Structure
CORIUM The foundation layer. It overlies the subcutaneous fat and varies in thickness from 0·5–3.0 mm. Many nerves run through the corium: these have key roles in the sensations of touch, pain and temperature (see NEURON(E)). Blood vessels nourish the skin and are primarily responsible for regulating the body temperature. Hairs are bedded in the corium, piercing the epidermis (see below) to cover the skin in varying amounts in di?erent parts of the body. The sweat glands are also in the corium and their ducts lead to the surface. The ?brous tissue of the corium comprises interlocking white ?brous elastic bundles. The corium contains many folds, especially over joints and on the palms of hands and soles of feet with the epidermis following the contours. These are permanent throughout life and provide unique ?ngerprinting identi?cation. HAIR Each one has a root and shaft, and its varying tone originates from pigment scattered throughout it. Bundles of smooth muscle (arrectores pilorum) are attached to the root and on contraction cause the hair to stand vertical. GLANDS These occur in great numbers in the skin. SEBACEOUS GLANDS secrete a fatty substance and sweat glands a clear watery ?uid (see PERSPIRATION). The former are made up of a bunch of small sacs producing fatty material that reaches the surface via the hair follicle. Around three million sweat or sudoriparous glands occur all over the body surface; sited below the sebaceous glands they are unconnected to the hairs. EPIDERMIS This forms the outer layer of skin and is the cellular layer covering the body surface: it has no blood vessels and its thickness varies from 1 mm on the palms and soles to 0·1 mm on the face. Its outer, impervious, horny layer comprises several thicknesses of ?at cells (pierced only by hairs and sweat-gland openings) that are constantly rubbed o? as small white scales; they are replaced by growing cells from below. The next, clear layer forms a type of membrane below which the granular stratum cells are changing from their origins as keratinocytes in the germinative zone, where ?ne sensory nerves also terminate. The basal layer of the germinative zone contains melanocytes which produce the pigment MELANIN, the cause of skin tanning.
Nail A modi?cation of skin, being analagous to the horny layer, but its cells are harder and more adherent. Under the horny nail is the nail bed, comprising the well-vascularised corium (see above) and the germinative zone. Growth occurs at the nail root at a rate of around 0·5 mm a week – a rate that increases in later years of life.
Skin functions By its ability to control sweating and open or close dermal blood vessels, the skin plays a crucial role in maintaining a constant body temperature. Its toughness protects the body from mechanical injury. The epidermis is a two-way barrier: it prevents the entry of noxious chemicals and microbes, and prevents the loss of body contents, especially water, electrolytes and proteins. It restricts electrical conductivity and to a limited extent protects against ultraviolet radiation.
The Langerhans’ cells in the epidermis are the outposts of the immune system (see IMMUNITY), just as the sensory nerves in the skin are the outposts of the nervous system. Skin has a social function in its ability to signal emotions such as fear or anger. Lastly it has a role in the synthesis of vitamin D.... skin
Habitat: Near the sea in pastures and on stony soils.
Features ? The bark has a white, peeling epidermis covering a hard, reddish-brown layer beneath. It is slightly fibrous on the inner surface, and the fracture is granular. The taste is pungent, astringent and bitter, the odour faintly aromatic.Part used ? The bark is the only part of the Bayberry shrub now used as a medicine.Action: A powerful stimulant, astringent and tonic to the alimentary tract.
Bayberry bark is one of the most widely used agents in the herbal practice. It figures in many of the compound powders and is the base of the celebrated composition powder, a prescription of which will be found in the "Herbal Formulae" section of this volume. In cases of coldness of the extremities, chills and influenza, an infusion of 1 ounce of the powdered bark to 1 pint of water is taken warm. This assists circulation and promotes perspiration, especially when combined with Cayenne as inthe formula referred to above.As an antiseptic the powder is added to poultices for application to ulcers, sores and wounds. It also makes an excellent snuff for nasal catarrh, and an ingredient in tooth powders, for which a prescription is given in the section previously mentioned.The virtues of Bayberry bark were recognized and used beneficially by the herbalists of many generations ago. Indeed, their enthusiasm for this, as for certain other remedies also extremely efficacious within proper limits, led them to ascribe properties to the bark which it does not possess. Many affections of the uterine system, fistula, and even cancer were said to yield to its influence.Even in these cases, however, Bayberry bark certainly did less harm than many of the methods employed by the more orthodox practitioners of that time !... bayberryCorns and bunions are caused by badly ?tting shoes, hence the importance of children and adults wearing properly ?tted footwear. Corns can be pared after softening in warm water, or painted with salicylic acid collodion or other proprietary preparations. Bad corns may need treatment by a chiropodist (see CHIROPODY). Bunions may require surgical treatment. Regular foot care is important in patients with DIABETES MELLITUS.... corns and bunions
Habitat: Cultivated mainly in Madhya Pradesh, Uttar Pradesh, Maharashtra, Bihar and Rajasthan.
