MALARIA

A. Definition
Malaria is a contagious infectious disease caused by parasites of the genus Plasmodium, transmitted through the bite of Anopheles mosquitoes with a picture of a disease that is often periodic fever, anemia, enlarged spleen and various collection of symptoms by its effects on several organs such as brain, liver and kidney. (Http://medicafarma.blogspot.com)
Malaria is an acute disease becomes chronic and can be caused by a protozoan (genus Plasmodium) that intra living cells (Iskandar Zulkarnain, 1999). Malaria is an infectious disease that can be acute or chronic, caused by protozoa of the genus plasmodium characterized by fever, anemia and splenomegaly.
B. Etiology
Plasmodium are parasites that includes vilum Protozoa, sporozoa class. There are four species of Plasmodium in humans, namely: Plasmodium vivax causes vivax malaria (malaria tertiana light). Falcifarum Plasmodium cause malaria falsifarum (malaria tertiana weight), and Blackwater faver pernicious malaria. Plasmodium malariae malaria kuartana cause, and cause malaria, Plasmodium ovale ovale. (Nelson, 1999)
The four species of Plasmodium can be distinguished by comparing the shape schizont morphology, trofozoit form, the form contained gametocytes in the peripheral blood and pre-eritrositik form of schizont contained in liver parenchymal cells.
C. CLINIC manifestations
1. Plasmodium vivax (malaria tertiana)
a. Fell dizzy
b. Chills chills / fever (8 to 12 hours, can occur two days after symptoms first occur can happen for 2 weeks after infection)
c. Cold sweat
d. Convulsions
e. Feelings of weakness, no appetite, pain in bones and joints.
2. Falcifarum Plasmodium (malaria, tropical)
a. Fell dizzy
b. Chills chills / fever (more than 12 hours, can occur two days after symptoms first occur can occur for 2 miggu setela infection)
c. Cold sweat
d. Convulsions
e. Feelings of weakness, no appetite, pain in bones and joints.

3. Plasmodium malariae (malaria kuartana)
a. Fell dizzy
b. Chills chills / fever (not the first symptoms occur between 18 to 40 days after infection. The symptoms are then likely to recur every 3 days)
c. Cold sweat
d. Convulsions
e. Feelings of weakness, no appetite, pain in bones and joints
4. Plasmodium ovale (rarely found)
Where similar clinical manifestations of malaria tertiana:
a. Fell dizzy
b. Chills chills / fever (8 to 12 hours, can occur two days after symptoms first occur can happen for 2 weeks after infection)
c. Cold sweat
d. Convulsions
e. Feelings of weakness, no appetite, pain in bones and joints.

