The body of each person, like other living beings, is covered with a protective layer - dermis. This is the largest organ designed to protect soft tissues and internal organs from external factors. But the dermis is not just a thin layer, because the structure of the skin is complex. Moreover, each ball performs a number of functions and has its own characteristics. The dermis is a multifaceted organ that plays an important role in the normal functioning of the entire body.

The skin is a complex organ that is the outer covering of the body. It performs many functions and ensures the normal functioning of the whole organism.

Doctors have studied in detail the structure of the skin, highlighting 3 main balls:

Today, the structure and function of the skin is still being studied. After all, new technologies promise a lot of unexpected discoveries in the field of medicine and human anatomy.

Modern doctors distinguish such functions that the layers of the skin perform:

Protective.
The dermis protects the body from external factors, UV radiation and invasion of pathogens, as well as from imbalance in moisture.
Thermoregulatory.
Its implementation is carried out by the release of heat and sweat.
Maintaining water-salt balance.
This function is carried out by perspiration.
Excretory.
Its implementation is carried out by sweating. Metabolic products, salts and medicines come out with it.
Blood depositing process.
In the vessels located in the dermis, about 1 liter of this fluid is constantly circulating.
Participation in metabolism and endocrine processes.
Its implementation is carried out due to the synthesis of vitamin D and a number of hormones.
Receptor.
The dermis is one of the most sensitive organs. Its entire surface is covered with hundreds of thousands of receptors that receive information and transmit it to the cerebral cortex.
Immunological.
In the skin, the process of capture, processing and transport of antigen cells is carried out, which is necessary for the appearance of the body's immune response.

Modern biology distinguishes 2 types of dermis:

Thick.
It is rougher and covers the palms, soles of the feet. Its base is a thick epidermis with a layer of 400 - 600 microns. This type is characterized by the absence of hair and sebaceous glands.
Thin.
Its layer, consisting of the epidermis (thickness in the range of 70 - 140 microns), covers the entire body. This type of dermis includes hair follicles and secretory glands.

Modern biology has proven that the skin contains many layers, each of which has a specific meaning. Only such a unique structure allows the body to provide reliable protection from the outside world.

The epidermis in detail

These are the upper layers of the skin, which are the first obstacle to external influences. It is this protective layer that is called the epidermis. This ball consists of a stratified epithelium with a very specific structure. So, its upper layers consist of dead cells that form the stratum corneum, and living elements that carry out active division are located below.

As new cells appear, the old keratinized components are exfoliated and replaced. This is a simple biology called epidermal renewal. In addition to eliminating old cells, this process also involves the elimination of toxins, toxins accumulated in the lymph and blood.

They are absorbed by the cells and eliminated by exfoliation. Complete renewal of the epidermis (from the basement membrane to the stratum corneum) can last as long as 21 days (in young people) and up to 2-3 months.

This unique structure makes the layers of the epidermis impervious to water and its solutions. Accordingly, heat loss due to excessive humidification is avoided. At the same time, the membranes of epidermal cells contain a fairly large amount of fat. This allows cosmetics and drugs to penetrate through its layers and exert the necessary effect.

The structure of the epidermis suggests a complete absence of blood vessels. In this case, the nutrition of this layer is carried out at the cell-membrane level.

Modern biology has proven that the epidermis contains the same types of beneficial cells, depending on their functions:

Keratinocytes.
These are the elements that produce keratin. This function can be performed by different types cells: prickly, basal, granular. Keratin is responsible for the elasticity and firmness of human skin.
Corneocytes.
These are transformed non-nuclear keratinocytes filled with keratin. They rise into the upper balls, become flat and perform a protective function, being a reliable barrier between the human body and the outside world.
Ceramides or ceramides.
These are specific fats that hold corneocytes together. They absorb moisture and fats.
Melanocytes.
These cells determine the shade of the human skin. They also provide partial protection from radiation and infrared radiation, preventing harmful sun rays from passing deeper.
Particles of Langergens.
They actively protect the body from the invasion of microbes and bacteria through the skin.

Modern biology has proven the importance of the epidermis, but the study of the cells of this layer is still just beginning.

Also, doctors distinguish 5 layers of the epidermis:

The importance of the epidermis is difficult to overestimate. After all, it is thanks to this layer that we are protected from external influences. Also, the appearance of human skin depends on the epidermis.

Derma and its features

This term refers to the inner layer of the skin. It is protected from the epidermis by a basement membrane. A table from the network or textbooks on biology, anatomy will help to study the structure of these layers in more detail. The average thickness of this part of the skin is no more than 0.5 - 5 mm.

This part of the human protective cover is characterized by the presence of hair follicles, blood and lymphatic vessels, as well as nerve endings, secretory glands and receptors. Accordingly, the dermis performs protective, bactericidal and thermoregulatory functions of the skin.

This part includes the following layers:

Reticulate.
It is a loose connective tissue with a high content of extracellular matrix. The latter includes collagen, elastin, reticulin, and polysaccharides. In fact, it is the skeleton of the human skin.
Papillary.
This layer contains specific "papillae" that create a special pattern of the skin, including fingerprints.

It is the layers of the dermis that form the external state of the epidermis, making the skin healthy or damaged.

Subcutaneous adipose tissue and its purpose

This part of the skin is also called the hypodermis. It performs thermoregulatory and protective functions. In fact, it is subcutaneous fat that softens falls and reduces the risk of soft tissue injury and internal organs... It is located directly under the dermis and such features of the structure of the skin are very justified. After all, it is in the fatty tissue that the reserves of nutrients, including vitamins, are stored.

The thickness of this layer can be different. But don't think that less fat is better. Too thin a layer of fiber leads to rapid aging of the skin and the appearance of wrinkles, because it is this layer that serves as a support for the dermis and epidermis.

In adipose tissue, it produces estrogens - female hormones. Therefore, its increase is good for the fair sex and detrimental to men. Indeed, with an increase in the amount of estrogen in the blood, testosterone production automatically decreases, which leads to the development of sexual dysfunction and impotence.

Also, fatty tissue contains aromatase (the culprit in estrogen production) and leptin. The latter is responsible for appetite and the appearance of a feeling of fullness. This hormone is produced depending on the needs of the body. So, if the layer of subcutaneous adipose tissue is critically reduced, then the production of leptin increases. Therefore, you also need to listen to your body.

The skin is the largest human organ. It helps all living things to exist fully, stabilizing hormonal levels and protecting against a number of micro and macro dangers.

»Hyperkeratosis and acne
»Comedogenic cosmetics and acne
»Subcutaneous mite demodex
»Propionbacterium Propionibacterium acnes and Propionibacterium granulosum
»Irritated skin and acne
»Heredity and acne
»Nutrition and acne
»Medicines and acne
»Steroids and acne

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Anti-aging (anti-aging)

The structure and main functions of human skin

Human skin renewal period

Skin is a fabric: elastic, porous, durable, waterproof, antibacterial, sensitive, which can maintain thermal balance, protect from harmful effects of the external environment, secrete fat, ensure the integrity of the skin, produce odoriferous substances and recover (regenerate), as well as absorb some necessary chemical elements and reject others, to ensure the protection of our body from the adverse effects of sunlight.

Human skin pH 3.8-5.6.

There are approximately 5 million hairs on the surface of human skin. For every square centimeter of human skin, there are on average 100 pores and 200 receptors.

Which layers of the skin can be affected by cosmetics?

Since cosmetic (cosmeceutical products) can penetrate deeply, can cosmetics reach the dermis?

According to the laws of most countries, a cosmetic product can only have an external effect. This means that no cosmetic additives must reach and affect the living layers of the skin. Cosmetic preparations can and must interact only with dead skin substances and under no circumstances should they reach its living layers and, moreover, affect them. This is the purpose of cosmetics.

However, in the lower part of the epidermis there is no "shutter" that prevents the penetration of substances into the depths of the dermis (into the blood and lymph vessels). The presence of an effective exchange between the epidermis and the dermis is confirmed by experimental data. Substances that have overcome the transepidermal barrier, with a certain degree of probability, enter the bloodstream and, in accordance with this, are able to affect all tissues of the body.

What substances are able to penetrate deep into the skin, overcome the transepidermal barrier and enter the dermis?

It has been proven that deep into the skin penetrate: nicatin, caffeine, nitroglycerin, essential oils(they are enhancers, they are found in the bloodstream), Vit E is retained at the junction of the epidermis and dermis, hilaurionic acid reaches the dermis within 30 minutes after application, and then enters the bloodstream (source: Journal of Investigative Dermatology). Scientists from the University of Rochester (University of Rochester Medical Center) have come to the conclusion that the nanoparticles that make up sunscreens penetrate deep into the skin. Liposomes are nanoparticles that freely penetrate into the deep layers of the skin and deliver the necessary nutrients there.

Skin structure

The secret of the amazing multifunctionality of the skin lies in its structure. The skin is made up of 3 important layers:

1. The outer layer is the epidermis,
2. The inner layer is the dermis,
3. The subcutaneous base is the hypodermis.

Each layer has a specific function.

In different parts of the body, the thickness and color of the skin, the number of sweat, sebaceous glands, hair follicles and nerves are not the same.

It is believed that the thickness of the skin is only a few millimeters, but if the skin constantly needs protection, then it becomes thicker, this is a defense mechanism that everyone has. Therefore, in some places the skin is thicker, in some it is thinner. The soles and palms have a denser epidermis and a layer of keratin.