English: Linseed, Flax.Ayurvedic: Atasi, Umaa, Masrnaa, Nilapushpi, Kshumaa.Unani: Kattan.Siddha/Tamil: (Seed).Action: Seed—demulcent, emollient, laxative, antilipidemic, antitussive, pectoral (used in bronchitis and cough). Flowers—used as nervine and cardiac tonic. Oil— used in burns, skin injuries and sores.
Key application: Internally, for chronic constipation, for colons damaged by abuse of laxatives, irritable bowel syndrome, diverticular disease, symptomatic short-term treatment of gastritis and enteritis. Externally, for painful skin inflammations. (German Commission E, ESCOP, The British Herbal Pharmacopoeia.)The plant contains chlorogenic acid and its isomer. Also present are palmitic, stearic, oleic, linoleic acids, along with amino acids, and sugars. Linseed also contains mucilage (3-10%) in epidermis; fatty oil (30-40%); cyanogenic glycosides (0.05-00.1%) mainly linus- tatin, neolinustatin and linamarin; lig- nans; phenylpropane derivatives including linusitamarin. (Cyanogenic glycosides are not found toxic in therapeutic doses as these are broken down only to a limited extent in the body.)The seeds are an excellent source of dietary alpha-linolenic acid for modifying plasma and tissue lipids. Flaxseed preparations reduced atherogenic risk in hyperlipemic patients. (Cited in Expanded Commission E Monographs.)Human studies have indicated Flax- seed's use in atherosclerosis, hyperc- holesterolemia, lupus nephritis, chronic renal diseases and in cancer prevention (active principle: lignan precursor secoisolariciresinol diglycoside). (Sharon M. Herr. Also Am J Clin Nutr, 1999, 69, 395-402.)The PP glucose response to a 50 g carbohydrate load given as Flaxseed bread was found to be 27% lower when compared with regular white bread.Taking Flaxseed oil daily for 3 months did not improve symptoms of pain and stiffness in rheumatoid arthritis and no effect was observed on RA, such as C-reactive protein and ESR. (Natural Medicines Comprehensive Database, 2007.)The water-binding capacity and rhe- ological properties of linseed mucilage resembled those of guar gum.Dosage: Ripe seed—3-6 g powder. (API, Vol. I.) Flower-bud—3-6 g; oil—5-10 ml. (CCRAS.)... linum usitatissimumNaevus simplex Also known as ‘salmon patch’. About one-third of white children are born with macular pink areas of ERYTHEMA on the nape, brow or eyelids which usually disappear after a few months, but patches on the nape may persist.
Naevus ?ammeus Also known as ‘portwine stain’ and present at birth. It is unilateral, usually on the face, and may be extensive. It tends to darken with age and is permanent. Laser treatment is e?ective.
Strawberry naevus (cavernous haemangioma) is usually not present at birth but appears within a few weeks and grows rapidly, reaching a peak in size after 6–12 months, when the lobulated red nodule may resemble a ripe strawberry. Untreated, the naevus disappears spontaneously over several years. It may occur anywhere and may be very troublesome when occurring around an eye or on the ‘nappy’ area. If possible it should be left alone, but where it is causing problems other than simply cosmetic ones it is best treated by an expert. This may involve medical treatment with steroids or interferon or laser therapy.
Spider naevus is due to a dilated ARTERIOLE causing a minute red papule in the skin, the small branching vessels resembling spider legs. A few spider naevi are common in young people, but multiple naevi are common in pregnancy and may also be a warning sign of chronic liver disease.... naevus
Pemphigus vulgaris is a serious form affecting skin and MUCOUS MEMBRANE. It affects young and middle-aged people with widespread blistering, erosion and crusting of the skin. Extensive involvement of the lips, mouth and throat interfere with nutrition. Untreated, it is eventually fatal, but the disease can now be controlled by large doses of oral CORTICOSTEROIDS and other immunosuppressive drugs. MORBIDITY from the adverse effects of steroids is a serious problem, but some patients are eventually cured.
Pemphigus foliaceus is seen in the elderly; the blistering is more super?cial in the epidermis. It may be very widespread, but is not life-threatening because mucous membranes are not affected. Topical corticosteroids will sometimes control the eruption, but in severe cases treatment is as for pemphigus vulgaris.
Pemphigoid is a variant where the blistering occurs because of separation of the epidermis and dermis. Mucosae are rarely affected and the disease affects mainly the arms and legs in the elderly. Treatment is as for pemphigus but smaller doses of corticosteroids usually su?ce.... pemphigus
Specialized cells in the epidermis respond to ultraviolet light by producing the pigment melanin.
