The integumentary system is a critical organ system in the human body that is made up of the skin, hair, nails, and glands that produce oil and sweat. This complex bodily system works together to protect the body from infection, injury, and sunlight. However, the integumentary system is susceptible to many diseases, disorders, and injuries. Since the skin is the largest organ of the body and the integumentary system, it is only natural that skin disorders and diseases are one of the most common ones that impact the integumentary system. Read on to find out more about the integumentary system in dermatology, diagnosis, treatment, and management of the various skin conditions that affect the integumentary system.
Brief Profile of the Integumentary System
The integumentary system is a critical bodily system comprising of the skin, hair, nails, and glands. This is the physical barrier between your internal organs and the external environment. It protects you from harmful pathogens, ultraviolet rays of the sun, injuries, and many other such factors. It also synthesizes vitamin D and regulates the body temperature. The integumentary system further forms the largest organ in the body, which is the skin.(1, 2, 3)
The skin, a vital part of the integumentary system, is the first line of defense of the body against the outside world and harmful factors. The skin is also responsible for keeping your internal organs safe. The skin contains sweat glands that help fight off dehydration and overheating as it releases sweat onto the surface of the skin. It also supports the growth of hair that provides insulation against hot and cold weather, while the nails protect your fingertips and toes from injury. This is how the integumentary system plays a critical in forming a physical barrier to keep your body safe.(4, 5)
Being the first line of defense of the body and with the skin being the largest organ of the body, the integumentary system is, therefore, quite susceptible to a variety of disorders, diseases, and injuries. These can range from being minor cuts and bruises, and relatively benign bacterial, viral, or fungal infections, to more severe and even fatal conditions like skin cancer and severe burns. Here are some of the most common conditions that affect the largest organ of the integumentary system, that is, the skin.
Conditions that Affect the Skin & Its Diagnosis, Treatment and Management
Skin diseases are conditions that affect the skin. These diseases can cause various symptoms including inflammation, rashes, itchiness, and other types of skin changes. Certain skin conditions might be hereditary, while others might be caused by lifestyle or environmental factors. Being the largest organ, the skin covers and protects the body and has many functions, and when you get skin diseases, they are likely to cause rashes and other changes to the appearance of the skin, which may range from being mild to severe. Skin diseases include all conditions that irritate, inflame, or clog your skin.
Some skin diseases are minor, while others can cause severe symptoms. Some of the most common types of skin diseases are as follows:
Acne is one of the most common skin conditions that cause pimples. The medical term for acne is acne vulgaris and there are several types of acne. Acne is caused when the pores of your skin get clogged. Young adults and teenagers are most susceptible to getting acne, but it can also develop in adulthood for some people. When the pores get blocked, you can get whiteheads, blackheads, and other types of pimples. Pimples are usually pus-filled bumps that develop on your skin and are usually painful. (6, 7)
There are different types of acne, including:
- Hormonal acne: This type of acne is more common in adults who have an overproduction of sebum (oil) that clogs the skin pores.(8)
- Fungal acne: Medically known as pityrosporum folliculitis, fungal acne develops when there is yeast build-up in the hair follicles of your skin. These quickly become inflamed and itchy.(9)
- Nodular acne: This is a very severe form of acne that causes pimples to appear on the surface of the skin, along with tender, nodular bumps that develop underneath the surface of your skin.(10)
- Cystic acne: This type of acne causes deep and pus-filled nodules and pimples, and usually leaves scars after they heal.(11)
The most common parts of the body affected by acne include the face, forehead, shoulders, chest, and the upper back. The common locations of acne are usually where the oil glands (also a part of the integumentary system) are the most.
Apart from clogged pores, there are many things in your environment that may trigger acne or make an acne breakout worse. These may include:
- Air pollution and certain weather conditions, including high humidity
- Wearing tight-fitting clothes and headgear
- Side effects of certain medications
- Using greasy or oily personal care products including creams or lotions
- Picking at existing acne
Certain foods and diets also cause acne, including diets that are high in added sugar, whey protein, and skim milk. Many people believe that eating chocolate also contributes to acne breakouts, however, no evidence has to date directly linked chocolate consumption to acne.(12, 13)
Acne is diagnosed by a doctor during a skin examination. During this examination, your doctor will look closely at your skin and ask about your symptoms. There are no specific diagnostic tests for acne, but you might be prescribed some tests to check for any underlying conditions if you develop a sudden and severe outbreak of acne, especially if you are an adult.