As for hairiness, for example, there are many hair follicles on the crown of the head, but not a single one on the soles. The tips of the fingers and toes contain many nerves and are extremely sensitive to touch.

The structure and properties of human skin: Epidermis

The epidermis is the upper stratum corneum of the skin, which is formed by the stratified epithelium. In the deep layers of the epidermis, the cells are alive, where they divide and gradually move to the outer surface of the skin. At the same time, the skin cells themselves die and turn into horny scales, which are peeled off and removed from its surface.

The epidermis is practically impervious to water and solutions based on it. Fat-soluble substances penetrate better through the epidermis due to the fact that the cell membranes contain a large amount of fat and these substances seem to "dissolve" in the cell membranes.

There are no blood vessels in the epidermis; its nutrition occurs due to the diffusion of tissue fluid from the underlying layer of the dermis. The intercellular fluid is a mixture of lymph and blood plasma flowing from the end loops of the capillaries and returning to the lymphatic and circulatory systems under the influence of heart contractions.

What cells does the epidermis consist of?

Most of the cells in the epidermis produce keratin. These cells are called keratinocytes (spiny, basal and granular). Keratinocytes are in constant motion. Young keratinocytes are born when the germ cells of the basement membrane, located at the border of the epidermis and dermis, divide. As they grow older, the keratinocyte moves to the upper layers, first to the prickly layer, then to the granular layer. At the same time, keratin, an especially strong protein, is synthesized and accumulated in the cell.

Eventually, the keratinocyte loses its nucleus and major organelles and turns into a flat "pouch" filled with keratin. From that moment on, it receives a new name - "corneocyte". Corneocytes are flat scales that form the stratum corneum (obsolete cells of the epidermis), which are responsible for the barrier function of the epidermis.

The corneocyte continues to move upward and, having reached the surface of the skin, exfoliates. A new one takes its place. Typically, the life course of a keratinocyte lasts 2-4 weeks. In childhood, the process of renewal of epidermal cells is more active, and slows down with age.

Corneocytes are held together by a plastic "cement" consisting of a double layer of special lipids - ceramides (ceramides). Molecules ceramides (ceramides) and phospholipids have hydrophilic "heads" (water-loving moieties) and lipophilic "tails" (fat-loving moieties).

Melanocytes are found in the basement layer of the skin (basement membrane) and produce melanin. These are the cells that produce the pigment melanin, which gives the skin its color. Thanks to melanin, the skin protects a person to a large extent from radiation: infrared rays are completely blocked by the skin, ultraviolet rays only partially. In some cases, the formation of age spots depends on the state of the basement membrane.

There are also special ones in the epidermis Langerhans cells, which perform the function of protection against foreign bodies and microbes.

How thick is the epidermis?

The thickness of the epidermis is approximately 0.07 - 0.12 millimeters (this is the thickness of a plastic film or paper sheet), especially rough skin of our body can reach a thickness of 2 mm.

The thickness of the epidermis is heterogeneous: it is different in different places of the skin. The thickest epidermis, with a pronounced stratum corneum, is located on the soles, a little thinner on the palms, and even thinner on the genitals and skin of the eyelids.

How many days does the complete renewal of the epidermis take place?

The appearance of the skin, its freshness and color depends on the condition of the epidermis. The epidermis consists of dead cells, which are replaced by new ones. Thanks to the constant renewal of cells, we lose about 10 billion cells per day, this is an ongoing process. During life, we shed about 18 kilograms of skin with keratinized cells.

When the skin exfoliates, it is cleansed - this is a necessary process of skin renewal, in which, together with dead cells, all substances harmful to the skin are removed: cells carry away dust, microbes, substances secreted by sweat glands (together with sweat, urea, acetone, bile pigments, salts, toxic substances, ammonia, etc.). and much more. The skin does not allow the army of microbes to reach us: during the day, our skin is attacked by 1 cm from 100 thousand, to several million of all kinds of microbes. However, if the skin is healthy, it becomes impervious to them.

The younger and healthier the skin, the more intensive the process of its renewal takes place. New cells push out old ones, old ones are washed away after we shower, wash, sleep, put on clothes. With age, cell renewal occurs less and less, the skin begins to age, wrinkles appear.

The epidermis is separated from the dermis by a basement membrane (it consists of elastin and collagen fibers) with a growth layer of continuously dividing cells, which gradually move from the basement membrane to the skin surface, where they then peel and fall off. The epidermis is completely renewed, exactly replacing with a completely new layer: a mole remains a mole, dimples remain dimples, freckles are freckles, cells reproduce with precision at the genetic level how the skin should look in accordance with the individual characteristics of each individual person.

The process of cell movement from the basement membrane to peeling and falling off the skin surface at a young age is equal to 21-28 days, and then occurs less and less often. Starting from about 25 years of age, the skin renewal process becomes slower and increases to 35-45 days by the age of 40 and 56-72 days after the 50-year milestone. This is the reason for the use of anti-aging and restorative drugs for a period of at least a month, and for a more mature age - at least 2-3 months.

The process of division and advancement of mature skin cells is not only slowed down, but also heterogeneous in different areas, which also affects the aesthetic appearance of the skin. If dead skin cells are layered, the process of cell division occurs more slowly, which leads to faster aging of the skin. In addition, the buildup of dead cells makes it difficult for oxygen and nutrients to penetrate the skin.

How many layers does the epidermis contain?

The epidermis consists of 12-15 layers of the stratum corneum. However, depending on the structure, the epidermis can be conditionally divided into five main zones (layers): basal, prickly, granular, shiny and horny. The upper (outer) layer of the epidermis consists of already dead cells without nuclei, the inner layer of living cells that are still capable of dividing.

Fragments of the stratum corneum, lustrous and granular layers that do not have the ability to divide can be attributed to dead skin structures, and, accordingly, the border between "living and dead" substances should be located somewhere in the spiny layer.

1. Basal layer of the epidermis (germ)

The basal layer is the innermost layer of the epidermis closest to the dermis. It consists of a prismatic single-row epithelium and a large number of slit-like spaces.

The bulk of the cells here are keratinocytes containing chromatin and melanin.

Between the basal keratinocytes, melanocytes are located, which contain a huge amount of melanin. Melanin is formed in these cells from tyrosine in the presence of copper ions. This process is regulated by the melanocyte-stimulating hormone of the pituitary gland, as well as catecholamines: adrenaline and norepinephrine; thyroxine, triiodothyronine and androgens. The synthesis of melatonin increases when exposed to ultraviolet radiation. Vitamin C plays a significant role in melanin synthesis.

Among the cells of the basal epithelium, there are few specific tactile cells (Merkel). They are larger than keratinocytes in size and contain osmiophilic granules.

The basal layer provides attachment of the epidermis to the underlying skin, and contains cambial epithelial elements.

2. Thorny layer of the epidermis (stratum spinosum)

Above the basal layer is the prickly one (stratum spinosum). In this layer, keratinocytes are located in several layers.

The cells of the prickly layer are large, their shape is irregular, gradually becoming flattened when approaching the granular layer. The cells of the spiny layer contain spines at the sites of intercellular contacts.

In the cytoplasm of spiny cells, there are keratinosomes - granules containing liids - ceramides. The cells of the prickly layer secrete outward ceramides, which, in turn, fill the space between the cells in the layers above. Thus, the stratified squamous keratinizing epithelium becomes impermeable to various substances.

In addition, there are also desmosomes - specialized cell structures.

Keratinocytes in the spiny layer contain very little chromatin, so they are paler. They have one feature: there are many special thin tonofibrils in their cytoplasm.

3. Granular layer of the epidermis (stratum granulosum)

The granular (keratohyaline) layer (stratum granulosum) consists of spiny keratinocytes and process epidermal cells. It is assumed that these cells are "wandering" epidermal macrophages that perform a protective function.

In the granular layer, there are from 1-3 on the palms and 5-7 on the soles of layers of flat cells, closely adjacent to each other. Their oval nuclei are poor in chromatin. A feature of the cells of the granular layer is a kind of grains in their cytoplasm, consisting of a substance similar in structure to DNA.

There are two main types of granules located in the cytoplasm of cells of the granular layer: keratoglian and lamellar. The former are necessary for the formation of keratin, and the latter ensure the moisture resistance of the skin by releasing special lipid molecules onto its surface.

4. Shiny (eleidin, transparent) layer of the epidermis (stratum lucidum)

The lustrous layer (stratum lucidum) is located above the granular. This layer is quite thin, and is clearly visible only in those areas where the epidermis is most pronounced - on the skin of the palms and soles.

It is not located on all areas of the skin, but only where the thickness of the epidermis is significant (palms and soles), and is completely absent on the face. Consists of 1-3 rows of flat cells, most of which do not contain nuclei.

Flat, homogeneous keratinocytes are the main cellular elements of this layer. The lustrous layer is inherently transitional from living epithelial cells to keratinized scales located on the very surface of human skin.

5. Horny layer of the epidermis (stratum corneum)

The stratum corneum is a layer of the epidermis in direct contact with the external environment.

Its thickness varies in different parts of the skin, and very significantly. The most developed is the stratum corneum on the palms and soles, much thinner - on the abdomen, flexor surfaces of the arms and legs, sides, skin of the eyelids and genitals.

The stratum corneum contains only thin anucleated cells tightly adjacent to each other. Horny scales are composed of keratin - a substance of albumin nature, which contains an excess of sulfur, but little - water. The scales of the stratum corneum are tightly connected to each other and provide a mechanical barrier for microorganisms.

