: the natural outer layer of tissue that covers the body of a person or animal

: the skin of an animal that has been removed from the body often with its hair or feathers
still attached and that is used to make things (such as clothes)

: the outer covering of a fruit, vegetable, etc.

Skin is the soft outer covering of vertebrates. Other animal coverings such as the arthropod
exoskeleton have different developmental origin, structure and chemical composition. The
adjective cutaneous means "of the skin" (from Latin cutis, skin). In mammals, the skin is the
largest organ of the integumentary system made up of multiple layers of ectodermal tissue,
and guards the underlying muscles, bones, ligaments and internal organs.[1] Skin of a different
nature exists in amphibians, reptiles, and birds.[2] All mammals have some hair on their skin,
even marine mammals which appear to be hairless. The skin interfaces with the environment
and is the first line of defense from external factors. For example, the skin plays a key role in
protecting the body against pathogens[3] and excessive water loss.[4] Its other functions are
insulation, temperature regulation, sensation, and the production of vitamin D folates.
Severely damaged skin may heal by forming scar tissue. This is sometimes discoloured and
depigmented. The thickness of skin also varies from location to location on an organism. In
humans for example, the skin located under the eyes and around the eyelids is the thinnest
skin in the body at 0.5 mm thick, and is one of the first areas to show signs of aging such as
"crows feet" and wrinkles. The skin on the palms and the soles of the feet is 4 mm thick and
the thickest skin in the body. The speed and quality of wound healing in skin is promoted by
the reception of estrogen. [5] [6] [7]

Scalp
From Wikipedia, the free encyclopedia
Jump to: navigation, search
For other uses, see Scalp (disambiguation).
Scalp

Illustration depicting the layers of the scalp and meninges

Latin scalpus
Gray's subject #105 378
supratrochlear, supraorbital, superficial temporal,
Artery
occipital
Vein superficial temporal, posterior auricular, occipital
supratrochlear, supraorbital, greater occipital, lesser
Nerve
occipital
Lymph occipital, mastoid
MeSH Scalp

The scalp is the anatomical area bordered by the face anteriorly and the neck to the sides and
posteriorly.

Contents
 1 Layers
 2 Blood supply
 3 Innervation
 4 Lymphatic drainage
 5 Role in aesthetics
 6 Hair transplantation
o 6.1 Redness in scalp after surgery

 7 Pathology
  8 Scalp conditions
 9 See also
 10 References
 11 External links

Layers

Diagrammatic section of scalp

It is usually described as having five layers, which can conveniently be remembered as a

mnemonic:[1]

 S: The skin on the head from which head hair grows. It contains numerous sabaeceous
glands and hair follicles
 C: Connective tissue. A thin layer of fat and fibrous tissue lies beneath the skin.
 A: The aponeurosis called epicranial aponeurosis (or galea aponeurotica) is the next
layer. It is a tough layer of dense fibrous tissue which runs from the frontalis muscle
anteriorly to the occipitalis posteriorly.
 L: The loose areolar connective tissue layer provides an easy plane of separation
between the upper three layers and the pericranium. In scalping the scalp is torn off
through this layer. It also provides a plane of access in craniofacial surgery and
neurosurgery. This layer is sometimes referred to as the "danger zone" because of the
ease by which infectious agents can spread through it to emissary veins which then
drain into the cranium. The loose areolar tissue in this layer is made up of random
collagen I bundles, collagen III. It contains the major blood vessels of the scalp,
which bleed profusely upon injury, partly due to the absence of venous valves found
in the circulation above the neck. It will also be rich in glycosaminoglycans (GAGs)
and will be constituted of more matrix than fibers.
 P: The pericranium is the periosteum of the skull bones and provides nutrition to the
bone and the capacity for repair. It may be lifted from the bone to allow removal of
bone windows (craniotomy).

The clinically important layer is the aponeurosis. Scalp lacerations through this layer mean
that the "anchoring" of the superficial layers is lost and gaping of the wound occurs; this
requires suturing. This can be achieved with simple or vertical mattress sutures using a non-
absorbable material, which are subsequently removed at around days 7-10.
Blood supply
The blood supply of the scalp is via five pairs of arteries, three from the external carotid and
two from the internal carotid:

 internal carotid
o the supratrochlear artery to the midline forehead. The supratrochlear artery is a
branch of the ophthalmic branch of the internal carotid artery.
o the supraorbital artery to the lateral forehead and scalp as far up as the vertex.
The supraorbital artery is a branch of the ophthalmic branch of the internal
carotid artery.
 external carotid
o the superficial temporal artery gives off frontal and parietal branches to supply
much of the scalp
o the occipital artery which runs posteriorly to supply much of the posterior
aspect of the scalp
o the posterior auricular artery, a branch of the external carotid artery, ascends
behind the auricle to supply the scalp above and behind the auricle.

Note: The walls of the blood vessels are firmly attached to the fibrous tissue of the superficial
fascial layer, hence cut ends of vessels here do not readily retract; Even a small scalp wound
may bleed profusely.