D. Pathogenesis / Pathophysiology
The occurrence of infection by the Plasmodium parasite into the human body can occur through two ways:
1. Naturally through the bite of female Anopheles mosquitoes containing malaria parasites
2. Namely if the stage asexual induction in erythrocytes get into human blood, for example through blood transfusions, injections, or the newborn via the placenta-infected mothers (congenital).
Pathophysiology of malaria is very complex and may relate to matters as follows:
a. Destruction of erythrocytes which occurs because of:
Rupture of erythrocyte-containing parasites
Phagocytosis of erythrocyte-containing and not containing parasites
The result is anemia and anoksia network and intravascular hemolysis
b. Endotoxin-macrophage release of mediators
In the process of releasing skizoni endotoxin, macrophages release various mediators endotoxin.
c. The release of TNF (tumor necrosis factor necrosing factor or tumor)
It is a monokin released by the malaria parasite. TNF is responsible for the fever, hypoglycemia, ARDS.
d. Sekuetrasi erythrocytes
Infected erythrocytes to form a knob on its surface. Knob contain malaria antigens, which then reacts with the antibody. Infected erythrocytes will stick to the capillary endothelium in the tool and forming clots causing dam. (Http://medicafarma.blogspot.com)
E. SUPPORTING DATA
1. Laboratories
Anemia in malaria can be acute or chronic, the acute objec rapid decline of Hb. The cause of anemia is destruction of erythrocytes by malaria parasites, emphasis eritropoesis and may be very important is the hemolysis by immunological processes. In acute malaria also occur eritropoesis inhibition on bone marrow, but when parasitaemia disappeared, the bone marrow into hiperemik, pigmentation active with hyperplasia of normoblast. In the peripheral blood can be found poikilositosis, anisositosis, polikromasia and basophilic spots resembling pernisioasa anemia. Thrombocytopenia can also be found that can interfere with the process of coagulation.
In severe tropical malaria, the plasma fibrinogen may decrease due to increased consumption of fibrinogen due to the occurrence of coagulation intravskuler. Mild jaundice occurs with indirect bilirubin increased more and abnormal liver function tests such as increased transaminase, sefalin flocculation tests positive, glucose and alkaline phosphatase decreased. Plasma proteins, especially albumin decreased, despite increased globulin. This change not only caused by fever alone but also because of increasing liver function. Hipokolesterolemia also can occur in malaria. Glucose is essential for respiration of plasmodia and the increase in blood glucose are found in tropical and tertiana malaria, may be associated with suprarenalis gland. Potassium in plasma increased at the time of fever, probably due to destruction of red blood cells. ESR is increased in malaria but returned to normal after being given treatment.
2. Diagnosis
Diagnosis of malaria often require proper diagnose the patient whether the patient about the origin of the malaria endemic region, history of travel to malaria areas, and preventip Portfolio kuratip treatment.
a. Examination drops of blood for malaria
Microscopic examination of peripheral blood for the detection of malaria parasites is essential for diagnosis. Examination one time with a negative result does not rule out the diagnosis of malaria. Peripheral blood examination three times and a negative result then the diagnosis of malaria can be excluded. The peripheral blood examination can be done through:
1) thick droplets of blood preparations
Is the best way to find malaria parasites because the blood drop quite a lot compared to thin blood preparations. Preparations are easy to make, especially for studies in the field. Thickness in making the preparations necessary to facilitate the identification of parasites. Parasite examinations performed for 5 minutes (an estimated 100 visual field with powerful magnification). Preparations declared negative when 200 of visual field after being reviewed by 700-1000 times magnification can not find the parasite. Calculate the parasite can be carried out in thick drops by counting the number of parasites per 200 leukocytes. When the leukocyte count parasites 10.000/ul then multiplied by 50 is the number of parasites is the number of parasites per micro-liter of blood.
b). A thin trickle of blood preparations. Used to identify the types of plasmodium, if the thick blood preparations difficult to determine. Parasite density expressed as arithmetic parasite (parasite count), it can be done based on the number of erythrocytes containing parasites per 1000 red blood cells. When the number of parasites> blood 100.000/ul indicate a severe infection. Calculate the parasite is important for determining the prognosis of malaria patients. Painting is done by staining Giemsa, or Leishman's, or Field's and also Romanowsky.
Giemsa staining is commonly used in several laboratories and is a painting that is easy with good results.
b. Antigen Test: p-f test
Which detects an antigen of P.falciparum (histidine rich protein II). Detection of very fast just 3-5 minutes, requires no special training, good sensitivity, requires no special equipment. Antigen detection for vivaks already circulating in the market that is by the method of ICT. Similar test by detecting lactate dehydrogenase from Plasmodium (pLDH) by immunochromatographic tests have been marketed under the name OPTIMAL. Optimal to detect than 000-200 parasites / ul blood and can distinguish whether or P.vivax P.falciparum infection. Sensitivity to 95% and false positive results is lower than the HRP-2 detection test. This test is now known as a rapid test (Rapid Test).
c). Serology Tests
Serology was introduced since 1962 by using indirect fluorescent antibody test technique. This test is useful to detect the existence of specific antibodies against malaria or in circumstances where the parasite is very minimal. This test is less useful as a diagnostic tool for a new antibody occurred after several days of parasitemia. Benefits of serologic tests, especially for epidemiological studies or blood donor screening tool. Titer> 1:200 is considered as a new infection, and test> 1:20 tested positive. Serologic test methods include indirect haemagglutination test, immunoprecipitation techniques, ELISA test, the radio-immunoassay.
d). PCR (Polymerase Chain Reaction) ---> examination of infection
This examination is considered to be extremely sensitive to DNA amplification technology, when used fairly fast and high sensitivity and specificity. The advantages of this test, although the number of parasites is very little to give positive results. This test is only used as a means of research and not for routine examination.