The structure and properties of human skin: Dermis

Dermis is the inner layer of the skin, the thickness of which is from 0.5 to 5 mm, the largest on the back, shoulders, hips.

The dermis contains hair follicles (from which hair grows), as well as a huge number of the thinnest blood and lymphatic vessels that provide skin nourishment, contraction and relaxation of blood vessels allows the skin to retain heat (thermoregulatory function). The dermis contains pain and sensory receptors and nerves (which branch into all layers of the skin and are responsible for its sensitivity).

Functional glands of the skin are also located in the dermis, through which excess water and salts are removed (excretory function): sweat (produce sweat) and sebaceous (produce sebum). The sebaceous glands produce the required amount of sebum, which protects the skin from aggressive external influences: it makes the skin waterproof, bactericidal (sebum, together with sweat, creates an acidic environment on the skin surface, which adversely affects microorganisms). Sweat glands help maintain a constant body temperature without overheating by cooling the skin through sweating.

How many layers does the dermis contain?

The dermis includes two layers: the reticular and papillary layers.

The reticular layer consists of loose connective tissue. This tissue includes the extracellular matrix (we will talk about it in more detail below) and cellular elements.

The papillary layer protrudes into the epidermis and forms the dermal papillae. These papillae create a special, unique "pattern" of our skin and are especially clearly visible on the pads of the toes and the soles of our feet. It is the papillary layer that is responsible for the "fingerprints"!

The basis of cells in the dermis is fibroblast, which synthesizes extracellular matrix, including collagen, hyaluronic acid and elastin.

The extracellular matrix, what is it and what does it consist of?

The extracellular matrix sucking consists of two main components: the fibrillar part and the matrix.

Fibrillar part- these are collagen, elastin, and reticulin fibers that create the skin skeleton. Collagen fibers intertwine with each other, thus creating an elastic network. This network is located almost on the surface of the skin under the epidermis and constitutes a framework that gives the skin strength and elasticity.

In the face area, collagen fibers create a special dense network. The collagen fibers in it are so strictly arranged and ordered that they form the lines of least stretch. They are known as the Langer lines. They are known to cosmetologists and masseurs: they perform facial massage and apply any cosmetic products along Langer's lines. This is done in order not to burden the skin, not to stretch it, thus provoking the formation of wrinkles.

In youth, the frame made of collagen fibers is strong and able to provide mobility and flexibility of the skin, while maintaining its elasticity and shape. Unfortunately, our female age is short ...

I really liked the comparison of leather with a Soviet bed, which is based on metal grid... The iron springs of the new bed quickly return to their original position, but the springs of the frame begin to sag from the tension, and soon our bed loses its shape. Our skin also works - young springs (collagen fibers) keep their shape perfectly, but with age they sag and become flabby. No matter how great a mattress we style to the surface, it will not solve our problem.

Matrix (matrix or amorphous component) its structure resembles a gel and consists of polysaccharides. The best known polysaccharides are chitosan, seaweed polysaccharides, hyaluronic acid.

It is the components of the extracellular matrix, both amorphous and fibrillar, that create the skin from the inside. By themselves, saccharides do not form fibers, but they fill all the gaps between connective cells and fibers. It is through them that the interstitial transport of all substances occurs.

As a result, it is the state of the dermis (water content in the polysaccharide gel, the integrity of collagen fibers, etc.) that determines the state of the epidermis and healthy look skin.

The structure and properties of human skin: Hypodermis (subcutaneous fatty tissue)

The hypodermis - the subcutaneous base (fat layer), protects our body from excess heat and cold (allows us to retain heat inside us), performing the function of a thermal insulator, softens the fall from impacts.

Subcutaneous adipose tissue - the storage of vitamins

Fat cells are also a depot in which fat-soluble vitamins (A, E, F, K) can be stored.

Less fat, more wrinkles

Subcutaneous adipose tissue is very important as a mechanical support for the outer layers of the skin. The skin, in which this layer is poorly expressed, usually has more wrinkles and folds, and "ages" faster.

The more fat, the more estrogen

An important function of adipose tissue is hormone-producing. Adipose tissue is capable of storing estrogens in itself and can even stimulate their synthesis (production). Thus, you can get into a vicious circle: the more subcutaneous fat we have, the more estrogen is produced. This is especially dangerous for men, since estrogenic hormones suppress their production of androgens, which can lead to the development of hypogonadism. This leads to a deterioration in the functioning of the gonads and leads to a decrease in the production of male sex hormones.

It is very important for us to know that adipose tissue cells contain a special enzyme - aromatase. It is with its help that the process of estrogen synthesis by adipose tissue is carried out. Guess where the most active aromatase is located? That's right, in the fatty tissue on the thighs and buttocks!

What is responsible for our appetite and satiety?

Our adipose tissue contains another very interesting substance - leptin. Leptin is a unique hormone that is responsible for the feeling of fullness. Leptin allows our body to regulate appetite and, through it, the amount of fat in the subcutaneous tissue.

The skin plays a very important role in the body. It not only covers the entire body, protecting it from adverse conditions, but is also a powerful organ of touch, temperature and pain sensitivity, participates in thermoregulation of the body, in the release of metabolic products, in the formation of some biologically important substances.

Skin structure

In the structure of the skin, the upper section is distinguished - the epidermis, and the lower - the dermis, or the skin itself. On the surface of the dermis, there are many dermal papillae in the form of outgrowths, which give the border between the epidermis and the dermis a wavy appearance in cross section.

The epidermis protects the skin from adverse effects. It consists of several layers. The lowest layer of epithelial cells adjacent to the dermis is called the basal layer. Its cells are constantly multiplying, renewing the overlying layers, they also contain the pigment melanin, which determines the color of the skin.

The second bottom layer of the epithelium is called the styloid, its irregularly shaped cells are separated by styloid tubules. The next layer is granular; in the cells of the epithelium of this layer, the process of formation of the horny substance of the skin begins. The fourth layer is shiny, it has this name because of the gloss that keratin gives the cells. The uppermost layer is the stratum corneum, its cells are flattened, loosely adjacent to each other and constantly slough off.

The dermis, or skin itself, consists of two layers. The lower papillary layer contains connective tissue fibers - elastic, collagen and reticulin. Collagen fibers pass into the subcutaneous fatty tissue. The top layer of the dermis is called mesh. It is dominated by elastic fibers that give the skin firmness and elasticity. The dermis contains hair follicles, temperature, pain and tactile receptors, sweat and sebaceous glands.

Skin diseases

The health of the whole organism affects the condition of the skin. The condition of the skin suffers with concomitant diseases of the digestive, endocrine and hematopoietic systems, with insufficient intake of some important substances, with unfavorable environmental conditions.

Skin diseases can occur at any age.

With a congenital genetic disease ichthyosis, excessively dry skin is subject to the process of excessive keratinization. It constantly cracks, which causes severe pain.

With dermatitis, inflammation develops in the skin. Contact dermatitis occurs when damaging agents - chemical, physical, biological - are exposed directly to the skin. Such dermatitis develops at the site of contact, and the area of the lesion is proportional to the site of contact. This category includes dermatitis with hogweed burns, contact with detergents, etc.

Allergic dermatitis develops upon repeated contact with an allergen, and inflammation is caused by the effects of histamine in the skin. In this case, the reaction is usually disproportionate to the strength of the irritant, and even small amounts of the allergen can cause significant damage in area and intensity. An allergen can either come in direct contact with the skin or come from the digestive tract. Children are characterized by such an allergic skin disease as atopic dermatitis. In adulthood, it manifests itself in the form of neurodermatitis. These conditions are characterized by dry skin, flaking, redness and itching.

Hyperkeratosis is manifested by excessive keratinization of the outer layer of the epidermis. It is a non-inflammatory skin disorder. Normally, excessive keratinization of the skin occurs during post-traumatic healing. In this case, the upper layers of cells excessively protect the lower layers, which are restored at this time. The phenomena of hyperkeratosis are also found with prolonged solar irradiation. Symptoms indicating hyperkeratosis are a thick dense layer of keratinized skin, its tuberosity and peeling, painful thickening on the palms and soles, keratinization of hair follicles.

Calluses on hands and feet during physical work are a special case of hyperkeratosis. They protect the skin from excess pressure. Pronounced manifestations of calluses can be the cause of flat feet, deformities of the feet.

Impetigo is more common in children. It is an acute infectious skin disease caused by staphylococci and streptococci. It is highly contagious, especially when immunity is low. The symptoms of impetigo are:

Focal redness of the skin;
Small and large vesicles with purulent contents in them on a reddened surface;
The bubbles break open from damage;
A golden yellow crust forms at the opening site.

The danger of impetigo is that it can significantly spread and lead to inflammatory lesions of other organs and tissues, and subsequently rheumatism.

Skin care

The skin requires regular care. In modern life conditions, she experiences severe stress, and it is important to help her withstand unfavorable environmental factors.

Skin care should start with general measures that will be beneficial for the whole body as well:

Get regular and adequate sleep;
Compliance with the regime of work and rest;
Healthy and proper nutrition.

It is important to cleanse the skin daily from sweat and sebaceous secretions, dust, dead epidermis. A daily shower will help to make it clean, and if you also alternate between hot and cold water, you will get a workout for the blood vessels, as well as a general hardening of the body.

Facial skin care requires a more subtle approach. The skin of the face is thin and delicate, and with improper cleansing it can sag, become flabby.