A dermatologist usually diagnoses and treats acne. There are many treatments for acne, with treatment varying by age, the type of acne you have, and the severity of your symptoms.
Your doctor may recommend some oral medications, or use topical medications to treat your skin. Medicated therapies are also used for treating acne. The basic goal of acne treatment is to prevent the development of new pimples from developing and also to help heal the existing breakouts on your skin.
Most doctors prescribe topical acne medications that contain one of these common ingredients:
- Benzoyl peroxide: This is usually available in over-the-counter products as a face wash or leave-on gel. It works by targeting surface bacteria that are responsible for aggravating the acne. Used in lower concentrations and in face wash formulations, these products usually cause less irritation to the skin.(14)
- Salicylic acid: Again available in over-the-counter acne products such as lotions or cleansers, salicylic acid helps remove the top layer of acne-damaged skin by dissolving the dead skin cells, thus preventing hair follicles from getting clogged.(15)
- Retinoids (a type of vitamin A derivate): Products with retinol are available over the counter and it helps break up the whiteheads, blackheads, and also prevents clogged pores. These products are not spot treatments and have to be applied on the entire area of the skin that is affected by acne to prevent new pimples from developing. You need to use retinoids for several months before noticing any substantial results.(16)
There are many oral acne medications as well that can help clear up your acne. These include antibiotics, contraceptives, isotretinoin, and hormone therapy.
If oral or topical medications don’t work for your acne or if you have substantial scars from your acne, your dermatologist may recommend other acne therapies like steroids, lasers, and chemical peels to clear up your skin.
Eczema or Atopic Dermatitis
Eczema is a type of skin condition that causes itchy and dry patches of skin. It is a common condition that causes mild to severe symptoms. The symptoms of eczema can flare up due to certain triggers, which vary from person to person. Eczema weakens the skin’s barrier function, which is what helps the skin retain moisture and also keeps your skin safe from outside elements.(17)
There are many types of eczema, with each type having its own set of unique triggers that impact the skin’s barrier function. It is also possible to have more than one type of eczema at the same time, though the condition is never contagious.(18)
Symptoms of eczema usually start appearing in childhood and can last well into adulthood. You are at a higher risk of having eczema if there is a family history of the condition or if you have certain allergies, asthma, dermatitis, or hay fever. The first symptoms of eczema are dry skin, itchiness, flaky or crusty skin, inflammation, bumps on the skin, and a rash. The symptoms can appear anywhere on the skin, and they usually appear when you come into contact with an allergen or trigger in your environment that led your symptoms to start or get aggravated. Identifying these triggers and consciously avoiding them can help reduce the risk of a flare-up. Some of the common eczema triggers include:(19, 20)
- Dry weather
- Soaps and detergents
- Fabrics or clothing material
- Food allergies, especially to dairy, peanuts, and eggs
Eczema is diagnosed by a dermatologist who diagnoses the condition after a thorough physical examination. Since eczema symptoms look similar to other conditions, your doctor may prescribe certain tests including an allergy test, blood tests to check the underlying causes of the rash, and a skin biopsy if the symptoms are severe.
The treatment for eczema is usually unique to each individual depending on the underlying causes of the symptoms. These may include: (21)
- Using topical medication to soothe the skin, including topical steroids.
- Using sensitive or gentle skin moisturizers for dry skin.
- Applying moisturizer when the skin is still damp right after a shower or bath.
- Taking oral medications like antihistamines, anti-inflammatory medicines, or corticosteroids to reduce swelling and itching.
- Light therapy to remove blemishes and improve the appearance of the skin.
- And, of course, to avoid triggers that cause eczema to flare up.