Innervation
Innervation is the connection of nerves to the scalp: the sensory and motor nerves innervating
the scalp. The scalp is innervated by the following:[2]

 Supratrochlear nerve and the supraorbital nerve from the ophthalmic division of the
trigeminal nerve
 Greater occipital nerve (C2) posteriorly up to the vertex
 Lesser occipital nerve (C2) behind the ear
 Zygomaticotemporal nerve from the maxillary division of the trigeminal nerve
supplying the hairless temple
 Auriculotemporal nerve from the mandibular division of the trigeminal nerve

The innervation of scalp can be remembered using the mnemonic, "Z-GLASS" for,
Zygomaticotemporal nerve, Greater occipital nerve, Lesser occipital nerve, Auriculotemporal
nerve, Supratrochlear nerve and Supraorbital nerve.[2]

Pathology
The scalp is a common site for the development of tumours including:
  epidermoid cyst
 pilar cyst
 actinic keratosis and squamous cell carcinoma
 basal cell carcinoma
 merkel cell carcinoma

Scalp conditions
 Dandruff – A common problem due to the excessive shedding of dead skin cells from
the scalp
 Seborrhoeic dermatitis – a skin disorder causing scaly, flaky, itchy, red skin
o Cradle Cap – a form of this disorder which occurs in newborns

 Cutis verticis gyrata – A descriptive term for a rare deformity of the scalp.
 Head lice
 Tycoon's cap, also known as acne necrotica miliaris, characterized by pustules and
itching.

 Dandruff
 From Wikipedia, the free encyclopedia
 Jump to: navigation, search
 For the album by Ivor Cutler, see Dandruff (album).
Dandruff
Classification and external resources

A microscopic image of human dandruff

ICD-9 690.18
DiseasesDB 11911
 Dandruff[1] is the shedding of dead skin cells from the scalp. As skin cells die a small
amount of flaking is normal; about 487,000 cells/cm2 get released normally after
detergent treatment.[2] Some people, however, experience an unusually large amount
of flaking either chronically or as a result of certain triggers, up to 800,000 cells/cm2,
which can also be accompanied by redness and irritation.
 Dandruff is a common scalp disorder affecting almost half of the population at the
post-pubertal age and of any gender and ethnicity. It often causes itching. It has been
well established that keratinocytes play a key role in the expression and generation of
 immunological reactions during dandruff formation. The severity of dandruff may
fluctuate with season as it often worsens in winter.[2] Most cases of dandruff can be
easily treated with specialized shampoos. There is, however, no true cure.[citation needed]
 Those affected by dandruff find that it can cause social or self-esteem problems,
indicating treatment for both psychological and physiological reasons.[3]

Signs and symptoms

Typical case of Dandruff.

The signs and symptoms of dandruff are an itchy scalp and flakiness.[4]

Causes
Dandruff can have several causes, including simple dry skin, seborrhoeic dermatitis, not
shampooing often enough, psoriasis, eczema, sensitivity to hair care products, or a yeast-like
fungus.[5] Dry skin is the most common cause of flaking dandruff.[5]

As the epidermal layer continually replaces itself, cells are pushed outward where they
eventually die and flake off. For most individuals, these flakes of skin are too small to be
visible. However, certain conditions cause cell turnover to be unusually rapid, especially in
the scalp. It is hypothesized that for people with dandruff, skin cells may mature and be shed
in 2–7 days, as opposed to around a month in people without dandruff. The result is that dead
skin cells are shed in large, oily clumps, which appear as white or grayish patches on the
scalp, skin and clothes.

According to one study, dandruff has been shown to possibly be the result of three factors:[6]

1. Skin oil commonly referred to as sebum or sebaceous secretions[7]

 2. The metabolic by-products of skin micro-organisms (most specifically Malassezia yeasts)[8][9]
[10][11][12]

3. Individual susceptibility and allergy sensitivity.

Older literature cites the fungus Malassezia furfur (previously known as Pityrosporum ovale)
as the cause of dandruff. While this species does occur naturally on the skin surface of both
healthy people and those with dandruff, in 2007 it was discovered that the responsible agent
is a scalp specific fungus, Malassezia globosa,[13] that metabolizes triglycerides present in
sebum by the expression of lipase, resulting in a lipid byproduct oleic acid (OA). During
dandruff, the levels of Malassezia increase by 1.5 to 2 times its normal level.[2] Penetration by
OA of the top layer of the epidermis, the stratum corneum, results in an inflammatory
response in susceptible persons which disturbs homeostasis and results in erratic cleavage of
stratum corneum cells.[10]

Seborrhoeic dermatitis

In seborrhoeic dermatitis redness and itching frequently occurs around the folds of the nose
and eyebrow areas, not just the scalp. Dry, thick, well-defined lesions consisting of large,
silvery scales may be traced to the less common affliction of the scalp psoriasis.

Inflammation and extension of scaling outside the scalp exclude the diagnosis of dandruff
from seborrhoeic dermatitis.[7] However, many reports suggest a clear link between the two
clinical entities - the mildest form of the clinical presentation of seborrhoeic dermatitis as
dandruff, where the inflammation is minimal and remain subclinical.[14][15]

Seasonal changes, stress, and immuno-suppression seem to affect seborrheic dermatitis.[2]

Mechanism
Dandruff scale is a cluster of corneocytes, which have retained a large degree of cohesion
with one another and detach as such from the surface of the stratum corneum. A corneocyte is
a protein complex that is made of tiny threads of keratin in an organised matrix.[16] The size
and abundance of scales are heterogeneous from one site to another and over time.
Parakeratotic cells often make up part of dandruff. Their numbers are related to the severity
of the clinical manifestations, which may also be influenced by seborrhea.[2]