With dry skin, it is advisable to wash your face with cool water using cleansers that do not contain soap, which dries the skin very much, washing off the protective lipid layer from it. Movement when washing or cleansing with cosmetic milk should be in the direction of the so-called massage lines. After washing, the skin is toned using special tonics. At night, excessively dry skin is moisturized with a cream, it is better to remove the excess with a cotton swab after 15 - 20 minutes.

For oily skin, it is better to use warm water for washing, since hot water enhances the secretion of sebum by the glands, and cold water does not sufficiently cleanse the skin. Oily skin must be cleansed at least 2 times a day.

For oily skin, it is especially helpful to use facial toners. To regulate the work of the sebaceous glands, dermatologists recommend doing therapeutic masks for oily skin 1 - 2 times a week.

A differentiated approach to cleansing and moisturizing the skin will make it beautiful and healthy, prolonging its youthfulness.

- skin type caused by excessive activity of the sebaceous glands and characterized by a rough texture, unhealthy color and shine. Owners of oily skin are faced with enlarged pores, comedones, cysts of the sebaceous glands, acne, manifestations of seborrhea. Oily skin requires increased attention to existing problems, a specific diet, proper home and professional care (cleaning, masks, peels, mesotherapy), competent selection cosmetics... To find out the causes of oily skin, consultations of a cosmetologist, dermatologist, endocrinologist are necessary.

General information

Oily skin is a type of problem skin characterized by increased oiliness and a shiny appearance. Depending on the secretory activity of the sebaceous glands in cosmetology and dermatology, it is customary to distinguish 4 types of skin: normal, dry, oily, combined (mixed). It should be noted that by itself, each skin type is a variant of the norm and cannot be considered as a disease. At the same time, different types of skin have their own characteristics, advantages and disadvantages, and therefore require a differentiated approach. Typically, skin type changes with age; in addition, the constant use of various cosmetics and make-up can create a false impression of the true characteristics of the skin. Oily facial skin is one of the most common types and is more prone to the appearance of various dermatological problems. That is why oily skin needs a special daily hygienic and competent professional care.

Causes of oily skin

Most often, oily skin occurs in adolescence and young age and by the age of 25-30 it turns into another type (usually combined). Only 5-8% of people remain owners of oily skin for life. The immediate cause of increased fat content of the skin is the increased work of the sebaceous glands, which, in turn, can be caused by hereditary characteristics, hormonal imbalance, gastrointestinal tract disorders, poor nutrition, and improper skin care.

The presence of oily skin can be genetically predetermined - in this case, the skin type does not change with age. In such a situation, the main efforts should be directed to ensuring correct daily care and rational selection of cosmetics. The causes of the endocrine order are primarily associated with puberty, during which the amount of testosterone increases, which contributes to an increase in the size of the sebaceous glands and increased sebum production. The function of the sebaceous glands is also influenced by other hormones, for example, adrenaline, the level of which in the blood rises in people under stress. In women, increased oily skin can be observed with prolonged or uncontrolled use of hormonal contraceptives, polycystic ovaries, less often during pregnancy or menopause. Oily facial skin combined with general dryness of the skin is characteristic of hypothyroidism.

Among the alimentary reasons that contribute to the appearance of oily skin, it is necessary to highlight the abuse of fatty or spicy foods, as well as flour products, sweets, fast food, carbonated drinks, alcohol. Quite often, people with oily skin suffer from diseases of the gastrointestinal tract (cholecystitis, colitis, constipation, etc.). Long-term stay and work in dirty and dusty rooms has its negative role on the skin condition.

A typical mistake of owners of oily skin is overly active and aggressive cleansing of the skin with the help of alcohol-containing cosmetics and scrubs. Regular degreasing of problem areas of the skin with tonics and lotions only aggravates the problem: in response to the removal of the surface lipid layer, the epidermis reacts by increasing the secretion of glandular secretions. Frequent mechanical cleansing and peeling of the face causes micro-trauma to the epidermis and intense production of sebum. The use of inappropriate creams and skin care products can also exacerbate the problem of oily skin.

Characteristics of oily skin

Most often, oily skin is localized in the so-called T-zone, which includes the forehead, nose and chin. Outwardly, oily skin looks shiny, oily, untidy, thick, and rough, often having an uneven surface, a dull color and a grayish tint. Makeup does not adhere well to oily skin; tonal creams and powders remove oily shine only for a while. Plots problem skin are also found on the body, usually in the chest and back; oily skin on the face and body is often combined with oily hair.

Insufficient cleansing of the skin from excess sebum leads to the fact that the sebaceous secretion, together with dead skin scales and dust, clogs the pores and contributes to their funnel-shaped expansion. Often, oily, porous skin looks like an orange peel. In addition to excessive shine and enlarged pores, oily skin is prone to the formation of comedones (black plugs in the openings of the sebaceous glands) and milia (whiteheads), acne. Vascular networks (telangiectasias) are more often visible on it. If, against the background of increased production of sebum, its qualitative composition also changes, such a pathological condition as seborrhea arises.

Despite all the disadvantages of oily skin, it also has certain advantages. So, it retains moisture better, and, therefore, is more protected and less sensitive to the effects of various adverse atmospheric factors (wind, sunlight, low temperatures). Due to this, this type of skin is less susceptible to photoaging, retains its elasticity longer, and age-related wrinkles appear later in women with oily skin than in women with other skin types.

If on oily skin long time inflammation persists, you should consult a dermatologist to exclude demodicosis. To find out the reasons for increased oily skin, you may need to consult and examine a dermatologist, gastroenterologist, endocrinologist, gynecologist-endocrinologist.

Features of care for oily skin

The main tasks of oily skin care are to remove excess sebum, open pores, and reduce the activity of the sebaceous glands. First of all, it is necessary to minimize or completely eliminate the negative effect on the skin (refuse to use alcohol-containing lotions, fatty creams, frequent skin scrubbing, etc.). It is categorically unacceptable to leave decorative cosmetics on the skin overnight. The basis of the diet of the owner of oily skin should be lean meats, fish, vegetables, fruits, bran, cereals; spices, smoked meats, baked goods and pastries, sweets should be limited as much as possible. Food should be rich in vitamins, especially group B.

It is advisable to divide the care of oily skin itself into home and professional. Daily self-care for oily skin involves cleansing, moisturizing and nourishing procedures. First of all, you need to wash your face twice a day using a special foam, gel and mousse for oily skin. As a rule, such agents have anti-inflammatory and sebum-regulating effects, but do not dry out the skin. When washing your face, you should not use a washcloth or sponge, or hot water, as these products will further stimulate the secretion of sebum. It is preferable to lather the skin with a cotton pad or fingertips, and rinse off the cleanser with warm or cool water. ethnoscience recommends for oily skin washing and steam baths with decoctions of herbs (chamomile, linden blossom, horsetail, mint, nettle) while taking these infusions inside.

A more thorough cleansing of oily skin by means of cosmetic peeling can be carried out once - maximum twice a week. In addition to a scrub, you can use peeling-gommage for deep cleansing of the skin: such film masks effectively remove dead horny cells, dust particles and excess sebum without injuring the skin. Once a week, it is useful to do clay masks with an absorbent effect, or fruit masks with a tightening effect.

After washing, the face must be blotted with a soft towel or napkin and wiped with a toner for oily skin - such products contain disinfecting, sebum-regulating and pore-tightening components. The finishing chord of your daily care for oily skin is the application of a cream designed for this type of skin. Usually creams, emulsions or hydrogels for oily skin are liquid and absorb quickly without leaving a shiny sheen.

When choosing decorative cosmetics for daytime make-up it is necessary to pay attention to the quality, composition of products and recommendations for use from manufacturers. For oily skin, it is better to choose light foundations, foundation creams and powders with a matte effect, which eliminate excess shine. You should refuse to use cream blush and eye shadow, liquid eyeliners - otherwise, the cosmetics may "float" on the face in a couple of hours after application.

Leather I Skin (cutis)

The skin is involved in the processes of immunity. Distinguish between nonspecific, which does not depend on previous infections or vaccinations, which forms when the skin is exposed to UV radiation, and specific, which develops when agents penetrate into K., to which it is especially sensitive, for example, the causative agent of anthrax. The skin has low electrical conductivity, and its electrical resistance, especially of the stratum corneum, is high. Electrical resistance decreases in wet areas of K., especially with increased sweating, as well as in persons with a predominance of parasympathetic tone. nervous system... The electrical resistance depends on physical properties K., the functional state of the sebaceous and sweat glands, blood vessels K., nervous and endocrine systems.

Through the skin (excluding K. of the head) secretes 7-9 G carbon dioxide and absorbs when t ° 30 ° 3-4 G oxygen, which accounts for about 2% of the total gas exchange in the body. Cutaneous respiration increases with an increase in ambient temperature, during physical work, an increase in barometric pressure, during digestion, acute inflammatory processes in the skin, etc. Cutaneous respiration is closely related to redox processes, the activity of sweat glands, rich in blood vessels and nerve fibers.

The absorption function is complex and not well understood. through K., water and dissolved salts in mammals practically does not occur due to the presence of shiny and stratum corneum impregnated with lipids. Fat-soluble substances are absorbed directly through the epidermis, and water-soluble substances are absorbed through the hair follicles and through the excretory ducts of the sweat glands during the period of inhibition of perspiration. Gaseous (for example, carbon dioxide) and some substances that dissolve and dissolve in them (chloroform, ether, etc.) are easily absorbed. Most toxic gases, except for skin blisters such as mustard gas, lewisite, do not penetrate through K.. Morphine, ethylene glycol monoethyl ether, dimethyl sulfoxide and other substances are easily absorbed, in small amounts.

