INTEGUMENTARY System

INTEGUMENTARY
System
Laboratorium Anatomi Histologi
FK UB
ANALISIS SITUASI  SKDI
Eczematous dermatitis
Contact dermatitis allergica
Lichen simplex chronicus
Contact dermatitis irritant
Atopic dermatitis (kecuali recalcitrant)
Nummular dermatitis
Napkin eczema
Erythro-squamous lesions
Psoriasis vulgaris
Seborrheic dermatitis
Pityriasis rosea
Disorders of skin eccrine and sebaceous glands
Rosacea
Acne vulgaris
Hidradenitis suppurativa
Perioral dermatitis
Miliaria
3A
3A
4
4
4
4
3A
4
4
3A
4
4
4
4
Vesicobullous diseases
Toxic epidermal necrolysis
Stevens-johnson's disease
Allergic skin diseases
Angioedema
Urticaria
Disorders of keratinizations
Ichthyosis vulgaris
Other noninfectious inflammatory skin disorder
Lichen planus
Granuloma annulare
Drug reactions
Exanthematous drug eruption
Fixed drug eruption
3B
3B
3B
4
3A
3A
3A
4
4
Pigmentary disorders
Vitiligo
Melasma
Post-inflammatory hyperpigmentation
Post-inflammatory hypopigmentation
NEOPLASMA KULIT
Premalignant and malignant epithelial tumor
Basal cell carcinoma
Epithelial cyst
HAIR
Alopecia areata
Androgenic alopecia
Trichotillomania
Telogen eflluvium
PLUS : yg disebabkan INFEKSI
3A
3A
3A
3A
2
3A
3A
3A
3A
3A
ANALISIS SITUASI  SKDI
DAFTAR MASALAH dalam Sistem Dermatomuskuloskeletal
1 Gatal-gatal
14 Bintil berair di kulit
2 Kulit kuning
Perubahan warna kulit (hipo
3
dan hiperpigmentasi)
4 Kulit bersisik
15 Rambut rontok
5 Kutil
18 Terlambat bisa berjalan
6 Benjolan pada kulit
19 Gerakan terbatas
Gangguan otot, nyeri otot, kaku otot,
20
otot mengecil
Gangguan sendi (nyeri, kaku,
21
bengkak, kelainan bentuk)
22 Nyeri punggung
7 Kulit merah dan nyeri
8 Kulit berminyak
9 Ruam kulit
10 Luka bakar
Luka (luka lecet, tusuk, sayat,
11
borok)
Luka yang tidak sembuh12
sembuh
13 Nyeri di kuku
16 Kebotakan
17 Gangguan jalan
23 Bengkak pada kaki dan tangan
24 Patah tulang
25 Terkilir
26 Rambut rontok
Learning Objective
Memahami STRUKTUR dan FUNGSI
Dari SISTEM INTEGUMEN
Mengaitkan dengan sign, symptom, dan
patofisiologi dalam keadaan klinis dari
sistem integumen
PENDAHULUAN
STRUKTUR
GAMBARAN UMUM
EPIDERMIS
DERMIS
HIPODERMIS
TIPE
STRUKTUR2 ASESORIS
FISIOLOGI
TERMINOLOGY
PENDAHULUAN
• 7 - 8 % total body mass
• Organ terbesar dalam sistem tubuh manusia
• Ketebalan: 1,5 -4,4 mm
• Menutupi seluruh permukaan tubuh
• Bervariasi
STRUKTUR
GAMBARAN UMUM
EPIDERMIS
DERMIS
HIPODERMIS
TIPE
STRUKTUR2 ASESORIS
GAMBARAN UMUM
nails
 Mengandung SEMUA jaringan dasar 
EPIDERMIS
• tdd : epithel squamous complex dg kornifikasi
• avascular
• Innervasi : free nerve end tanpa kapsul
• 4 - 5 lapis :
– Str. Corneum
– Str. Lucidum ( + )
– Str. Granulosum
– Str. Spinosum
– Str. Basale = str germinativum
EPIDERMIS
Str.Corneum
Str.lucidum
Str.Granulosum
Str.Spinosum
A
B
stratum
malpighii.
Str.Basale
A = epidermal ridges
B = Dermal papillae
Dermalepidermal
junction
– Str. Corneum :
• tdd >> lapisan keratinosit mati, yang terluar dekuamasi
• Berisi soft keratin (lower sulfur and more elastic)
– Str. Lucidum ( + )
• sel kehilangan inti, sitoplasma berisi aggregat keratin
yg tersusun paralel, materi intercelluler meningkat
– Str. Granulosum :
• Granula keratohyalin, lamellar bodies (mengandung
lipid)
– Str. Spinosum :
• beberapa lapis keratinosit dg kecepatan mitosis lbh
rendah, >> intermediate filament cytokeratin 
tonofibril  desmosome
•  Berperan dlm strength and flexibility
– Str. Basale :
• supplier keratinocyte  str germinativum
Keratinization begins
EPIDERMIS
SEL :
– Keratinocyte :
 Sel utama
epidermis
 Produksi keratin
– Melanocyte :
sintesa melanin
– Langerhans :
berperan dlm sistem
imun
– Merkel :
mechano-receptor
The combination of melanocytes
and keratinocytes forms an
epidermal-melanin unit.