(See also sunlight, adverse effects of; sunburn.)... suntan
Researchers are having success in growing human skin in the laboratory for grafting on to people who have been badly burned and have insu?cient intact skin surface to provide an autologous graft (one provided by the recipient of the graft). Other techniques being researched are the use of specially treated shark skin and the production of arti?cial skin.... skin-grafting
Touch sense proper, by which we perceive a touch or stroke and estimate the size and shape of bodies with which we come into contact, but which we do not see.
Pressure sense, by which we judge the heaviness of weights laid upon the skin, or appreciate the hardness of objects by pressing against them.
Heat sense, by which we perceive that an object is warmer than the skin.
Cold sense, by which we perceive that an object touching the skin is cold.
Pain sense, by which we appreciate pricks, pinches and other painful impressions.
Muscular sensitiveness, by which the painfulness of a squeeze is perceived. It is produced probably by direct pressure upon the nerve-?bres in the muscles.
Muscular sense, by which we test the weight of an object held in the hand, or gauge the amount of energy expended on an e?ort.
Sense of locality, by which we can, without looking, tell the position and attitude of any part of the body.
Common sensation, which is a vague term used to mean composite sensations produced by several of the foregoing, like tickling, or creeping, and the vague sense of well-being or the reverse that the mind receives from internal organs. (See the entry on PAIN.)
The structure of the end-organs situated in the skin, which receive impressions from the outer world, and of the nerve-?bres which conduct these impressions to the central nervous system, have been described under NERVOUS SYSTEM. (See also SKIN.)
Touch affects the Meissner’s or touch corpuscles placed beneath the epidermis; as these di?er in closeness in di?erent parts of the skin, the delicacy of the sense of touch varies greatly. Thus the points of a pair of compasses can be felt as two on the tip of the tongue when separated by only 1 mm; on the tips of the ?ngers they must be separated to twice that distance, whilst on the arm or leg they cannot be felt as two points unless separated by over 25 mm, and on the back they must be separated by more than 50 mm. On the parts covered by hair, the nerves ending around the roots of the hairs also take up impressions of touch.
Pressure is estimated probably through the same nerve-endings and nerves that have to do with touch, but it depends upon a di?erence in the sensations of parts pressed on and those of surrounding parts. Heat-sense, cold-sense and pain-sense all depend upon di?erent nerve-endings in the skin; by using various tests, the skin may be mapped out into a mosaic of little areas where the di?erent kinds of impressions are registered. Whilst the tongue and ?nger-tips are the parts most sensitive to touch, they are comparatively insensitive to heat, and can easily bear temperatures which the cheek or elbow could not tolerate. The muscular sense depends upon the sensory organs known as muscle-spindles, which are scattered through the substance of the muscles, and the sense of locality is dependent partly upon these and partly upon the nerves which end in tendons, ligaments and joints.
Disorders of the sense of touch occur in various diseases. HYPERAESTHESIA is a condition in which there is excessive sensitiveness to any stimulus, such as touch. When this reaches the stage when a mere touch or gentle handling causes acute pain, it is known as hyperalgesia. It is found in various diseases of the SPINAL CORD immediately above the level of the disease, combined often with loss of sensation below the diseased part. It is also present in NEURALGIA, the skin of the neuralgic area becoming excessively tender to touch, heat or cold. Heightened sensibility to temperature is a common symptom of NEURITIS. ANAESTHESIA, or diminution of the sense of touch, causing often a feeling of numbness, is present in many diseases affecting the nerves of sensation or their continuations up the posterior part of the spinal cord. The condition of dissociated analgesia, in which a touch is quite well felt, although there is complete insensibility to pain, is present in the disease of the spinal cord known as SYRINGOMYELIA, and a?ords a proof that the nerve-?bres for pain and those for touch are quite separate. In tabes dorsalis (see SYPHILIS) there is sometimes loss of the sense of touch on feet or arms; but in other cases of this disease there is no loss of the sense of touch, although there is a complete loss of the sense of locality in the lower limbs, thus proving that these two senses are quite distinct. PARAESTHESIAE are abnormal sensations such as creeping, tingling, pricking or hot ?ushes.... touch
Common warts (verruca vulgaris) are seen mainly in children and young adults on the backs of the ?ngers and hands, and less often on the knees, face or scalp. They may be single or numerous and range from 1 mm to 10 mm or more in size. Untreated, they often resolve spontaneously after weeks or months. They may be occupationally contracted by butchers and meat-handlers.
Plane warts (verruca plana) are small, ?at-topped, yellowish papules seen mainly on the backs of the hands, wrists and face in young people. They may persist for years.
Digitate warts (verruca digitata) are ?nger- or thread-like warts up to 5 mm in length with a dark rough tip. They tend to grow on the eyelids or neck.