The excretory function of K. is carried out by the sweat and sebaceous glands. The amount of substances secreted through K. depends on gender, age, topographic features of the skin (see Sweat glands , Sebaceous glands) . In case of insufficiency of the function of the kidneys or liver through K. of such substances, which are usually excreted in the urine (, bile pigments, etc.), increases. occurs synchronously in different parts of K. under the control of a c.s.s. Sweat contains organic matter (0.6%), chloride (0.5%), impurities of urea, choline, volatile fatty acids. On average, from 700 to 1300 are allocated per day ml sweat. sweat depends on the temperature of the environment, the state of K., the intensity of the basal metabolism, etc. Sweating increases with an increase in the temperature of the environment, dry air, hyperemia K.; during sleep or anesthesia, it sharply decreases and even stops. The sebaceous glands consist of 2/3 of water, and 1/3 of analogs of casein, cholesterol and some salts. With it, free fatty and unsaponifiable acids, metabolic products of sex hormones, etc. are released. The maximum sebaceous glands are observed from puberty to 20-25 years. The skin acts as a filter that prevents excess water from reaching the surface.

The pigment-forming function of K. is the production of melanin. This is produced by melanocytes, which contain specific cytoplasmic organelles - melanosomes, on the protein matrix of which melanin is synthesized from tyrosine under the action of tyrosinase. It is deposited as a melanoprotein complex. Melanogenesis is regulated by the melanocyte-stimulating hormone of the pituitary gland. the skin is mainly caused by the deposition of melanin. However, human K. contains other pigments - melanoid, oxyhemoglobin and reduced. Impaired pigmentation leads to hyperpigmentation (for example, in Addison's disease) or depigmentation (and others).

Among the nerve fibers innervating blood vessels K., adrenergic and cholinergic are distinguished. Neurohumoral factors constantly exert a regulatory influence on blood vessels. , norepinephrine and the posterior lobe of the pituitary gland cause vasoconstriction, while acetylcholine and androgens dilate them. Normally, most of K.'s blood vessels are in a semi-contracted state, the blood flow rate in the capillaries is insignificant; it varies greatly depending on local and general reasons. The dilated blood vessels of the dermis can accommodate up to 1 l blood (depositing role of the skin); their rapid expansion can lead to significant circulatory problems.

K. plays a very important role in thermoregulation of the organism. The production of heat energy in the body due to thermoregulation is maintained at a certain level despite fluctuations in ambient temperature (see Thermoregulation) . 80% occurs through K. by radiation, heat conduction, and due to the evaporation of sweat. Fatty lubrication of the surface of K. and poor thermal conductivity of the subcutaneous tissue prevent both excess heat or cold from the outside and excessive loss of heat.

Heat regulation is a complex reflex act in which the brain (thermoregulation centers) and sympathetic are involved; it is also influenced by the vasomotor and respiratory centers, sweating, adrenal glands, pituitary gland, thyroid and gonads. K.'s temperature depends on the time of day, food intake, the intensity of sweating and sebum secretion, muscle work and the age of a person. A person emits about 2,600 calories of heat per day, children are slightly more. K.'s temperature in different parts of it is not the same (from 31.1 to 36.2 °), the highest temperature in the skin folds is up to 37 ° in the norm.

The skin plays an important role in metabolic processes. In addition to gas exchange during cutaneous respiration, intermediate carbohydrate, protein, fatty, salt, and vitamin processes occur in K.. In terms of the intensity of water, mineral and carbon dioxide metabolism, K. is slightly inferior to the liver and muscles. To. Faster and easier than other organs, accumulates and gives up a large amount of water. Through K. water is released twice as much as through the lungs. Metabolic processes and acid-base balance depend on many factors, including on human nutrition (for example, when acidic food is abused in K., the sodium content decreases). To., Especially subcutaneous tissue, is a powerful depot of nutrient materials that are consumed by the body during fasting.

The skin is a huge receptor field through which the body's connection with the environment is carried out. She participates in various reflex reactions - to the cold, high fever and others, as well as in the plantar, pilomotor and other reflexes. Exteroceptors K. perceive various external stimuli, which in the form of a nerve impulse are transmitted to the c.ns. There are different types of skin sensitivities. Pain occurs when exposed to mechanical, thermal stimuli and electric current, temperature - cold and heat irritants. Tactile sensitivity (see Touch) is most pronounced on the pads of the fingers, in K. of the external genital organs, in the nipple area, where there is the greatest number of highly differentiated nerve endings. Its variant, obviously, is hair sensitivity K., which arises when touching the hair and depends on irritation of the complex basket-like nerve plexus of the hair follicle. Complex types of sensitivity include a sense of place (localization), stereognostic, two-dimensional spatial and a sense of separation (discriminatory sensitivity).

Different parts of K. do not perceive the same thing in the same way. It is believed that 1 cm 2 the skin has 100-200 pain points, 12-15 cold, 1-2 heat and about 25 pressure points. Most of the cutaneous receptors are polyvalent in function. Under the influence of various environmental factors, the number of functioning sensory receptors can change, It develops, especially to tactile and temperature irritations. the weakest to painful irritations.

Unconditioned and conditioned skin plays an important role in the life of the body. Newborns have congenital unconditioned skin reflexes - sucking and grasping. Distinguish between skin and skin reflexes (irritation and response occurs to K.), muscle-hair, unconditioned vasomotor - reflex Dermographism , vasomotor reactions in response to intradermal administration of adrenaline, histamine, etc. Musculocutaneous reactions include abdominal, cremaster reflex, plantar. There is also a galvanic skin reflex, a reflex to. The impulses coming from the skin receptors support normal muscles. Musculocutaneous reflexes are of great importance in human labor activity, especially in the automation of movements, the accuracy of which is developed as a result of differentiation of skin and visual sensations, combined with proprioceptive ones coming from muscles and tendons. Painful irritations To. Are accompanied by a change in the secretion of the pituitary gland, an increased release of adrenaline, inhibition of the digestion process, a change in the biocurrents of the brain. There are also skin-respiratory, skin-vascular and other skin-visceral reflexes. Well-known reflex, which occurs not only at the sight of blood-sucking insects, but even at the mere mention of them, conditioned reflex (the so-called erythema of shame, anger), "goose bumps". The same conditioned reflex mechanism underlies hemorrhages, blisters, and even blisters caused by suggestion.

Structural proteins have been identified in the skin: reticulin, and keratin. concentrated mainly in the dermis, it makes up about 70% of the skin devoid of water and fat (see collagens) . Reticulin and elastin are contained in K. in much smaller quantities, they form the basis of reticulin and elastic fibers of the dermis, connective tissue membranes of the sebaceous and sweat glands, are part of the membrane of hair follicles. Keratin is the basis of the stratum corneum K. In its cells ends (the process of formation of the stratum corneum in the epidermis), which begins in the basal epidermal cells. The skin also contains protein breakdown products: uric acid, and creatinine, ammonia, etc. In the skin there are three times more of them (up to 150 mg%) than in the blood; especially a lot of them accumulate in pathologically altered areas of K. with the predominance of decay processes. The formation of the horny substance is regulated by genetic mechanisms, as well as by the endocrine and immune systems. Violations of keratinization () are observed in skin tumors, Daria's disease, etc. A significant part of K.'s cells, as well as other cells of the body (especially their nuclei), are nucleoproteins and (and RNA).

Of carbohydrates, K. contains glycogen and glycosaminoglycans. With the depolymerization of glycosaminoglycans (for example, with an increase in the activity of hyaluronidase), the gels formed by them decrease, and so on. K. rises for microorganisms and various toxic products, in K. it is formed and accumulates in mast cells; it plays an important role in the regulation of microcirculatory processes.

A variety of lipids are found in and on the skin. Neutrals make up the bulk of the subcutaneous tissue. They are dominated by the most low-melting triglyceride - triolein (up to 70%), in connection with which the human has the lowest melting point (15 °). On the surface of K., lipids mix and form.

The water content in Kazakhstan ranges from 62 to 71%. The skin is rich in enzymes, the most important of which are phosphorylase,. The mineral constituents of K. account for 0.7 to 1% of its dry weight, and in the subcutaneous tissue - about 0.5%. The skin is an important depot of sodium, potassium, calcium and other trace elements. For the normal state of K., zinc, arsenic, and some others, which are part of enzymes, vitamins, or play the role of activators of biological processes, are most important.

The skin is involved in the body's metabolism; it deposits blood, lymph, tissue metabolism products, macro- and microelements; due to the fact that proteins are temporarily delayed in K., their toxic effect on other organs is weakened. K. frees the body from excess water, toxic metabolites, which improves thermoregulation processes, increases barrier, bactericidal, and other functions. Separate stages of the chemical transformation of a number of substances that take part in metabolic processes occurring in other organs and tissues of the body take place in the skin. It forms sebum and.

Violation of protein metabolism leads to the development of gout (Gout) , Amyloidosis , Porphyrias , mucinosis of the skin (deposition of mucin in K.) and other diseases with pronounced changes in K. Violation of lipid metabolism is the cause of lipidosis (Lipidosis) . Changes in carbohydrate metabolism, accompanied by the accumulation of blood and K., lead to necrobiosis lipoid (necrobiosis lipoid) , contribute to the occurrence of furunculosis (see Furuncle , chronic pyoderma and other diseases K. Deviations and activity of enzymes are noted in dermatoses, for example, eczema (Eczema) , Neurodermatitis , Psoriasis .

