Anatomy of the Skin Surface
2006
Human perception is based on visualization of surfaces. Because we cannot look
inside, we define objects through their interfaces. This, of course, holds true for
human skin. The interface, which meets our eyes, is the stratum corneum, the dead
outer layer of the epidermis, composed of flattened horny cells, which are constantly being shed. Still, the physical state of the stratum corneum often reflects
changes that have occurred below in the viable tissue. For example, in the epidermis, either thickening (acanthosis) or thinning (atrophy) results in characteristic
changes of the glyphic patterns. Inflammation is typically followed by scaling in
patterns, which often enable us to diagnose the underlying disorder. Examples
are endless, including dermal and epidermal pigmentation, respectively reflecting
brown or blue coloration, and numerous forms of hyperkeratosis, follicular and
nonfollicular, resulting in a rough, dry, cracked surface. Pathologic events in the
dermis can cause soft or firm swellings of the surface. It is important to realize that
clinical diagnosis frequently depends on how we perceive the surface. Knowledge
about the stratum corneum in health and disease is thus crucial to dermatologic
practitioners.
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