On the 16^th of October 2018 I was insructed to complete an investigation report relevent to my course choice Beauty Therapy studies level 2 by Elaine Donaldson, my Anatomy Tutor.

I have choosen to do my report on the structure and functions of the skin and how Multiple Sclerosis effects the nerve endings of the Integumentary system. This will be completed by 31^st of October for review.

Procedures

In order to complete the relevent investigation, the following procedures were implemented to obtain all the information in this report.

One source of research that was completed were notes from classes held by the tutor Elaine Donaldson
Online research from various sites which will be listed in the Bibliography.
Reading, Beauty Therapy, The Foundations : The Official Guide to Beauty Therapy Level Two by Lorraine Nordman.
Anatomy and Physiology, Therapy Basics (fourth edition) by Helen Mcguinness

Findings/Investiagtion

Structure Of The Integumentary System

There are 3 layers to the integumentary system (the skin) each with there own purpose and job to do in the running of the biggest organ’s in our body. A fully grown adults skin can weigh up to 8 pounds (3.6kg) and stretch 22 square feet (2 square meters). The skin is our bodies coveringand does a lot more than make us look presentable. In fact, without it, we’d literally evaporate.

Epidermis

The epidermis is the outer most layer of the skin and in this layer a lot happens and consists of 5 layers

Stratum Corneum(cornified, horney layer)

This layer is formed from several layers, scale like flattend overlapping cells compiled of dead kertin. Keratin combined with lipid fats create a waterproof barrier protecting the skins surface from bacteria, reflect UVA light and protect us from enviromental factors.

Stratum Luicidum (clear, transparent layer)

This layer is only found in the palms and the soles of the feet. The areas where no hair grows and thicker skin. The cells here have no nucleous (brain) and the clear liquid layer filled with a substance called eledin produced by the body as a further stage of keratinisation.This layer cushions and protects.

Stratum Granulosum(the granuler layer)

This layer is composed of either one, two or three layers of flattend cells. The nucleous in this layer is beginning to break up as it moves up towards the stratum lucidium

Stratum Spinosum (prickly layer)

This layer has 8 to 10 layers of keratinocytes formed as a result of cell division from the basal layer of the epidermis. This layer also has a dendtritic cell called langherhans cells which engulf foreign bacteria, particles and damaged cells.

Stratum Germinitivium (basal layer)

This layer is the deepest layer of the epidermus and connects to the dermis, it bonds to the dermis with collegen fibers called the basment memebrane. The dermal paillila is also located here, this increasing the strenth of the connection from the epidermis and the dermis.

Diagram 1: Layers of the Epidermis

Dermis

The dermis is the second layer of the integumentary system and is a thick layer of fiberous and elastic tissue made of mostly collegen and an important componant, though small of elastin. These componenets give the dermis its strength and flexability.

The dermis has 2 main layers the:

Papillary layer (the uppermost layer)
Reticular layer (the lower layer)

The dermis contains a lot of important structures and functions such as:

Sabaceous glands
Dermal papillia
Hair follicle
Hair bulb
Sweat glands
Sweat pores
Sensory nerves
Motor nerves
Lympathitic
Melanocytse
Blood vessels

Each function and structure playing an extremley important part in the running and maintenance of the human body, like a super-computer all components have to work in sync for optimal results.

Diagram 2: Image of the Dermis

Subcutaneous layer (hypodermis)

The subcutaneous layer or otherwise know as the hypo dermis is the third and bottom layer of the integumentary system. This is the most widley distrubuted tissue for protecting the underlying tissues and organs, provides insulation and the bodies shock absorber from impacts. It consists mainly of adipose tissue and is the storage for most body fats. (see Diagram 2. for refrence to location)

Function Of The Integumentary System

The are seven main functions of the integumentary system, again each with there own purpose yet collectivly ensure smooth running of the system as a whole.

Sensation

This function is to do with the mass network or nerve cells in our skin to send and recive information. The nerve endings in the skin help detect: hot, cold, pain, pressure and touch.