Metabolism in K. is influenced by nervous and hormonal factors. Dysregulation of biochemical processes at the cellular and intracellular levels play an important role in the occurrence of skin diseases. In particular, an important pathogenetic mechanism of psoriasis is a violation of the cellular regulatory system adenylcyclase - cyclic.

Lack of vitamin A plays a role in the development of Ichthyosis a , seborrhea (seborrhea) , Defeat the disease (Defeat the disease) , dystrophy of nails (see. Nails), etc. Lack of vitamin PP causes the development of pellagra (Pellagra) with severe skin lesions, and vitamin C - scurvy (scurvy) . The pathogenesis of neurodermatitis is associated with a lack of B vitamins, especially B 6. In the pathogenesis of some skin diseases, violations of water and mineral metabolism are important. Shifts in acid-base balance affect the bactericidal functions of the skin. In adults, the pH of the skin surface is 3.8-5.6: in women, this indicator is slightly higher than in men. In the armpits, inguinal-femoral folds, sweat has a slightly alkaline or slightly acidic reaction (pH 6.1-7.2). Pronounced shifts in pH towards an alkaline reaction contribute to the occurrence of mycoses (Mycoses) . In addition to the biochemical processes common to the body, transformations inherent only to it occur in K.: the formation of keratin, melanin, sebum, and sweat.

With slowly developing acidosis, intercellular edema occurs (), manifested by multi-chambered vesicles (see Rashes) . When intercellular communication is disturbed, unicameral intraepidermal bubbles are formed. Coagulation and collisional cell death (see Necrosis) leads to erosion that heals without a scar or ulcer (Ulcer) , penetrating into the connective tissue part of K. and healing with the formation of a scar.

Often K.'s inflammation is accompanied by the development of purulent exudate and the formation of pustules (see. Rashes) . With productive inflammation, a cellular one with a dermal papule or tubercle is formed (with specific inflammation). , resolving without necrosis, ends with cicatricial atrophy, and disintegrating - with a scar. Chronic granulomas constitute a special group of inflammatory processes. Inflammatory infiltrate in the dermis, disrupting, causes the appearance of various secondary changes in the epidermis (edema, atrophy, etc.). Inflammation of the subcutaneous tissue is manifested by edema, the formation of a node or diffuse infiltrate. Inflammation To. Can occur as a result of hypersensitivity to a strictly defined antigen (see.Allergy) , in other cases it is not specific and is caused by any strong stimulus.

K.'s condition is associated with the condition of the whole organism. Nephropathies are often accompanied by the so-called cutaneous uremia caused by azotemia, oxalemia, and urea retention. Focuses of chronic infection (in the tonsils, teeth, etc.) can be the cause of a number of dermatoses. Often a backdrop for the onset and development of eczema, urticaria (urticaria) , neurodermatitis, circular hair loss are neurovegetative disorders. After mental trauma, red flat, psoriasis, etc. often appear. The skin reacts to disruption of the endocrine system. So, a disorder of the thyroid gland function contributes to the development of myxedema of the skin, increased sweating, itching, urticaria, eczema, etc.; dysfunction of the ovaries - chloasma (see Dyschromia of the skin) ; adrenal gland disease - hirsutism (see Viril syndrome) , increased pigmentation; diseases of the pancreas are accompanied by persistent furunculosis, etc.

Certain (for example,) atmospheric factors (long-term, wind, cold, etc.), mechanical, physical, and chemical influences can have an adverse effect on K.. Stagnation in the circulatory system contributes to the occurrence of varicose ulcers, etc.

A variety of factors affecting K., the complexity of its morphological structure and a wide range of functions performed determine a large number of skin diseases (about 2 thousand different forms), the classification of which has not been finally developed (see Dermatoses) .

A large group is made up of K.'s lesions associated with hereditary factors (see Genodermatoses) or which are congenital malformations of the fetus as a result of adverse effects in the processes of embryogenesis (intrauterine intoxication, infections, circulatory disorders, etc.) K., due to genetic factors, are very diverse ; often they wear a family one. Congenital malformations and developmental anomalies not associated with genetic factors are more rare. Part of malformations To. Are abortive manifestations of more complex congenital defects: swimming membranes - an abortive form of syndactyly (see Brush) , sacral hypertrichosis is a latent manifestation, congenital sinuses and cysts on the neck and face are the result of incomplete closure of congenital fissures, additional breast nipples are incomplete gynecomastia, etc.

With other congenital anomalies of K., the main disturbances in the development of the fetus are concentrated in K. Thus, the congenital absence is known - K., accompanied by the underdevelopment of K.'s appendages and teeth (congenital ectodermal). Congenital aplasia of the skin (defect of the epidermis and dermis) is characterized by the presence of ulcers in the child at birth up to 10 cm in the parietal, occipital or posterior auricular region of the head. Congenital defect K. is formed in the fetus in the form of a bullous lesion (bladder), by the time the child is born, it forms in the place of the bladder. Gradually, it closes, leaving behind a cicatricial atrophy. Congenital aplasia K. can be combined with a defect of the bones of the skull. With other types of aplasia K., areas devoid of skin can be located on the body, limbs. They are covered with a thin membrane through which the underlying organs and tissues are clearly visible.

Such congenital anomalies as rubber hyperelastic K., imperfect desmogenesis, pachyderma are associated with changes in connective tissue. The number of developmental defects includes birthmarks, angiomas, lymphangiomas, varied in clinical forms.

A large group is made up of diseases caused by damage to K. - mechanical (for example, abrasion, callousness , Intertrigo) , beam, incl. ionizing radiation(see Dermatitis , Photodermatosis) , exposure to electric current, high and low temperatures (see Burns , Frostbite) , as well as various chemical and biological factors.

Inflammatory lesions of K. may be based on allergic reactions of the body, changes in the nervous and endocrine systems (see.Toxidermy , Hives , Eczema , Neurodermatitis , Pruritus, etc.). Skin is often affected by diffuse connective tissue disorders (see table Diffuse Connective Tissue Disorders) , Sarcoidosis , vasculitis of the skin (vasculitis of the skin) , metabolic disorders in the body (see Lipidosis , Amyloidosis , Calcification , Xanthomatosis, etc.).

Pathological processes in K., associated mainly with individual morphological structures of the skin, - see Hair , Nails , Sweat glands , Sebaceous glands .

Skin tumors... According to the WHO histological classification (1980), among tumors K. distinguish between skin, benign, precancerous (precancerous) skin diseases, tumors with local growth and malignant tumors. By origin, epithelial, pigment and connective tissue tumors of the skin are isolated.

Malformations of the skin. These include papillomatous, comedogenic nevus, epidermal cyst, hair cyst, dermoid cyst (see Dermoid) , whiteheads, atheroma, etc.

Papillomatous malformation is characterized by the appearance of warty papillomatous growths (hyperkeratotic nevus) from the moment of birth or in early childhood in any area of K. A limited form is distinguished in the form of a dense grayish-brown focus and a multiple form, in which the lesions may tend to orderly localization (along the Zakharyin-Ged zones). often combined with other skin malformations (pigmented nevus, nevus of the sebaceous glands).

Comedonic nevus is localized mainly on the limbs and trunk. It is within which follicular papules are closely grouped. The central part of the papules is penetrated with dark gray or black horny masses (preserved after their removal).

Seborrheic keratosis, or seborrheic, occurs more often in the elderly (after 40 years); localized in closed areas of the skin, for example, the trunk ( rice. 3 ). It is characterized by the appearance of sharply hyperpigmented (from brown to black) plaques, often multiple, with a diameter of 0.5-4 cm and more, covered with easily removable greasy crusts.

Benign epithelial tumors can originate from sweat glands, hair follicles, and sebaceous glands. Benign tumors of the sweat glands are papillary, eccrine pore, papillary, eccrine spiradenoma, etc.

Papillary hydradenoma is a solitary mobile tumor of the apocrine gland. It is found mainly in women, localized in K. of the external genital organs, as well as in the perineum. Has a soft texture and large size (4-6 cm). Usually grows slowly.

Eccrine poroma is a tumor of the intradermal duct of the eccrine sweat gland. It is localized mainly on the plantar surface of the feet, on the palms, the inner surface of the fingers. It is a single flattened tumor formation in the form of a plaque with a diameter of 10-20 mm with a smooth or hyperkeratotic surface of pink or dark brown... Eccrine poroma is painless on palpation; may ulcerate.

Papillary syringocystadenoma () - excretory duct of the sweat gland. It is, as a rule, a nevoid formation. It is rare, usually in children and adolescents. It is located more often on the scalp, neck, groin and axillary folds. It looks like a single or multiple tumor-like formations of dense consistency, grayish or grayish-yellow in color with papillomatous growths on the surface.

Eccrine spiradenoma is a tumor that develops from the glomerular part of the sweat glands. It is rare, more often observed in young men. It is localized, as a rule, on K. of the face, the front surface of the body. It is a dark yellow or bluish-red color, dense consistency, sometimes painful on palpation.

Benign epithelial tumors of the hair follicle include cylindroma, trichoepithelioma, etc., localized on the face and scalp (the so-called turban tumor). It is a large tumor with a smooth surface ( rice. 4 ), characterized by progressive growth, a tendency to relapse after surgical excision.

Trichoepithelioma is multiple and single. The plural form is more common in childhood - hereditary. Numerous small nodules are located mainly on the face ( rice. 5 ), sometimes the scalp, neck, front surface of the body. The solitary form occurs mainly in adults - actually trichoepithelioma. It is localized on any part of the body, usually on the face.