Vitiligo is another type of skin condition that impacts the integumentary system. Vitiligo causes the skin to lose its pigment or color. This causes the skin to start appearing lighter than your normal skin tone. In many cases, the affected skin turns white. If you have vitiligo on a part of the body that has hair, it is possible for the hair also to turn silver or white.(22)
Vitiligo occurs when your immune system begins to destroy melanocytes, which are skin cells found in the topmost layer of the skin called the epidermis. Melanocytes are responsible for producing melanin, the pigment that lends skin its color.(23)
Vitiligo is especially visible in people who have darker skin tones and it commonly develops before the age of 30. You are at a higher risk of developing vitiligo if you have an underlying autoimmune disease, such as diabetes type 1, lupus, Addison’s disease, psoriasis, or rheumatoid arthritis. Vitiligo is a rare disease and it only affects around one percent of the world’s population.(24)
The reason why some parts of the skin start to lose the pigment melanin causing vitiligo is still unknown. Researchers believe that vitiligo is usually a result of an underlying autoimmune condition, genetic mutations, high levels of stress, or environmental triggers like UV radiation and exposure to toxic chemicals that affect the functioning of the melanocyte cells.
Research has shown that nearly 30 percent of all cases of vitiligo are hereditary. This is why it is believed that the condition is genetic and you are most likely to inherit vitiligo from your family.(25, 26)
Vitiligo is typically diagnosed by a dermatologist through a visual examination of your skin. Your doctor might use a specialized Wood’s lamp to examine your skin. This type of lamp makes use of UV light to differentiate vitiligo from other skin conditions. Your doctor will also questions about your and your family’s medical history.
The treatment for vitiligo revolves around medications, light therapy, depigmentation therapy, counseling to deal with the depression that often affects vitiligo patients, and surgery. Treatment for vitiligo is not always necessary since the condition is not painful or harmful to the body. It is only a cosmetic condition. If you have severe or widespread vitiligo or the appearance of your skin with vitiligo is affecting your emotions and causing you to feel depressed, your doctor will help you find a treatment option. Treatments help create a more uniform skin tone by either eliminating the remaining color in the skin through depigmentation or trying to restore the skin color through repigmentation.(27, 28, 29)
There are no specific medications that can stop vitiligo from progressing or affecting your skin. However, there are some drugs that can slow down the speed at which the pigmentation loss happens. Some medications can also help the melanocyte cells grow back or bring back color to the skin. Corticosteroids, calcineurin inhibitors, and topical Janus kinase inhibitors such as ruxolitinib are often prescribed for certain cases.(30, 31)
There are many other types of skin conditions as well that affect the integumentary system, including alopecia areata, psoriasis, Raynaud’s phenomenon, rosacea, and skin cancer. It is important to take care of the integumentary system as it works tirelessly to protect your body from harm by working together with other bodily systems. While many skin diseases are not preventable since there is no way to change your genetics or prevent an autoimmune disorder, you can take many steps to avoid getting infectious or contagious skin diseases by being careful. Avoid sharing your personal items or cosmetics with others, and disinfect objects that you use in public spaces. At the same time, drink plenty of water to keep your organs well hydrated. Having a well-balanced and nutritious diet will also ensure the well-being of your whole body.
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- Diegel, K.L., Danilenko, D.M. and Wojcinski, Z.W., 2018. The integumentary system. Fundamentals of Toxicologic Pathology, pp.791-822.
- Bruner, R., Küttler, K., Bader, R., Kaufmann, W., Boothe, A., Enomoto, M., Holland, J.M. and Parish, W.E., 2001. Integumentary system. In International Classification of Rodent Tumors. The Mouse (pp. 1-22). Springer, Berlin, Heidelberg.
- Egert, M. and Simmering, R., 2016. The microbiota of the human skin. Microbiota of the Human Body, pp.61-81.
- Nielsen, K.P., Zhao, L., Stamnes, J.J., Stamnes, K. and Moan, J., 2008. The optics of human skin: Aspects important for human health. Solar radiation and human health, 1, pp.35-46.
- Williams, H.C., Dellavalle, R.P. and Garner, S., 2012. Acne vulgaris. The Lancet, 379(9813), pp.361-372.
- Zaenglein, A.L., 2018. Acne vulgaris. New England Journal of Medicine, 379(14), pp.1343-1352.
- Thiboutot, D., 2004. Acne: hormonal concepts and therapy. Clinics in dermatology, 22(5), pp.419-428.