EPIDERMIS
In the superficial layers of the
epidermis the melanin granules
of melanosomes are more
evenly dispersed and become
progressively finer
DERMIS
• Jaringan ikat irreguler
• vascular
• >> free nerve end, reseptor sensoris
berkapsul, serabut autonom untuk VSMC
• Mengandung folikel rambut, kelenjar,
pembuluh darah, limfatik, & saraf
• lebih tebal dr epidermis
DERMIS
• lapisan :
– papillary layer : dg anyaman kapiler  maintenance
• Ada tonjolan2, dg nerve ending (Meissner)
• Mengandung kapiler
– reticular layer : dg anastomose arteriovenosus
• strength, extensibility & elasticity
• Struktur asesoris (Dermal appendages)
HYPODERMIS
• (bukan kulit)
• tdd j.i longgar dan lemak
•  fascia subcutanea /
(bila tebal) panniculus adiposus
TIPE kulit
Berdasar ketebalan & struktur histologi
Kulit TEBAL
TIPE
Kulit TIPIS
Karakteristik
Lokasi
Telapak tangan & kaki
Bagian tubuh lain
tebal
0,8 – 1,4 mm
0.07 – 1,12 mm
Str. corneum
15- 40 lapis
10 – 20 lapis
Str. lucidum
+
p.u -
Str. granulosum
Bbrp lapis
1, p.u diskontinu
Str. basale
>> Merkel cell
<<
Dermatoglifi
+
-
EPIDERMIS
DERMIS
Kulit TEBAL
Kulit TIPIS
Rambut
-
+, (kcl : glans penis, labia minora,
clitoris, bibir)
Klj. Cebacea
<<
>>
Klj. Keringat
>>
<<
Meissner
>>
<<
Serabut
elastik
<<
>>
Dermal-epidermal junction
• Basement membrane, di bawah str. Basale
• Interdigitasi dermal papillae – epidermal ridges
TEBAL
TIPIS
EPIDERMIS
Dermalepidermal
junction
TIPE kulit
Berdasar sensitivitas terhadap UltraViolet
Fitzpatrick’s classification
Always burn, never tan
Always burn,
sometimes tan
sometimes burn,
sometimes tan
sometimes burn,
always tan
Never burn,
sometimes tan
Never burn, always
tan
STRUKTUR ASESORIUS
– hair
– nails
– exocrine glands :
sebacea (lemak),
sudorifera (keringat)
Dr dermis  epidermis
RAMBUT
• A hair follicle is an
invagination of the
epidermis extending
deep into the dermis.
• Hair shaft is a long,
slender filament in the
center of the follicle
• Hair Root -- below the
sebaceous gland
tipe RAMBUT
• Lanugo : 3rd month s.d lahir
• Dewasa :
–
Vellus : halus, di hampir seluruh permukaan tubuh
–
Intermediate : di extremitas
–
Terminal : tebal, lebih berpigmen, kadang ikal.
Termasuk alis dan “bulu” mata
•
! Warna rambut ditentukan oleh densitas melanin di
cortex
Struktur terkait dengan
rambut:
• M. Arrector pili
– smooth muscle in
dermis contracts
with cold or fear.
– forms goosebumps
as hair is pulled
vertically
• glands
KUKU
The cells are hard, tightly
adherent, and throughout
most of the body of the nail,
clear and translucent.
Nail keratin has higher sulfur
content than the keratin of the
epidermis  hard keratin
! Perubahan pd kuku dapat
mengindikasan adanya suatu
kondisi patologis
(ex : icteric, cyanosis)
Kelenjar eksokrin
CLINICAL CORRELATION :
Miliaria
CLINICAL CORRELATION :
Hidradenitis suppurativa
SIKLUS RAMBUT
Fungsi Umum
– PROTEKSI :
• Sbg barrier thd mikroba, toxic subs, radiasi,
benturan, tekanan
• Via sistem imun
– Regulasi suhu tubuh (Thermoregulation)
– Sensoris
– Ekskresi
– Metabolisme vit D (pro-vitamin D berada di kulit)
– Penyimpanan lemak
– etc
Fungsi spesifik
Sensory Receptor in The Skin
>>fingertips, lips
Free nerve
endings
Fungsi spesifik
Sistem Keratinisasi :
• cell renewal (aktivitas mitosis) : di germinativum
& spinosum
• diferensisasi (keratinisasi) : dr germinativum ke
atas
• death cell : lucidum ke atas
• Durasi : 15-30 hr secara bergelombang,
• kedalaman & tahap berbeda  gambaran
berlapis dan bergelombang
Tahap Keratinisasi : (tumpang tindih)
– Mitosis
– Diferensiasi
– Apoptosis
– Exfoliasi
It takes about 2 weeks for the cells to migrate from the
basal cell layer to the top of the granular cell layer, and a
further 2 weeks for the cells to cross the stratum corneum
to the surface, where they finally are shed……
CLINICAL CORRELATION :
psoriasis
Warna kulit & Sistem Pigmentasi
Faktor warna kulit:
• Aktivitas melanosit  pigmen  Sistem Pigmentasi
• ketebalan epidermis
• pembuluh darah dermis
• warna darah pd pembuluh
• genetik
sistem pigmentasi = melanin pathway
Melanin
• sintesa oleh melanosit
• macam :
– eumelanin : warna : coklat gelap. Di
epidermis, iris, rambut hitam & coklat
– pheomelanin : warna kuning kemerahan
• Fungsi melanin
– Perlindungan.
