INTEGUMENTARY System

Laboratorium Anatomi Histologi FK UB

ANALISIS SITUASI SKDI

Eczematous dermatitis Contact dermatitis allergica 3A Lichen simplex chronicus 3A Contact dermatitis irritant 4 Atopic dermatitis (kecuali recalcitrant) 4 Nummular dermatitis 4 Napkin eczema 4 Erythro-squamous lesions Psoriasis vulgaris 3A Seborrheic dermatitis 4 Pityriasis rosea 4 Disorders of skin eccrine and sebaceous glands Rosacea 3A Acne vulgaris 4 Hidradenitis suppurativa 4 Perioral dermatitis 4 Miliaria 4

Vesicobullous diseases Toxic epidermal necrolysis 3B Stevens-johnson's disease 3B Allergic skin diseases Angioedema 3B Urticaria 4 Disorders of keratinizations Ichthyosis vulgaris 3A Other noninfectious inflammatory skin disorder Lichen planus 3A Granuloma annulare 3A Drug reactions Exanthematous drug eruption 4 Fixed drug eruption 4

Pigmentary disorders Vitiligo 3A Melasma 3A Post-inflammatory hyperpigmentation 3A Post-inflammatory hypopigmentation 3A NEOPLASMA KULIT Premalignant and malignant epithelial tumor Basal cell carcinoma 2 Epithelial cyst 3A HAIR Alopecia areata 3A Androgenic alopecia 3A Trichotillomania 3A Telogen eflluvium 3A

PLUS : yg disebabkan INFEKSI

ANALISIS SITUASI SKDI

DAFTAR MASALAH dalam Sistem Dermatomuskuloskeletal

1 Gatal-gatal 14 Bintil berair di kulit

2 Kulit kuning 15 Rambut rontok

3 Perubahan warna kulit (hipo

dan hiperpigmentasi) 16 Kebotakan

4 Kulit bersisik 17 Gangguan jalan

5 Kutil 18 Terlambat bisa berjalan

6 Benjolan pada kulit 19 Gerakan terbatas

7 Kulit merah dan nyeri 20 Gangguan otot, nyeri otot, kaku otot,

otot mengecil

8 Kulit berminyak 21 Gangguan sendi (nyeri, kaku,

bengkak, kelainan bentuk)

9 Ruam kulit 22 Nyeri punggung

10 Luka bakar 23 Bengkak pada kaki dan tangan

11 Luka (luka lecet, tusuk, sayat,

borok) 24 Patah tulang

12 Luka yang tidak sembuh-

sembuh 25 Terkilir

13 Nyeri di kuku 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

FISIOLOGI

EPIDERMIS

DERMIS

HIPODERMIS

STRUKTUR2 ASESORIS

TIPE

GAMBARAN UMUM

TERMINOLOGY

• 7 - 8 % total body mass

• Organ terbesar dalam sistem tubuh manusia

• Ketebalan: 1,5 -4,4 mm

• Menutupi seluruh permukaan tubuh

• Bervariasi

PENDAHULUAN

STRUKTUR EPIDERMIS

DERMIS

HIPODERMIS

STRUKTUR2 ASESORIS

TIPE

GAMBARAN UMUM

GAMBARAN UMUM

Mengandung SEMUA jaringan dasar

nails

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

Str.Corneum

Str.lucidum

Str.Granulosum

Str.Spinosum

Str.Basale

EPIDERMIS

A B

A = epidermal ridges

B = Dermal papillae

Dermal-

epidermal

junction

stratum

malpighii.

– 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

• 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)

DERMIS

• (bukan kulit)

• tdd j.i longgar dan lemak

• fascia subcutanea /

(bila tebal) panniculus adiposus

HYPODERMIS

TIPE Kulit TEBAL Kulit TIPIS

Lokasi Telapak tangan & kaki Bagian tubuh lain

tebal 0,8 – 1,4 mm 0.07 – 1,12 mm

EPIDERMIS

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 + -

Karakteristik

T I P E k u l i t

Berdasar ketebalan & struktur histologi

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

Dermal-

epidermal

junction

Berdasar sensitivitas terhadap UltraViolet

Always burn, never tan

Always burn, sometimes tan

sometimes burn, sometimes tan

sometimes burn, always tan

Never burn, sometimes tan

Never burn, always tan

Fitzpatrick’s classification

T I P E k u l i t

– hair

– nails

– exocrine glands :

sebacea (lemak),

sudorifera (keringat)

Dr dermis epidermis

STRUKTUR ASESORIUS

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

! Perubahan pd kuku dapat

mengindikasan adanya suatu

kondisi patologis

(ex : icteric, cyanosis)

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

Kelenjar eksokrin

CLINICAL CORRELATION :

Hidradenitis suppurativa

CLINICAL CORRELATION :

Miliaria

SIKLUS RAMBUT

– 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 Umum

Fungsi spesifik

Sensory Receptor in The Skin

Free nerve

endings

>>fingertips, lips

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

CLINICAL CORRELATION :

psoriasis

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……

Faktor warna kulit:

• Aktivitas melanosit pigmen Sistem Pigmentasi

• ketebalan epidermis

• pembuluh darah dermis

• warna darah pd pembuluh

• genetik

Warna kulit & Sistem Pigmentasi

Melanin

• sintesa oleh melanosit

• macam :

– eumelanin : warna : coklat gelap. Di

epidermis, iris, rambut hitam & coklat

– pheomelanin : warna kuning kemerahan

sistem pigmentasi = melanin pathway

• 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

minimal deposition of

melanin; high tyrosinase activity

Spherical; no melanin deposition

moderate deposition of melanin;

high tyrosinase activity

heavy deposition of melanin;

minimum tyrosinase activity

• 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

Melanosit

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

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

Fisiologi Sistem Integumen dalam Kehamilan

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

• 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

Extrinsic aging

SIKLUS RAMBUT

active

growth

involution

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

TERIMA KASIH

Available @ : anatomi.lecture.ub.ac.id