A benign tumor is a true adenoma of the sebaceous glands. It is very rare, mainly in old age. It looks like single, dense, round, sometimes nodules or knots sitting on a leg.

Fibroma can appear on any part of K. Distinguish between hard and soft fibroids. Solid fibroma has a wide base, dense texture, smooth surface, color normal skin or slightly pink. This is a limitedly mobile tumor that rises above the surface of K. Soft fibroma is multiple and single. It is localized mainly on the neck, the front surface of the chest, in the groin folds and armpits. It looks like a bag-shaped hanging tumor of various sizes with a wrinkled surface of pinkish or brown color.

Dermatofibroma can be single ( rice. 6 ) and plural. It is found, as a rule, in women, on K. of the upper and lower extremities. dense consistency, dark brown, round shape deeply located in K. often does not protrude above its surface.

A bulging dermatofibrosarcoma is a locally invasive tumor. It occurs more often in men in the area of the shoulder girdle, on the head. It can be single and multiple. protrudes above the surface of K., has a smooth, bumpy surface that can ulcerate. Characterized by a slow and a tendency to develop relapses after excision.

Hemangioma develops from blood vessels. Allocate capillary ( rice. 7 ), arterial, arteriovenous and cavernous ( rice. eight ) forms (see. Blood vessels , tumors). A special form of hemangioma is pyogenic granuloma ( rice. nine ). It arises as a result, is localized on the face, more often in the area of the lips, on the upper limbs. It is a dark red tumor on a pedicle or broad base with an erosive surface.

Lymphangioma is a tumor arising from the lymphatic vessels. It is often detected from birth. It is localized on any part of the skin. Combines with hemangioma. Distinguish between capillary, cystic and cavernous forms. Against the background of cystic and cavernous lymphangiomas, areas of papillomatosis and hyperkeratosis may develop. Secondary lymphangioma can be a manifestation of lymphostasis, sometimes appears after an infectious disease (for example, erysipelas).

Leiomyoma is a tumor arising from the muscles that lift the hair. There are 3 clinical types: multiple leiomyoma, solitary leiomyoma on the genitals and nipples, and angioleiomyoma, which develops from small blood vessels K. Multiple leiomyoma is characterized by the appearance of small tumors on the trunk and limbs (3-5 mm in diameter) round in shape, with a smooth surface, painful on palpation, with a tendency to grouping. Solitary leiomyoma has a size of up to 20 mm in diameter; erythema is observed around the lesion. - solitary tumor of deep red color, dense elastic consistency. It is often localized in the area of large joints.

Lipoma - tumor of adipose tissue in the form of single or multiple foci. Localized in any part of K., towering above its surface. Has, as a rule, large sizes (up to 10 cm in diameter), doughy consistency, normal skin color. A variant of the lipoma is symmetrical multiple (Derkuma), characterized by the appearance mainly on the upper extremities of lesions that are painful on palpation.

Various forms of a pigmented nevus and belong to benign pigmentary tumors K. Pigmented nevi are characterized by the appearance on K. of spots or neoplasms consisting of nevus cells. They appear after birth or in the first years of life; sometimes appear in adolescence and middle age under the influence of sunlight or during pregnancy. Pigmented nevi - spots or flat nodules of dark gray, brown or black color, elongated or rounded, 1 in diameter cm and more ( rice. ten ). The surface of the pigmented nevus is often smooth, but sometimes there are papillary warty growths. In some cases, a large nevus occupies a significant part of the body, face, neck, or extremities and represents a cosmetic defect (giant pigmented nevus). Hair often grows on its surface. Sometimes the nevus is blue - a blue nevus. It is more common in women on the face and forearms. A variety of blue nevus is Mongolian. It occurs mainly in persons of Asian descent 1–2 days after birth, usually in the lumbosacral region. Has a bluish or brownish color, up to 10 cm and more. After 4-5 years, the stain gradually fades and disappears.

Ota's nevus is more often observed in women - representatives of Asian peoples. It can be congenital or appears in the first years of life. It looks like a pigment spot located on the face along the I and II branches of the trigeminal nerve (, the zygomatic region, the wings of the nose, as well as the sclera and eyes). There is also Sutton's nevus (Sutton's disease) - age spot small in size with a rim of depigmented skin, localized on the trunk or extremities.

Blue nevus, Oty's nevus, pigmented nevus with papillary warty growths during trauma can transform into melanoma.

Pre-malignant skin diseases. These include pigmented xeroderma (pigmented xeroderma) , radiation damage to the skin (see radiation damage) , solar keratosis, etc. A number of authors include in this group also Bowen's disease, Keir's disease and Paget's disease (when localized outside the nipple and areola of the mammary gland), which are rare.

Solar keratosis occurs as a result of excessive sun exposure. At the same time, against the background of poikiloderma (a combination of foci of hyperpigmentation with areas of atrophy), multiple foci of hyperkeratosis appear in the form of elongated or oval plaques up to 0.5-1 cm in diameter, covered with dense gray scales. Bowen's disease or squamous cell carcinoma may develop in the affected areas.

Bowen's disease is considered by most researchers as intraepidermal cancer. It is observed mainly in persons of middle and elderly age, more often it is localized on K. of the face, trunk. Usually it is a single grayish-brown plaque, poorly infiltrated, with irregular, clear boundaries, covered with scales or crusts.

The lesion slowly grows along the periphery, its surface often ulcerates, there are areas of atrophy on it, which, together with scales and cortical layers, gives the tumor a motley appearance. People with Bowen's disease are often diagnosed with cancer of the internal organs.

Paget's disease when localized outside the nipple and areas of the mammary gland is characterized by limited foci of maceration and oozing, located mainly in the perineum and navel.

Tumors with localized growth. An epithelial tumor with local growth is (basal cell carcinoma). It develops from the basal layer of the epidermis or K.'s appendages (sebaceous and sweat glands). This is the most common epithelial tumor K. It is observed mainly in old age. Characterized by invasive growth; extremely rarely metastasizes. Clinical manifestations are diverse. Allocate superficial (the most favorable form), cystic, ulcerative, scleroderma-like and pigmented forms of basal cell carcinoma.

Superficial basalioma is a limited spot, along the periphery of which there is a ridge, consisting of separate nodules ("pearls"). It is localized more often in open areas of the body exposed to insolation, prolonged mechanical irritation. For persons with fair skin multiple lesions may occur, which merge into large plaques covered with scales ( rice. 12 ). Often, spontaneous growth occurs in the center of the plaque, and tumor growth along the periphery (self-scarring basalioma).

With cystic basalioma, the lesion is often single, sharply demarcated from the surrounding tissue, bright pink, pasty consistency; there are often telangiectasias on the surface. It is localized mainly on the skin of the face (around the eyes, nose).

Ulcerative basalioma ( rice. 13.14 ) can develop from superficial or cystic. It occurs more often on the chin, at the base of the nose, or in the inner corner of the eye. Manifested by the formation of nodules prone to ulceration. It is characterized by tumor infiltration of the underlying tissues with the development of a defect up to the destruction of bone and cartilage tissue. The most severe forms of ulcerative basalioma are - a corrosive ulcer ( rice. 15 ) and ulcus terebrans (penetrating ulcer). With ulcus terebrans, the process also spreads along the periphery. In some cases, papillomatous growths (verrucous-ulcerative basalioma) appear on the ulcerated surface.

With scleroderma-like basalioma on the face, upper body, plaques of dense consistency with clear boundaries are formed. They resemble foci of scleroderma, in which an erythematous corolla is noted along the periphery of the lesion. Unlike scleroderma, with scleroderma-like basalioma, a ridge-shaped edge and single nodules - "pearls" are found along the periphery of the lesion.

Pigmented basalioma has a darker color (from yellowish-brown or bluish-brown to dark brown or black), which is associated with the presence of melanin in the cytoplasm of tumor cells.

Depending on the histological picture, multicentric, solid and adenoid forms of basalioma are distinguished. A logical connection between the histological picture and the clinical form of basal cell carcinoma, as a rule, is not observed. In those cases when structures resembling histologically reveal, they speak of trichobasalioma. It is localized on K. of the forehead, scalp in the form of a single, less often multiple nodules of a rounded shape from 2 to 5 mm in diameter, dense consistency, dark gray or brownish color. In rare cases, the nodules are larger, have an uneven surface, sometimes with pronounced telangiectasias.

To malignant skin tumors include squamous cell carcinoma, pigmented tumors - precancerous Dubreya and melanoma (Melanoma) . Squamous cell carcinoma K. is an epithelial malignant tumor. It occurs more often in places of constant irritation, mechanical, against the background of long-term non-healing trophic ulcers, fistulas, radiation damage K., and can also develop from lesions characteristic of Bowen's disease, pigmentary xeroderma, solar keratosis. According to the clinical picture, endophytic (ulcerative) and exophytic (tumor or papillary) forms of squamous cell carcinoma are distinguished. In the ulcerative form, a crater-shaped ulcer with a dense bottom and roller-like edges is formed. slowly but steadily growing, bleeding. In the papillary form, single hard nodules look like a wart or keratoacanthoma, merge together into large lesions resembling cauliflower ( rice. 16 ). Keratinizing squamous cell carcinoma is characterized by infiltrative growth into the underlying tissues, metastases to the lymph nodes and lymphatic vessels, and in advanced cases, to the blood vessels.