– Cara : absorbsi radikal bebas
Penyebab2 peningkatan sintesa melanin
(Facultative skin pigmentation):
• paparan ultraviolet
• Hormon : MSH, estrogen, ACTH
• Obat2an : chloroquin, khemoterapi
• Polusi : logam berat
• Postinflamasi
sistem pigmentasi
Spherical; no melanin deposition
minimal deposition of
melanin; high tyrosinase activity
moderate deposition of melanin;
high tyrosinase activity
heavy deposition of melanin;
minimum tyrosinase activity
Melanosit
• Jumlah melanosit PER unit area (densitas) sama
pada semua jenis warna kulit (pada area yang
sama).
• Jumlah melanosit berbeda pada area tertentu
• Densitas dapat dipengaruhi faktor luar
– Melanocyte density and differentiation is influenced by
the environment, including UV and factors secreted by
neighboring keratinocytes and fibroblasts
RESUME : skin pigmentation is determined by:
• the migration of melanoblasts to that tissue during
development (from neural crest ectoderm)
• their survival and differentiation to melanocytes
• the density of melanocytes,
• (d) the expression/function of enzymatic and structural
constituents of melanosomes,
• (e) the synthesis of different types of melanin (eu- and
pheomelanin),
• (f) the transport of melanosomes to dendrites,
• (g) the transfer of melanosomes to keratinocytes, and
finally
• (h) the distribution of melanin in suprabasal layers of
the skin.
Yang membedakan warna kulit dalam sistem pigmentasi :
– Kecepatan sintesa melanin
– Kecepatan akumulasi / kecepatan transfer
– Kecepatan degradasi
– Ukuran dan isi melanosome
European
Note :
darkly pigmented skin has
melanosomes that contain more
melanin and are larger; once
transferred to keratinocytes, the
melanosomes are singly dispersed
and degraded more slowly
Fisiologi Sistem Integumen dalam Kehamilan




Terutama akibat pengaruh hormon
Hormon yang terlibat : estrogen, MSH
(meningkat t.u trimester III)
pengaruh :
 Melanocyte lebih besar, lebih aktif
 Sirkulasi & neovaskularisasi
Klinis :
 Melasma gravidarum / Chloasma
 Linea nigra
SKIN VS AGING
Jenis “Skin aging”
• Intrinsic aging – true aging
– Fisiologis, sesuai waktu.
– Banyak dipengaruhi scr genetik
– Cx : kerusakan endogen oleh ROS (reactive oxygen
species), yg dihasilkan dlm metabolisme oksidatif
seluler
• Extrinsic aging
– Krn paparan lingkungan eksternal.
– Ex : p.u UV light ( photoaging). Lain : radiasi ion,
stress fisik dan psikis, alkohol,gizi kurang,obesitas,
polusi lingkungan.
Intrinsic aging
Manifestasi :
• Kerutan (Fx : otot, subkutan, gravitasi, tulang, & kartilago)
• Xerosis
• Laxity (longgar)
• Slackness (kendur, tidak elastis)
• Tumor jinak
Extrinsic aging
• Disebabkan oleh UVB (290–320 nm), dan UVA
(320–400 nm)
• UVB menyebabkan perubahan pada epidermis 
merusak DNA pada keratinocytes dan
melanocytes.  Lebih bersifat “membakar”.
• UVA penetrasi lebih dalam (s.d dermis)  ROS.
 Lebih berperan dalam photoaging.
• Efek rokok : cigarette skin
active
growth
involution
SIKLUS RAMBUT
rest
two additional stages:
• hair shaft-extrusion (exogen/teloptosis)
• empty hair follicle (kenogen)
Hair facts :
• 10–20% of the total number of hairs are in
telogen phase at any given time
• around 100 telogen hairs are shed per day
CLINICAL CORRELATION:
- alopecia
Available @ : anatomi.lecture.ub.ac.id
TERIMA KASIH