Plantar warts (verruca plantaris) occur on the soles of the feet, most commonly in older children, adolescents and young adults. Spread by walking barefoot in swimming pools, changing rooms, etc., these warts may appear as minor epidemics in institutions, such as schools. They are ?attened, yellow-white discrete lesions in the sole or heel, tender when squeezed. Multiple black points in the wart are thrombosed capillaries. Occasionally, aggregates of plantar warts form a mosaic-like plaque, especially in chronically warm, moist feet.
Genital warts are sexually transmitted. In the male they occur on the shaft of the PENIS and on the PREPUCE or around the anus. In women they occur around the entrance to the VAGINA and LABIA minora. Genital warts vary from 1–2 mm pink papules to ?orid, cauli?ower-like masses. Pregnancy facilitates their development.
Mucosal warts may develop on the mucous membranes of the mouth.
Laryngeal warts may be found in children whose mothers had genital warts (see above) at the time of delivery. Some subtypes of genital wart can infect the uterine cervix (see UTERUS), causing changes which may lead eventually to cancer.
Treatment CRYOTHERAPY – freezing with liquid nitrogen – is the principal weapon against all types of warts, but curettage (scraping out the wart with a CURETTE) and cauterisation (see ELECTROCAUTERY) or LASER therapy may be required for resistant warts. Genital warts may respond to local application of PODOPHYLLIN preparations. Sexual partners should be examined and treated if necessary. Finally, treatment of warts should not be more onerous or painful than the disease itself, since spontaneous resolution is so common.... warts
Plant essences give plants their scent and were known to the ancient civilisations of Egypt and Greece as the ‘vital force’ or spirit of the plant. They were used for inhalation, rubbing on the skin or as a healthful addition to baths and foot-baths. The art is complementary to phytotherapy, acupuncture and other systems of alternative medicine.
The aromatherapist uses oils individually or in blends of different oils. The natural concentrated oil is usually diluted by adding a vegetable oil before direct application to the skin. A massage oil usually comprises 6 drops essential oil to 10ml (2 teaspoons) carrier oil – Almond, Peanut or other vegetable oil.
The skin is known to be an integral part of the immune system. T-cells are scattered throughout, primarily in the epidermis or outer layer. It has been demonstrated that oils rubbed on the skin are readily absorbed and borne to distant organs in the body via the bloodstream to soothe, relax and heal. Some oils should not be used during pregnancy or lactation.
An oil may be used as a natural perfume. As a bath oil, 5-6 drops of a favourite oil may be added to bathwater. Oils freshen a room; stimulate or relax as desired when added to water on a warm radiator. Oils are never used on the skin undiluted.
The aromatherapist never uses essential oils internally. Other carrier oils may be used: Sesame seed, Sunflower seed, Apricot kernel and Wheatgerm. Usual methods of applying essential oils: massage, inhalation and baths. When adding oils to baths water should not be too hot which causes oils to evaporate.
Remedies absorbed into the body via the skin avoid metabolism by the liver as when taken by mouth.
When the therapy was used in a geriatric ward in Oxford drug expenditure on laxatives and night sedatives fell. It was reported to have given profoundly deaf patients, many of whom had multiple sensory deficits, tranquillity. The results of a randomised trial in patients on an intensive care unit showed significantly greater psychological improvement (as demonstrated with anxiety and mood rating scales) in those given aromatherapy (1 per cent Lavender and Grapeseed oil) over those massaged with Grapeseed oil only or those prescribed rest alone. (The Lancet 1990 336 (8723) 1120)
The governing body of the therapy in the UK is the Aromatherapy Organisations Council (AOC) which represents the majority of professional practitioners. Enquiries: AOC, 3 Latymer Close, Braybrooke, Market Harborough. Leicester LE16 8LN. Tel/Fax 01858 434242. ... aromatherapy
A burn is covered with a non-stick dressing to keep the area moist. If necessary, analgesic drugs are given, and antibiotic drugs are prescribed if there is any sign of infection. For extensive 2nddegree burns, when there may be slow healing or a fear of infection, a topical antibacterial agent such as silver sulphadiazine is used. Skin grafts are used early in treatment to minimize scarring. 3rd-degree burns always require skin grafting. Extensive burns may require repeated plastic surgery.... burns
The outermost epidermis is composed of dead cells and the protein keratin. As these dead cells are worn away, they are replaced by new ones from the inner epidermis. Some epidermal cells produce the pigment melanin, which protects the body from ultraviolet light in sunlight.
The dermis is composed of connective tissue interspersed with hair follicles, sweat glands, sebaceous glands, blood and lymph vessels, and sensory receptors for pressure, temperature, and pain.... skeleton
burning mouth syndrome (BMS) a disorder characterized by a burning sensation in the mouth for which there is no obvious medical or dental cause. Other symptoms may include thirst, sore throat, and an unpleasant taste. BMS occurs most commonly in older females and may be related to menopause, stress, or vitamin deficiencies.... burn