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The skin is the site of many complex and dynamic processes as demonstrated in Figure 1-1 and Table 1-1. These processes include barrier and immunologic functions, melanin production, vitamin D synthesis, sensation, temperature regulation, protection from trauma and aesthetics.

Figure 1-1.

Cross-section of skin.

Table 1-1.Structure and function of the skin.


The epidermal barrier protects the skin from microbes, chemicals, physical trauma, and desiccation due to transepidermal water loss.1–3 This barrier is created by differentiation of keratinocytes as they move from the basal cell layer to the stratum corneum. The keratinocytes of the epidermis are produced and renewed by stem cells in the basal layer resulting in replacement of the epidermis approximately every 28 days. It takes 14 days for these cells to reach the stratum corneum and another 14 days for the cells to desquamate.

Keratinocytes produce keratins, structural proteins that form filaments that are part of the keratinocyte cytoskeleton. In the stratum spinosum keratin filaments radiate outwards from the nucleus and connect with desmosomes which are prominent under the microscope giving a "spiny" ...

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