Sima Jain - Dermatology: Illustrated Study Guide and Comprehensive Board Review
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Gestational Age (Estimated) | Epidermal Development | Hair, Nail, and Gland Development | Dermal/Subcutaneous Development |
|---|---|---|---|
First trimester | |||
34 weeks | Single layer of ectoderm | ||
6 weeks | Outer flattened periderm and inner, cuboidal germinal (basal) layer | Germinal layer in contact w/ underlying mesenchyme | |
7 weeks | Fetal basement membrane | Tooth primordia | |
812 weeks | Epidermal stratification begins 8 week | Dermal-subcutaneous boundary distinct | |
Appearance of | |||
Melanocytes | |||
Langherhans cells | |||
Merkel cells | |||
912 weeks | Appearance of anchoring filaments/hemidesmosomes | Hair follicle and nail primordia seen | |
Second trimester | |||
12 weeks | Formation of dermo-epidermal junction (DEJ) | Nail bed starts to keratinize, proximal nail fold forms | Type III collagen appears |
1214 weeks | Parallel ectodermal ridges (fingerprints) | Eccrine and sebaceous gland primordia seen | Fibroblasts actively synthesizing collagen and elastin in dermis |
1224 weeks | Melanin production (1216 weeks), melanosome transfer (20 weeks) | Hair follicles differentiate during second trimester (seven concentric layers present) | |
1520 weeks | Follicular keratinization, nail plate completely covers nail bed | Papillary/reticular boundary distinct, dermal ridges appear | |
22 weeks | Trunk eccrine gland primordia | Elastic fiber seen | |
2224 weeks | Mature epidermis complete (w/ interfollicular keratinization ) | Adipocytes appear under dermis |
- Functions as a mechanical and antimicrobial barrier; protects against water loss and provides immunological protection; thickness varies from 0.04 mm (eyelid skin) to 1.5 mm (palmoplantar skin)
- Divided into four layers (each with characteristic cell shape and intracellular proteins): stratum corneum, stratum granulosum, stratum spinosum, and stratum basale (germinativum); of note, stratum lucidum is additional layer in palmoplantar skin
- Ectodermal derivation : keratinocytes comprise approximately 8085% of epidermal cells
- Total epidermal turnover time: average 4560 days (3050 days from stratum basale to stratum corneum and approximately 14 days from stratum corneum to desquamation)
- Epidermal self-renewal maintained via stem cells in basal layer of interfollicular epithelium and the bulg e region of hair follicles (latter location only activated with epidermal injury)
- Keratinocytes produce keratin filaments (syn: intermediate filaments or tonofilaments), which form the cells cytoskeletal network; this provides resilience, structural integrity, along with serving as a marker for differentiation (i.e., basal layer: K5/14)
- Six different types of keratin filaments: type I/II are epithelial/hair keratins, type IIIVI include desmin, vimentin, neurofilaments, nuclear lamins, and nestin
- >50 different epithelial/hair keratins, expressed as either type I (acidic) or type II (basic), and type I/II coexpressed together as a heterodimer (i.e., K5/14)
- Type I (acidic) epithelial keratins: K928, chromosome 17
- Type I (acidic) hair keratins: K3140 (old nomenclature: hHa1-hHa8, Ka35, Ka36)
- Type II (basic) epithelial keratins: K18 and K7180, chromosome 12
- Type II (basic) hair keratins: K8186 ( old nomenclature: hHb1hHb6 )
Type II | Type I | Location of Expression | Associated Diseases |
|---|---|---|---|
Suprabasal keratinocytes | Epidermolytic hyperkeratosis (EHK), Unna-Thost palmoplantar keratoderma (PPK) | ||
Palmoplantar suprabasal keratinocytes | Vorner PPK | ||
2 ( 2e ) | Granular and upper spinous layer | Ichthyosis bullosa of Siemens | |
Cornea | Meesman corneal dystrophy | ||
Mucosal epithelium | White sponge nevus | ||
Basal keratinocytes | Epidermal bullosa simplex (EBS), Dowling-Degos disease | ||
6a | Outer root sheath | Pachyonychia congenita I | |
6b | Nail bed | Pachyonychia congenita II | |
Simple epithelium | Cryptogenic cirrhosis | ||
K81 K86 | Hair | Monilethrix | |
Stem cells |
- Basal layer just above basement membrane; contains keratinocytes, melanocytes, merkel cells , and Langerhans cells (latter mainly in stratum spinosum)
- 10% of cells in basal layer are stem cells
- Expression of ornithine decarboxylase (ODC), which is a marker for proliferative activity (ODC stimulated by UVB and partially blocked by retinoic acid/corticosteroid/vitamin D3)
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