Dubreus' precancerous melanosis is a slow-growing tumor that usually occurs after age 30, more often in women. It is localized, as a rule, in open areas K. It has the appearance of a single large plaque (40-60 mm in diameter) with uneven outlines and uneven pigmentation (from light brown to dark brown and black). A tendency to growth, a change in the color of the tumor (darkens), the development of papillomatous growths on the surface or the appearance of areas of atrophy indicate its transformation into melanoma.

Treatment. Most of K.'s tumors are not accompanied by noticeable subjective sensations. When neoplasms appear, the patient should be referred for a consultation with an oncologist or dermatologist (oncologist), who establishes on the basis of anamnesis data, clinical signs and results of histological and cytological examinations and conducts. With benign tumors K., surgical treatment (removal of the tumor) is carried out in the case of localization of the tumor in places subject to injury, as well as at the request of the patient (for example, with a cosmetic defect). Pre-malignant diseases are subject to compulsory treatment. For this purpose, a surgical procedure is used, incl. electrosurgical, cryodestruction, radiation therapy (Radiation therapy) , laser (see Lasers) . According to indications, various cytostatic drugs are also locally prescribed (5-fluorouracil, flutorafur, prospidin, etc.).

Prophylaxis consists in the early detection of the initial signs of a tumor K., conducting preventive examinations and identifying risk groups (persons suffering from long-term healing ulcers, with cicatricial changes in the skin, etc.), in the active treatment of precancerous dermatoses. Excessive sun exposure and contact with oncogenic substances should be avoided.

Bibliography: Apatenko A.K. Epithelial tumors and skin malformations, M., 1973; Berenbein B.A. Skin pseudo-cancer, M., 1980; Differential Skin Diseases, ed. B.A. Berenbein and A.A. Studnitsina, s. 366, M., 1989; Kalantaevskaya K.A. and physiology of human skin. Kiev, 1972; P.V. Kozhevnikov General, L., 1970; Guidelines for the pathological diagnosis of human tumors, ed. ON. Kraevsky and A.V. Smolyannikov, s. 403, M, 1976, bibliogr .; Trapeznikov N.N. etc. Pigmented nevi and skin neoplasms, M., 1976, bibliogr.

Rice. 1. The structure of the human finger skin: 1-5 - epidermis (1 - basal layer, 2 - prickly layer, 3 - granular layer, 4 - shiny layer, 5 - stratum corneum); 6 - excretory duct of the sweat gland; 7-8 - dermis (7 - papillary layer, 8 - reticular layer); 9 - terminal sweat gland; 10 - hypodermis.

Rice. 6. Dermatofibroma: a large rounded knot in the lower part of the auricle.

In infants, exudative-catarrhal diathesis occurs, manifested in the hereditary tendency of the child's body to inflammatory processes, allergic reactions. The first signs of such a diathesis may be in the nature of a milk crust, persistent diaper rash of the skin, the so-called geographical language.

Milk scab manifests itself in the form of yellowish scale-crusts, which sit quite tightly on the skin of the scalp of the child, especially in the parietal region. In these cases, a nursing mother needs to carefully analyze her diet and exclude foods that have an allergenic effect from it (see below). On the crusts, apply warm boiled vegetable oil (sunflower, olive, peach) for several hours, then gently comb the softened crusts with a comb and then wash your hair; repeat the procedure if necessary.

With excessively tight swaddling of the child, overheating it, insufficient care of the skin (especially in the axillary, inguinal-femoral, intergluteal folds), as a result of the irritating action of the products of skin secretion (fat, sweat), as well as urine, feces, the skin turns red, macerates - diaper rash occurs. To prevent the further development of this process, it is necessary to make adjustments to the child care system, make sure that it does not overheat, change linen frequently, boil it, iron it. An important role is played by careful observance of the toilet of the genitals and perineum: after each urination and bowel movement, the skin should be washed with a weakly borne solution of potassium permanganate or a decoction of chamomile, oak bark, St. John's wort, or a string, diluted in boiled water to a slightly yellow color. Skin folds should be treated with sterile oil (olive, peach, sunflower, rosehip, sea buckthorn), fish oil, calcium liniment or baby cream. You can also use talcum powder. It is advisable to leave the affected areas of the body open more often. Persistent diaper rash can be a sign of exudative diathesis, and therefore should be reviewed by the nursing mother (see below). In the presence of erosions and abrasions in the diaper rash area, it easily joins, in this case, the child should be shown to the doctor.

In conditions of improper child care (excessive, insufficient fluid intake) in children who are weakened, suffering from rickets, feverish, as a result of imperfect thermoregulation system and increased sweating, small (punctate) pink nodules and vesicles often appear on the skin of the back, the back of the neck, buttocks - prickly heat... In this case, daily hygiene with the addition of a decoction of chamomile is advisable. After washing, the skin is gently blotted with a soft, carefully ironed diaper or towel. The child's skin should be wiped daily with a warm alcohol solution (half vodka with boiled water). You should also drink plenty of water for the child, take care of his more comfortable clothes, stop excessive wrapping, use air baths, avoid using oilcloth or plastic wrap in the form of linings under the sheet during prolonged sleep, which will help avoid overheating and sweating.

Since children's skin is tender, the slightest injury and pollution can lead to the appearance pustules- small red nodules with a purulent head at the top or vesicles with yellowish purulent contents. When such skin changes appear, you should refrain from bathing the child, treat, if they are single, with a solution of brilliant green (brilliant green), fucorcin or gentian violet, and wipe the skin around them with a warm alcohol solution (vodka in half with boiled water). At the same time, it is very important to change the linen frequently, which must be boiled and thoroughly ironed. If there are many rashes or they continue to appear, you should consult a dermatologist or pediatrician.

Skin allergies. In case of violation of the diet by a nursing mother (consumption of oranges, chocolate, honey, condensed milk, etc.), with the introduction of complementary foods or the transition to artificial feeding in infants, manifestations of exudative diathesis may occur in the form of skin redness, bright red small nodules, bubbles, with opening of which weeping skin areas are formed. After a while, they become covered with yellowish scales, crusts. Most often, such skin changes occur on the face (especially on the cheeks), buttocks, the back of the hands, forearms, feet, legs, thighs and are accompanied by itching. These skin changes can progress to childhood eczema and other difficult-to-treat allergic skin conditions. By combing the affected skin, the child will be able to introduce infectious agents into the lesions, as a result of which the process will worsen. The development of exudative diathesis is promoted by age-related immaturity of the digestive system, insufficient secretory activity, and sometimes enzyme deficiency, as a result of which a number of food products can cause an allergic reaction in such children in the form of skin lesions. It should be borne in mind that the leading food allergens for children can most often be cow's milk, especially its protein lactoglobulin (boiling milk causes the destruction of lactoglobulin, and milk becomes less allergenic); chicken eggs, especially protein (heat treatment reduces their allergic properties, but does not completely destroy); fish, caviar, crayfish, crabs, shrimp and products from them (heat treatment has little effect on the degree of allergic reaction to these products); grain products (usually wheat, rye,); fruits and (most often oranges, tangerines, lemons, strawberries, strawberries, tomatoes, carrots); and nuts; honey, chocolate, coffee, cocoa.

Spreading artificial feeding, early introduction of mixtures made from cow's milk often leads to a rapid increase in sensitivity to food allergens. In this case, it can be combined with medicinal, household (home, fluff, animal hair), pollen (pollen of herbs, flowering trees). If the child has a pronounced taste for milk, then you can try to use it in his diet (kefir, yogurt, biolact, etc.). Acidophilic products prepared by fermenting dairy products, including dry ones, with special acidophilic lactobacilli with proteolytic (protein-degrading) and antibacterial properties are also advisable. You can enter more early dates fruit, vegetable purees and beef meat, and cook porridge in fruit and vegetable broths. Foods are often steamed to reduce the content of extractives.

Potatoes, white cabbage, lettuce, peeled cucumbers, green onions, green apple puree, plums, dried fruits, rose hips, beef, cottage cheese. You cannot give such children meat, chicken, fish broths, tomatoes, citrus fruits, cauliflower, green peas, spinach. In older children, you need to be very careful with the introduction of chicken, eggs, into the diet. With good tolerance, you can give boiled chicken meat (without skin and chicken broth), hard-boiled chicken eggs once a week.

Proper nutrition will in many cases prevent the development of chronic allergic diseases. At the same time, in the diet, it is necessary to provide for the intake of proteins, fats and carbohydrates, trace elements, vitamins into the body, since this is a condition for the normal functioning of the body and, in particular, its immune system, which plays an important role in the development of allergic reactions.

The indispensable components of food are protein products, the lack of which in a child can lead to growth retardation, metabolic disorders, unfavorable changes in the function of the liver, pancreas, etc. The participation of proteins in the formation of the body's defense mechanisms (immunity) is very important. and vitamins promote the synthesis of hormones, enzymes. At the same time, easily absorbed fats entering a large number into the body, slow down the synthesis of protective antibodies, increase the tendency of tissues to inflammatory reactions, enhance sensitization processes.

Among the foods that should be avoided by both children and adults with the appearance of an allergic rash on the skin are eggs, canned food, citrus fruits, mushrooms, smoked and fatty sausages, crabs, strawberries, chocolate and honey.

Adults should adhere to a predominantly dairy-vegetable diet with a reduced content of table salt, with the exception of spicy, smoked, salty foods, and alcohol. The diet may contain boiled meat, fish, mainly river (low-fat), cottage cheese, kefir and other lactic acid products, buckwheat, rice and oatmeal, vegetarian soups, vegetables, fruits.

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