Heat Regulation

This function helps regulate tempreture by sweating or shivering via the sweat glands and hair. By releaseing sweat it starts to cool the body when to hot. When cold we shiver activating the arrector pilli muscles trapping a layer of heat between the hairs to keep you warm.

Absorbtion

This function of the skin absorbs UVA (ultriviolet light) which help with the production of vitamin D. Some creams and oils can be absorbed by the skin but due to the next function not a lot of these products will not make it through.

Protection

This function is called the acid mantle. The skin protects its self from to much UVA light with a pigment called melanin. The acid mantle creates a barrier over your skin to prevent bacteria and germs entering the skin. Without a protective barrier our skin would absorb everything including water becoming a sponge for everything. The acid mantle is your water proof winter jacket for all year round.

Exccretion

This functions job is remove waste products and toxins from the body by realeasing them through the sweat glands. Lymph nodes also release toxins from the body also.

Secretion

This function secretes sebum oil and sweat on the skins surface to lubricate and keep the skin soft. When the sebum oil and sweat combines on the surface of the skin it creates the acid mantle.

Multiple Sclerosis

Multiple Sclerosis (MS) is an autoimmune neurologial disease which effects the Central Nervous System (CNS) in the brain and spine. There are different stages of Multiple Scleorsis:

Relapsing – Remitting MS

Primary – Progressive MS

Secondary – Progressive MS

Progressive – Relapsing MS

Most common, being Relapsing remitting.

MS is a progressive, immune-mediated disorder, this means the system designed to keep your body healthy mistakenly attacks parts of your body that are vital to everyday function. The protective coverings of nerve cells are damaged, (demyelination) which leads to diminished function in the brain and spinal cord.

This disease effects the protective myelin sheath that covers and protects each nerve for efficiant relay of information from the brain and spine to the body as a whole. When the myelin sheath has been damaged it leave nerves exposed and interrupts the system of sending and receiving infromation from the brain.

Some of the common symptoms of MS:

vision problems
tingling and numbness
pains and spasms
weakness or fatigue
balance problems or dizziness
bladder issues
sexual dysfunction
cognitive problems
loss of sensation (touch, pressure and temperature)

Diagram 3. Image of Demyelination

Multiple Scelrosis and the Integumentary System

The integumentary system (nerve endings in the skin) is responsible for the function of sensation to pressure, pain, tempreture and touch. This system is your bodies defence system, your personal alarm so to speak. Multiple Sclerosis and the demyelination process effects this system and function in the integumentary system leading to loss/alterd sensation and or strange sensations due to the missfire of the nerves and where the damage has been made.

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Altered sensations depending on which part of the CNS has been damaged can occur in any part of the body, but most commonly in the legs, arms, face and torso, but may also include the genital area in both men and women. It may occur on just one side of the body or on both sides.

Those diagnoised with MS describe sensation in many ways:

hot/burning
Tingly
Pins and needles
wet
Numbness
Prickling
Skin feels sensitive
Burning
Stabbing
Shooting like electricity
Itchy
Crawling

Each person is different and is affected in a different way (snowflake disease as not two patients are the same)

Treatment Plans/Lifestlye Changes

There are multiple treatments on the market for Multiple Sclerosis called DMTs (Disease Modifying Thearpy). And treatments to help a relapse.

Treatments for MS attacks/flare ups

Corticosteroids, such as oral prednisone and intravenous methylprednisolone, are prescribed to reduce nerve inflammation. Side effects may include insomnia, increased blood pressure, mood swings and fluid retention.

Plasma Exchange (plasmapheresis), the liquid portion of part of your blood (plasma) is removed and separated from your blood cells. The blood cells are then mixed with a protein solution (albumin) and put back into your body. Plasma exchange may be used if your symptoms are new, severe and haven’t responded to steroids.

