. The dead cells and keratin form the shaft of the hair.
Each hair has three layers. they are the medulla at the centre, which is soft, the cortex, which surrounds the medulla and is the main part of the hair and the cuticle, the hard outer layer that protects the shaft. each hair grows about a quarter of an inch or about 6 millimetres every month and keeps on growing for up to 6 years. The hair then falls out and another grows in its place. The length of a person’s hair depends on the length of the growing phase of the follicle. Follicles are active for 2 to 6 years and they rest for about 3 months after that. A person becomes bald if the scalp follicles become inactive and no longer produce new hair. Thick hair grows out of large follicles while narrow follicles produce thin hair.
The colour of a person’s hair is determined by the amount and distribution of melanin in the cortex of each hair. This is the the same melanin that is found in the epidermis. Hair also contains a yellow-red pigment. People who have blonde or red hair have only a small amount of melanin in their hair. Hair becomes grey when people age because sufficient pigment is not formed to colour the hair.
Nails grow out of the deep folds in the skin of the fingers and toes. as epidermal cells below the nail root move up to the surface of the skin, they increase in number and those closest to the nail root become flattened and pressed tightly together. each cell is transformed into a thin plate and these plates are piled in layers to form the nail. as with hair, nails are formed by keratinization. when the nail cells accumulate, the nail is pushed forward. The skin below the nail is called the matrix. The larger part of the nail, the nail plate, looks pink because of the network of tiny blood vessels in the underlying dermis. The whitish crescent-shaped area at the base of the nail is called the lunula. Fingernails grow about three or four times as quickly as toenails. Like hair, nails grow more rapidly in temperate climes. if a nail is torn off, it will re-grow if the matrix is not severely injured. White spots or lines on the nail are sometimes due to temporary changes in growth rate of the nail.
The term dermatitis refers to any inflammation characterised by swelling, itching, and redness of the skin. There are many types of dermatitis. Atopic dermatitis or eczema is common, hereditary dermatitis that causes an itchy rash primarily on the face, trunk, arms, and legs. it commonly develops in infancy, but can also appear in early childhood. it may be associated with allergic diseases such as asthma and seasonal, environmental and food allergies. Contact dermatitis occurs when the skin comes into contact with an irritating substance or one that the person is allergic or sensitive to. There may be several causes which include chemicals found in laundry detergent, cosmetics, perfumes and metals like nickel plating on jewellery. Seborrhoeic dermatitis is an oily rash which appears on the scalp, face, chest and back. it is is related to an overproduction of sebum from the sebaceous glands. This condition is seen regularly in infants and adolescents.
Several types of bacterial infections can occur in the skin. Impetigo is a bacterial infection that results in a honey-coloured crusty rash, often on the face near the mouth and nose. Cellulitis is an infection of the skin and subcutaneous tissue that typically occurs when bacteria are introduced through a puncture, bite or some other break in the skin. The area with cellulitis is usually warm, tender and has some redness. certain types of these bacteria are also responsible for distinctive rashes on the skin, including the rashes associated with scarlet fever and toxic shock syndrome.
Certain types of fungal infections can occur in the skin and nails. A warm, moist environment, such as that found in the folds of the skin in the diaper area of infants, is perfect for growth of the yeast Candida. Yeast infections of the skin in older children, teens, and adults are less common. another fungal infection is Tinea infection or ringworm. Contrary to popular belief, it is not caused by a worm. it is caused by a fungus infection that can affect the skin, nails or scalp. Tinea fungi can infect the skin and related tissues of the body. The medical name for ringworm of the scalp is tinea capitis, ringworm of the body is called tinea corporis and ringworm of the nails is called tinea unguium. With tinea corporis, the fungi can cause scaly ring-like lesions anywhere on the body. Tinea pedis or athlete’s foot is an infection of the feet caused by the same types of fungi that cause ringworm. Athlete’s foot is commonly found in adolescents and is more likely to occur during warm weather.
There are a few other conditions that affect the skin. Parasites, usually tiny insects or worms, can feed on or burrow into the skin, often resulting in an itchy rash. Scabies and lice are examples of parasitic infestations. both are contagious and can be easily caught from other people. many viruses cause characteristic rashes on the skin, including varicella, the virus that causes chickenpox and shingles, herpes simplex which causes cold sores, human papillomavirus the virus that causes warts and a whole host of others. Acne is most common in teens. Some degree of acne is seen in 85 per cent of adolescents, and nearly all teens have the occasional pimple, blackhead or whitehead. Skin cancer is rare in children and teenagers but good sun protection habits established during these years can help prevent skin cancers such as melanoma which is a serious form of skin cancer that can spread to other parts of the body, later in life, especially among fair-skinned people who sunburn easily. in addition to these diseases and conditions, the skin can be injured in a number of ways. Minor scrapes, cuts, and bruises heal quickly on their own, but other injuries such as severe deep cuts and burns, require medical treatment.
There are certain diseases or disorders that affect the scalp and hair. Tinea capitis, a type of ringworm, is a fungal infection that forms scaly, ring-like lesion in the scalp. it is contagious and common among school-age children. Alopecia is an area of hair loss. Ringworm is a common cause of temporary alopecia in children. Alopecia can also be caused by tight braiding that pulls on the hair roots. This condition is known as called tension alopecia. Alopecia areata occurs when hair falls out in round or oval patches on the scalp. it is a less common condition that can affect children and teenagers.
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