F. COMPLICATIONS
Complications of malaria is generally caused by P.falciparum and is often called pernicious manifestasions. Often occur suddenly without symptoms sebeumnya, and often occurs in people who are not immune as in the newcomers and pregnancy. Complications occur in 5-10% of all patients who were treated in hospital and 20% of them are fatal cases.
Malaria patients with kompikasi generally classified as severe malaria according to WHO defined as P.falciparum infection with one or more complications as follows:
1. Cerebral malaria (coma) that are not caused by other diseases or more than 30 minutes after a seizure, the degree of impairment of consciousness should be evaluated based on the GCS (Glasgow Coma Scale) was below 7 or equal to the clinical situation soporous.
2. Acidemia / acidosis, blood pH <> respiratory distress.
3. Severe anemia (Hb <> 10.000/ul; when anemianya hipokromik or miktositik must set aside the iron deficiency anemia, thalassemia / hemoglobinopathy other.
4. Acute renal failure (urine less than 400 ml/24 hours in adults or 12 ml / kg in children) after rehydration, with creatinine> 3 mg / dl.
5. Non-kardiogenik/ARDS pulmonary edema (adult respiratory distress syndrome).
6. Hypoglycemia: Blood sugar <>
7. Failed circulation or shock: systolic blood pressure <> C: 8).  10
8. Spontaneous bleeding from the nose or gums, gastrointestinal tract and laboratory abnormalities accompanied by intravascular coagulation disturbances
9. Recurrent seizures over 2 hour kali/24
10. Macroscopic hemoglobinuri because of acute malaria infection (not because of anti-malarial drugs / erythrocyte abnormalities (lack of G-6-PD)
11. Diagnosis of post-mortem with the discovery of parasites in the dense network of capillaries in the brain.

G. MEDICAL MANAGEMENT
Treatment of malaria can be done by giving the drug antimalari. Antimalarial drugs can be divided in 9 groups, namely:
1.kuinin (quinine)
2.mepakrin
3.klorokuin, amodiakuin
4.proguanil, klorproguanil
5.Primakuin
6.pirimetamin
7.sulfon and sulfonamide
8.kuinolin methanol
9.antibiotic
Based on the susceptibility of various stages of the malaria parasite to antimalarial drugs, the antimalarial drug can also be divided into 5 groups, namely:
1 Skizontisida primary tissue that can kill parasites in the liver praeritrositik stage so as to prevent the parasite into the erythrocyte, so it is used as a causal prophylactic drug. Medicine are proguanil, pyrimethamine.
2 Skizontisida secondary networks can kill the parasite cycle eksoeritrositik P. vivax and P. ovale and used for radical treatment as anti-relapse drug, medicine adala primaquine.
3 Skizontisida that kill blood stage parasites eritrositik, which is associated with acute illness accompanied by clinical symptoms. These drugs are used for suppressive treatment for the four Plasmodium species and also to kill the stage gametocytes of P. vivax, P. malariae and P. ovale, but not effective for the gametocytes of P. falcifarum. Medicine are quinine, chloroquine or amodiakuin; or proguanil and pyrimethamine which have a limited effect.
4 Gametositosida that destroys all sexual forms including gametocytes of P. falcifarum. Medicine are primaquine as gametositosida for four species, and quinine, chloroquine or amodiakuin as gametositosida to P. vivax, P. malariae and P. ovale.
5 Sporontosida that can prevent or inhibit the gametocytes in the blood to form oocysts in the mosquito Anopheles and sporozoit. Drugs - drugs that include this group is primaquine and proguanil.

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PAIN COPING TECHNIQUES "DISTRACTION"

Unnderstanding
A method for the relief of pain by diverting attention to the client on other matters, so that the client will forget to pain experienced.

The types of techniques distraction
1. Breathing slowly
2. Massage gently pulling breath
3. Listen to the song while patting-nepukan finger / foot
4. Imagine the beautiful things she closed eyes
5. Watching TV (the show craze)

Mentoring imagination (guided imagery)
1. Community Relations of trust
2. Explain the procedure: purpose, position, time, and the role of nurses as mentors.
3. Instruct the client to find a comfortable position according to client
4. Sitting with a client but did not interfere.
5. Perform well to coaching clients.
6. If the client shows signs of agitation, anxiety or discomfort, the nurse had to stop training and start again when the client is ready.
 Ask the client to think of pleasant things or experiences that help to use all the senses with a soft voice.
 When the client relaxes, the client focuses on the shadow and the time nurses do not need to talk anymore.
 If the client shows signs of agitation, anxiety or discomfort, the nurse had to stop training and start again when the client is ready.
 Relaxation will hit the entire body. After 15 minutes, the client must pay attention to her body, then note that tagang area and this area will be replaced with relaxation. Usually clients relax after a blind eye or listen to soft music as the background that helps.
 Write down the things depicted in the mind to use client-specific information provided by the client and not make changes to client's statement.