Treatment options for relapsing-remitting MS include:

Beta Interferons, These medications are among the most commonly prescribed medications to treat MS. They are injected under the skin or into muscle and can reduce the frequency and severity of relapses. Side effects of beta interferon’s may include flu-like symptoms and injection-site reactions.

You’ll need blood tests to monitor your liver enzymes because liver damage is a possible side effect of interferon use. People taking interferon’s may develop neutralizing antibodies that can reduce drug effectiveness.

Ocrelizumab (Ocrevus), this humanized immunoglobulin antibody medication is the only DMT approved by the FDA to treat both the relapse-remitting and primary progressive forms of MS. Clinical trials showed it reduced relapse rate in relapsing disease and slowed worsening of disability in both forms of the disease.

Ocrevus is given via an intravenous infusion by a medical professional. Side effects may infusion-related reactions including irritation at the injection site, low blood pressure, fever, and nausea among others. Ocrevus may also increase the risk of some types of cancer, particularly breast cancer.

Glatiramer Acetate (Copaxone) – this medication may help block your immune system’s attack on myelin and must be injected beneath the skin. Side effects may include skin irritation at the injection site.

Dimethyl Fumarate (Tecfidera) – this twice-daily oral medication can reduce relapses. Side effects may include flushing, diarrhoea, nausea and lowered white blood cell count.

Fingolimod (Gilenya) – this once-daily oral medication reduces relapse rate. You need to have your heart rate monitored for six hours after the first dose because your heartbeat may be slowed. Other side effects include headache, high blood pressure and blurred vision.

Teriflunomide (Aubagio) – this once-daily medication can reduce relapse rate. Teriflunomide can cause liver damage, hair loss and other side effects. It is harmful to a developing foetus and should not be used by women who may become pregnant and are not using appropriate contraception, or their male partner.

Natalizumab (Tysabri) – this medication is designed to block the movement of potentially damaging immune cells from your bloodstream to your brain and spinal cord. It may be considered a first line treatment for some people with severe MS or as a second line treatment in others. This medication increases the risk of a viral infection of the brain called progressive multifocal leukoencephalopathy in some people.

Alemtuzumab (Lemtrada) – This drug helps reduce relapses of MS by targeting a protein on the surface of immune cells and depleting white blood cells. This effect can limit potential nerve damage caused by the white blood cells, but it also increases the risk of infections and autoimmune disorders.

Treatment with alemtuzumab involves five consecutive days of drug infusions followed by another three days of infusions a year later. Infusion reactions are common with alemtuzumab. The drug is only available from registered providers, and people treated with the drug must be registered in a special drug safety monitoring program.

Mitoxantrone – This immunosuppressant drug can be harmful to the heart and is associated with development of blood cancers. As a result, its use in treating MS is extremely limited. Mitoxantrone is usually used only to treat severe, advanced MS.

Life style changes

A diagnosis of Multiple Sclerosis can be like loosing a loved one, just you have lost the person you were. With the right help and medical team you can live a normal life with adjustments such as healthy diets, physiotherapy, reduce or cut out any bad habits like smoking and consuming alcohol. This in time will slow the proggession of the disease. Daily living can become an issues, just bathing can be dangerous so using a reliable thermometer to regulate tempreture to not cause any burns. Watching carefully while using sharp implements (your eyes will become your best friends) and avoiding treatments and activties where tempreture cannot be regulated. Recommended to go out in the sun as Vitamin D is extremly important for people with this diagnosis and is thought to be one of the enviromental components or therefor lack of, that contributes to the diseases off set.

Bibliography

Websites

www. Nationalgeoraphic.com
https;//opentext.ca/anatomyandphysiology.com
https;//en.m.wikipedia.org>wiki>dermis
https;//mkarcgrad.wordpress.com
https://www.healthline.com/health/multiple-sclerosis/early-signs
https://www.mstrust.org.uk/a-z/altered-sensations#what-are-altered-sensations
https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/diagnosis-treatment/drc-20350274