- Rao, J., Fungal Acne Is A Real Thing With Real Solutions: A Guide To Defeating It.
- Newman, M.D., Bowe, W.P., Heughebaert, C. and Shalita, A.R., 2011. Therapeutic considerations for severe nodular acne. American journal of clinical dermatology, 12(1), pp.7-14.
- Marynick, S.P., Chakmakjian, Z.H., McCaffree, D.L. and Herndon Jr, J.H., 1983. Androgen excess in cystic acne. New England journal of medicine, 308(17), pp.981-986.
- Fulton, J.E., Plewig, G. and Kligman, A.M., 1969. Effect of chocolate on acne vulgaris. Jama, 210(11), pp.2071-2074.
- Spencer, E.H., Ferdowsian, H.R. and Barnard, N.D., 2009. Diet and acne: a review of the evidence. International journal of dermatology, 48(4), pp.339-347.
- Taylor, G.A. and Shalita, A.R., 2004. Benzoyl peroxide-based combination therapies for acne vulgaris. American journal of clinical dermatology, 5(4), pp.261-265.
- Zander, E. and Weisman, S., 1992. Treatment of acne vulgaris with salicylic acid pads. Clinical therapeutics, 14(2), pp.247-253.
- Thielitz, A., Krautheim, A. and Gollnick, H., 2006. Update in retinoid therapy of acne. Dermatologic therapy, 19(5), pp.272-279.
- Sohn, A., Frankel, A., Patel, R.V. and Goldenberg, G., 2011. Eczema. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine, 78(5), pp.730-739.
- Diepgen, T.L., Agner, T., Aberer, W., Berth‐Jones, J., Cambazard, F., Elsner, P., McFadden, J. and Coenraads, P.J., 2007. Management of chronic hand eczema. Contact dermatitis, 57(4), pp.203-210.
- Williams, H., Stewart, A., von Mutius, E., Cookson, W., Anderson, H.R. and of Asthma, I.S., 2008. Is eczema really on the increase worldwide?. Journal of Allergy and Clinical Immunology, 121(4), pp.947-954.
- Caubet, J.C. and Eigenmann, P.A., 2010. Allergic triggers in atopic dermatitis. Immunology and Allergy Clinics, 30(3), pp.289-307.
- Ring, J., Alomar, A., Bieber, T., Deleuran, M., Fink‐Wagner, A., Gelmetti, C., Gieler, U., Lipozencic, J., Luger, T., Oranje, A.P. and Schäfer, T., 2012. Guidelines for treatment of atopic eczema (atopic dermatitis) Part II. Journal of the European academy of dermatology and venereology, 26(9), pp.1176-1193.
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- Nordlund, J.J. and Lerner, A.B., 1982. Vitiligo: it is important. Archives of dermatology, 118(1), pp.5-8.
- Krüger, C. and Schallreuter, K.U., 2012. A review of the worldwide prevalence of vitiligo in children/adolescents and adults. International journal of dermatology, 51(10), pp.1206-1212.
- Spritz, R.A. and Andersen, G.H., 2017. Genetics of vitiligo. Dermatologic clinics, 35(2), pp.245-255.
- Zhang, X.J., Chen, J.J. and Liu, J.B., 2005. The genetic concept of vitiligo. Journal of dermatological science, 39(3), pp.137-146.
- Daniel, B.S. and Wittal, R., 2015. Vitiligo treatment update. Australasian Journal of Dermatology, 56(2), pp.85-92.
- Bishnoi, A. and Parsad, D., 2018. Clinical and molecular aspects of vitiligo treatments. International journal of molecular sciences, 19(5), p.1509.
- Tamesis, M.E.B. and Morelli, J.G., 2010. Vitiligo treatment in childhood: a state of the art review. Pediatric dermatology, 27(5), pp.437-445.
- Rosmarin, D., Pandya, A.G., Lebwohl, M., Grimes, P., Hamzavi, I., Gottlieb, A.B., Butler, K., Kuo, F., Sun, K., Ji, T. and Howell, M.D., 2020. Ruxolitinib cream for treatment of vitiligo: a randomised, controlled, phase 2 trial. The Lancet, 396(10244), pp.110-120.
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