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Regarding the Blue Baby Syndrome

Blue Baby Syndrome / Baby Blues Syndrome, or often also called Postpartum Distress Syndrome is feeling sad and upset experienced by approximately 50-80% of women after giving birth to her baby.
Strange indeed ... feeling happy looking forward to the birth of the baby, turned out in some mothers can turn into depression after the birth of a baby.
Blues Baby Syndrome is still relatively mild and usually lasts up to 2 weeks. If you experience more than 2 weeks, it could be a Postpartum Depression and you should consult with your doctor ...

Some symptoms of Blues Baby Syndrome Cases:
1. Crying for no apparent reason
2. Easily annoyed
3. Tired
4. Anxious
5. Impatient
6. Reluctant to pay attention to the baby
7. Not confident
8. It's hard to rest in peace
9. Touchy
If after delivery you are experiencing a variety of conditions and feelings of the above, then most likely you're hit by Baby Blues Syndrome ...
What difference with Baby Blues Postpartum Depression Syndrome?
The difference lies both in frequency, intensity, and duration of ongoing symptoms above. In Postpartum Depression, you will feel the symptoms are more frequent, more intense, and longer.
How do I tell?
Actually it's easy. One way is to pay attention to the mother's sleep patterns. If when there is someone else look after the baby, the mother could sleep, then it is probable that the mother suffered only Blues Baby Syndrome (BBS). But if the mother is very difficult to fall asleep while the baby is maintained by someone else, then maybe the level of depression was included in the Postpartum Depression (PPD).
Some Symptoms of Postpartum Depression:
1. Fast furious
2. Confused
3. Easy to panic
4. Feeling hopeless
5. Changes in eating and sleeping patterns
6. There is a feeling of fear could hurt her baby
7. There is a feeling of worry could not properly care for her baby
8. Arises the feeling that he could not be a good mother
PPD can last up to 1 year after the birth of a baby ...
In cases of acute PPD, the mother could have committed suicide or hurt her own baby ...
What causes PPD?
Although up to this writing no one knows the exact cause of PPD, but the following factors seem very influential:
1. Changes in the mother's hormones
2. The pressure becomes new mother
3. There is a family history associated with depression
4. Lack of assistance when giving birth
5. Feeling isolated
6. Fatigue

Here are some tips related to blue baby syndrome before the birth:
1. Ask for help and support of extended family before giving birth.
2. The mother had a lot of reading about infant care knowledge.
3. Prepare mentally by sharing the mother, increasing medical knowledge and reproduce worship.
Blue Baby Syndrome Treatment
After the birth and found the mother mengealami blue baby syndrome symptoms, then the following tips can be done to overcome the problem of blue baby syndrome in young mothers.
1. Request assistance from a large family to take care of the baby.
2. Many sleep for the mother.
3. The mother should be sharing the difficulties and problems on the husband or family.
4. Utilizing time for relaxation.
5. Do not forget to eat and note the pattern of nutrient intake.

ref:doktersehat.com

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Attractive Appearance and Healthy

Attractive appearance and healthy? Who does not want? Both men and women would want to be healthy at the same time interesting. In fact, many funds allocated for the purchase of cosmetics and skin care products, especially the face. Users of cosmetics that currently is not restricted age and gender make cosmetic industries competing to make cosmetic products in great demand. Have you ever watched the number of cosmetic whitening products, anti-wrinkle and anti-acne? But on the other hand, there are cosmetic case is revoked license orbit by the Food and Drug Supervisory Agency (BPOM) due to the presence of a prohibited material. In fact, there are some products that do not have a distribution license from BPOM. So how should users be cosmetic?


Cosmetic preparations which are intended for use on the entire exterior of the human body (epidermis, hair, nails, lips and genital organs outside) or the teeth and mucous membranes around the mouth, especially to clean, perfume, change or improve appearance and body odor and / or protect or preserve the body in good condition. From the above definition, it is clear that the use of cosmetics are intended to maintain the body in good condition and not included in the group of drugs.


RI BPOM laboratory test results in 2007 found 27 brands of cosmetics contain ingredients that are prohibited from use in cosmetics, namely mercury, retinoic acid, rhodamine (red and red K10 k3). These materials are prohibited from use in cosmetics because it is dangerous for the skin.

Mercury
Mercury, mercury, or lead commonly misused as a whitening product. In fact, the side effects of mercury one of which is hyperpigmentation, which is the emergence of black spots on the skin. Mercury including hazardous heavy metals, although used in small concentrations. The use of mercury can cause a variety of ways, ranging from skin discoloration, skin irritation, permanent damage to the nervous system, brain, kidneys, and impaired fetal development. Short-term exposure to mercury in high doses cause vomiting, diarrhea and even kidney damage. Mercury is a substance that is carcinogenic (a substance that can trigger cancer) in humans.

Retinoic acid
In addition, the material that is often misused in the cosmetics anti-acne is retinoic acid or tretinoin. This substance encourages the sloughing of skin and clogged pores. The use of retinoic acid can cause dry skin, burning, and has teratogenic effects, which cause defects in the fetus. Tretinoin can cause serious symptoms, called retinoic acid syndrome (retinoic acid syndrome). A syndrome characterized by fever, difficulty breathing, pain in the chest, the presence of fluid around the lungs and heart, as well as hypoxia (oxygen deficiency). The use of retinoic acid as a treatment is only allowed (under strict supervision of doctors and pharmacists), but not as a cosmetic.

Rhodamine
Other materials BPOM findings are a red dye K10 (rhodamine B) and k3 red as a dye in the eye shadow and blush. These dyes are synthetic dyes are commonly used as paper dyes, textiles, or ink. Red dye red K10 and k3 is a substance that is carcinogenic. Rhodamine in high concentrations can cause liver damage.

Hydroquinone
The use of hydroquinone as an active ingredient in cosmetics that are allowed is 2%. Melanosom reduce the formation of hydroquinone (pigment granules of melanin) in skin pigment cells. Hydroquinone cream preparations may contain sodium metabisulphite which may cause serious allergic reactions. Side effects that can be caused by excessive use of hydroquinone include burning, itching, dry skin, or allergic to the affected skin contact, even skin discoloration.


Carefully Before Buying
Carefully before purchasing an expression that will never be obsolete. Researching an attitude that must be owned by the consumer.

Thorough Legality Cosmetics
Before release, cosmetic manufacturers must register their products to BPOM. After getting approval from the BPOM, the producer will get a registration number which consists of a combination of letters and numbers. For example POM CD 1234567890. POM CD shows that the cosmetic is a cosmetic in the country, while the CL is imported cosmetics. But now, pembarian registration number based on the regional level, such as POM CA, which means a registered cosmetics is a production of Asia (Hong Kong, Vietnam, Indonesia, etc.).

Thorough Cosmetic Composition
As a consumer, careful also about the presence or absence of hazardous materials in cosmetics. Cosmetic products which have been registered and approved for registration, must include the entire composition of the product.

Thorough Cosmetic Manufacturers and Distributors
Both producers and distributors of cosmetics must include the name and address on the packaging of cosmetics. This can facilitate better oversight of government agencies and consumers.

Researching The Cosmetic Use
Make sure the packaging of cosmetic products have batch number or production code, and time expired (cosmetics that stability is less than 30 months must include expiry date). If not specified expiration time, the cosmetics have a long time stability, ie more than 30 months.

In essence, both cosmetic users, manufacturers, and government agencies both need each other. However, consumers as users still have to pay attention to cosmetics before menbeli and must continue to find out. Hopefully useful and you can look more beautiful with a safe cosmetics.

Cosmetics is every women hearts!. But we also have to be careful in choosing and using safe cosmetics.

If the usage is wrong, we face not only the impact. Such as irritation, acne until permanent damage to the face! Horrible?!! But do not be afraid first, whatzups will invite you to know the ins and outs of more cosmetic.

1. Skin Type
Know your skin type correctly. In general, nearly 80 percent of Indonesia combination skin type (oily in the T areas: forehead, nose, forehead). Choose cosmetics, like moisturizers, foundation, or powder that match your skin type.

2. Stop sharing personal cosmetics
If you see a tester at the mall or the mall, do not immediately tempted to try it. Request a cosmetics saleswoman who is clean before use. After use you also have to clean it back immediately instead of waiting until the home. Karna due to share, you do not know what diseases can be transmitted by these cosmetic ... ihhhhh serem right. Tips for safe side, use the area of ​​your arm, not the face to check the color.

3. Alergy testing
Before you buy cosmetics, you should note the content of these chemicals in cosmetics. If your skin problem, use cosmetics for sensitive skin that levels of the chemical has been tested.

You also have to consider a simple check on these cosmetics. For example you can put on the arm or back of the neck while searching other cosmetics. If you feel itchy do not buy it, or stop usage.

4. Stay away from the Sun
Keep your cosmetics in a container or a place far from heat or sunlight. In addition to damaging the quality, also can lower your color cosmetics. You also must painstaking sealed cosmetics after using it. To prevent dust from dirt and germs in the air.

5. Observe the storage period of cosmetics
Be wise in store cosmetics you use. Do not force when he was already more than two or three years. Because, can make infection of the skin and cause irritation to fatal!.

Age lipsticks, mascara, powder, foundation, moisturizer and eye shadow on average can last up to 2 years. However, liquid or liquid product age is younger than cosmetic.

5. Clean up tools cosmetics
Note the cleanliness of your cosmetic tools. Get used to wash equipment before using it regularly.

Dust and dirt, and oil stuck to the face can trigger the proliferation of bad bacteria. Thus, instead of your pretty face will be problematic

ref : http://dodolkeren.wordpress.com

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SKIN ANATOMY PHYSIOLOGY

Understanding
The skin is a layer of tissue found on the outer cover and protect the surface of the body, continuous with the membrane that lines the lender cavities, the holes inside. On the surface of the skin and sweat glands leads to mucous glands.
A. Crust
Consists of 3 (three) layers from top to bottom:
1. Epidermis.
2. Corium / goose vera.
3. Sub goose / hypodermic.

1). Epidermal
Consisting of several layers of cells:
1.1 stratum corneum.
- Cell was already dead
- Does not have the cell nucleus
- The core cell is dead
- Contains substance ceratin.
1.2 Stratum Lucidium:
- Cell was flat, the difference with graulosum stratum is: Here the cells
so many have lost the core and the grain-grain has become very clear and penetrating rays, the items are still there called claidi which is phase II in the formation of keratine.
- This layer is only found on the palms of the hands and feet.
- In the layer looks like a ribbon of the cornea, the cell boundaries are not so visible is called the stratum lucidium.
1.3 Stratum Granulosum.
- Stratum consists of flat cells such as coils.
- These cells contained only two to three layers parallel to the surface of the skin.
- In the cytoplasma contained grains called keratohyalin which is a phase in the formation of keratin because of the many points of the stratum granulosum.
1.4 Stratum spinosum / stratum acantosum.
- This layer is the thickest layer and can reach 0.2 mm, consisting from 5-8 layers.
- These cells are called spinosum because if we look under the microscop that the cells consist of cells that form polygenal / many angles and has a horn (spine).
- Called acantonsum because the cells spiked.
- Apparently spine or horn there is a relationship between other cells called intercelulair intercelulair bridges or bridges.
1.5 Stratum Basale / Germinativum.
- Called for the stratum basale cells terltak basal section / base.
- Also called the stratum germinativum for replacing cells that are on it and is the stem cells.
- The form cylindaris (tube) with an oval core.
- It poses a fine grain is called grain melanine / color.
- Cells are arranged like a fence (polysode).
- The bottom of the cell have a membrane called the basement membrane.
- Basal cells with basement membrane is the lowest limit of the epydermis with dermys.
- It turned out that this limit is not flat but wavy, at the time of corium protruding bulge at epydermis Corri are called papillae (papilla skin).
- On the other hand epydermis bulge protruding toward the corium is called Riter ridges or rite Pegg = Prosessus interpapillaris.

2). Dermis
Dermis is the second layer of skin boundary with epydermis coated by basement membrane and on the bottom adjacent subcutis but this limit is not clear we simply take as a benchmark is the start there were fat cells.

Dermis consists of 2 (two) parts:
- The upper, papillary Pars (Stratum papilare)
- The lower part, Reticulari (Stratum recticularis).
Boundary between the pars papillary with pars reticularis is the bottom up to the sub goose.
Both papillary and pars pars reticularis consists of loose connective tissue composed of fibers:
a. Collagen fiber.
b. Elastic fibers.
c. Reticulus fibers.
Fibers are mutually beranyaman and each has different tasks:
- Collogen fibers, to give strength to the skin.
- Serabur elastic, giving flexibility to the skin.
- Reticulus, there foli especially around glands and hair and gives strength to the tool.
Among these are woven fluids between cells.

3). SUB Cutis
Sub goose gangs composed of fat cells and among these gangs walk connective tissue fibers of the dermis. These fat cells are round with the point pressed kepinggir, thus forming a ring.
This fat layer is called Puniculus adiposus, the thickness is not the same in each place and also the division between men and women are not equal (different).
Usability paniculus adiposus are as follows:
a. Shok brokor, spring / when pressure mechanical trauma that afflicts the skin.
b. Heat insulator or who maintain the temperature.
c. Hoarding calories.
d. Supplement for the beauty of the body.
Under sub goose muscle membrane and then there are the muscles.

B. TUBE BLOOD AND NERVE
1. TUBE BLOOD.
Skin blood vessels consist of two woven blood vessels pulse is:
a. Matting skin arteries above or beyond:
We have webbing between the papillary stratum and stratum reticulair, plaited runs arterioren at each papilla Corri.
b. Matting pulse blood vessels under the skin or in:
We have webbing between the corium and sub goose, matting provides pembukuh artery branches into additional tools contained in the corium.
In this case also gave branches that form the surface skin webbing arteries.
Webbing in the arteries which is formed by branches of the artery-cabanag contained in a layer of sub goose.
Branches are then going into veins / vein which will also form the webbing, that is woven deep veins.
Blood circulation in the skin is very important because estimated one fifth of the blood circulating through the skin. Besides the blood vessels in the skin very quickly narrows / widens by influence or stimulation of heat, cold, pressure, pain, pain and emotion, narrowing and widening to occur by reflex.

2. SKIN STRUCTURE OF NERVE
On the skin as well as in other organs there are branches of spinal nerves and the surface consists of motor nerves and sensory nerves.
Motor nerve endings is useful to move the muscle cells found in skin, whereas sensory nerve stimulation is useful to accept that there are from the outside or skin.
In the skin sensory nerve endings is shaped variety and use to receive stimuli such as:
- Edge-free nerve endings that are to receive a stimulus pain numerous in epydermis.
- What constitutes end organ, here the nerve endings have been a typical form of an organ.

C. COMPLEMENTARY SKIN
1. HAIR.
Tues epydermis has changed, the hair grows from hair follicles within epydermis, hair follicles bounded by an upper epydermis basically there is a clear pupil where hair grows, the roots are within the follicle at the end of the deepest and the exit section is called the hair shaft, hair follicles contained in the smooth muscle small as a hair enforcement.
Hair consists of:
a. Long hair pat on the head, pubic and beard.
b. Short hair in the nostrils, ear canal and eyebrows.
c. Lanugo hair all over body hair.
d. Sexual hair in the pubic and axial (armpit).
Skin color is influenced by:
a. Blood vessels in the skin.
b. More or less fat.
c. Skin pigment called melanine, more or less melanine dipengarukhi by:
- Racial or ethnic origin,
- Hormones.
- Effect of ultraviolet and infra red.

2. NAIL
Nails are epydermis cell skins have changed yana Pelung nails embedded in grooves along the lines of the skin.
Trench innervation and nail to get a lot of blood vessels. Part praksimal situated in multiples of skin is the beginning of the nail grows, nail body parts that are not covered with strong leather bound in leather trench and the top part of the free.
Part of the nail:
a. The tip of the nail over the tip line.
b. Agency is part of a large nail.
c. The root of the nail (radik).

3. Skin glands
Skin glands have lubulus rolling with straight exit channel is the way to remove various substances from the body (sweat glands).
Subasea glands derived from the hair that comes down the line the hair follicle to lubricate hair and skin adjacent.
Regeneration of skin and the aging process.
The skin has a large regeneration after skin injury of these cells in the dermis against local infection capillaries and connective tissue regenerating epithelium grows from the edge of the wound cover jarigan tie the generations, forming reddish belly at first because of the increased number of capillaries eventually turned into fibers kalogen whiteness visible through the epithelium.
Manifestation of aging skin.
Skin layer becomes thinner with respect to changes in the composition of basic chemicals jaringnan tie, then the cause of lack of fluid in the loss elastisitet the elastic fibers of the dermis and sub goose due to skin folds caused by pulling the tissue below it slowly disappeared and the incidence of irregular pigmentation spots .
Subasea gland.
Glands in the skin pocket shaped like a bottle and empties into the hair follicle, most numerous on the head and face around the nose, mouth and ears. Not found on the feet and palms.
These glands are lined by cel epithil.
There are 2 (two) glands located on the skin:
1. Sweat glands produce glanula sudorivera.
2. The gland produces glanula subasea bone.
Gland or glanula consist of:
1. Body gland.
2. Channels gland.
3. Estuary gland.

D. FUNCTIONS OF THE SKIN AS A HEAT TIMER
Despite the changes in environmental temperature, body temperature stable because of adjustments between the heat generated by the central regulator of heat is the temperature of blood flowing through the medulla oblongata. Normal temperature in the body that is visceral brain from 36 to 37.5 ° for skin temperature slightly lower.
Control of neural and cutaneous arterial vaso motor and there are 2 ways:
1. Vase dilatation, dilated capillaries, the skin becomes hot and excess heat emitted into the sweat glands, causing evaporation of fluid on the surface of the body.
2. Vase Construksi, blood vessels shrink, the skin becomes pale and cold, loss of sweating is limited and the heat / temperature of the body is not removed.
How to release heat from the skin:
1. Evaporation of the amount of blood flowing through the capillaries of the skin.
2. Radiant heat from surrounding air.
3. Heat is applied to objects such as clothing touching.
4. Pangaliran hot air.

Sweat
Aktil secretion from sweat glands taken control of the sympathetic nervous sweat contains water and a little salt is removed through a simple diffusion ± 500 cc / day.
Sweat gland is a major tool to control body temperature will be reduced at the time of cold climate and more in hot climates.

E. SKIN AS A sense of touch
Sense of touch caused by stimulation of the nerve endings in the skin varies according to the stimulated nerve endings, feeling hot, cold and sick dtimbulkan because of pressure in and feeling the weight of an object such as the muscle and bone.
Skin as a store of water.
Skin and underlying tissues to work as water storage adipose tissue under the skin of the main fat storage in the body.

Sense of touch (SKIN)
We have five senses of touch on the skin in addition to the skin as well as the heat release in the body, the skin cover and continuous with the mucous membrane that lines the cavities and holes.
The skin has many nerve endings of touch that receive stimuli from outside forwarded to the nerve centers in the brain.
Skin Function:
1. As an organ of the body's heat regulator.
2. Cover and protect the body surface.
3. Helps manage and protect water loss from the body.
- Exkretori (expenditure process substances that are not used by the body).
- Secretory (expenditure process used by the body's metabolism).
- Absorption (the absorption of food substances that occur on the skin).
4. As a means of stimulating flavor that comes from outside, from the nipple-nipple feeler carried by motor and sensory spinal nerves were taken to the central nerve in the brain.
Receptors are widespread in the lining epithelium and connective tissue of the human body. Each different receptors, the vast majority were reeptor pain then touch sensation, cold and heat.
Receptors located in the epithelial layer, was found in oral mucosa and respiratory tract to sense touch and pain, and flattened epithelial tissue layers at the root of the hair.
Receptors located in the connective tissue:
So many lies in the skin below the mucous layer around the joints, pleura, endocardium, peritoneum, etc..
Sense of touch caused by stimulation of the nerve endings in the skin vary by stimulated nerve endings that sense heat, cold, sick of all these different feelings.
Feelings of pressure caused a very deep and feelings allows one to determine and assess the weight of an object arises in deeper structures such as the muscles and joints.

F. ABILITY TO PROTECT THE SKIN
1. Avoiding the loss of fluid from the network and avoid the entry of water into the network.
2. Prevents injury to the structures underneath.
3. Preventing dehydration is more severe hazard if the epidermis is damaged

G. SKIN FUNCTIONS
1. Meindungi body against injury, mechanical, chemical, and thermic because epithelnya with glandular secretions help provide protection against skin.
2. Protection against pathogenic microorganisms.
3. Maintain body temperature with the help sirculasi blood.
4. Regulate fluid balance through sirculasi gland
5. Tools senses through feeling, respiratory, sensory and pressure, temperature and pain.

H. PSYCHOLOGICAL RELATIONSHIP WITH LEATHER
The skin is closely related to one's psychological, if someone in anger / joy red face and skin looks pale and sweaty terliahat cool if someone in a state of fear.

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