A ballet dancer stretching on a wooden floor, wearing a black lace leotard and a white tutu. Her hair is styled in a bun as she leans forward, elegantly showcasing her skin, back muscles, spine, and ribs.
Meg Mountainbear LaRance, MSN, CRNA 33 min read


Is Skin the Body's Largest Organ? Discovering Surprising Facts About Our Voluminous Tissue

Within the intricate composition of our human form, our many organs work together like ensembles of coordinated dancers. Organs fluidly perform signature arrangements while bearing their weight of purpose with grace. Their harmonious sequences merge to compose life’s ongoing symphony of eternal movement.

Among these marvels, our skin takes center stage as a unifier of all organs. Much like the cohesive costumes worn by a corps de ballet that emphasize their collective nature, provide protective covering during performances, and capture visual appreciation from the audience, our skin physically encloses, unifies, and safeguards our organs, while bejeweling us.

As the sole organ to cover the entirety of our body’s external surface, our voluminous skin is often only associated with the aspect of our body that we can see and touch.1 What lies just beneath our skin’s outer surface is an extraordinary display of cellular organization, coordination, and activity that yields perpetual change. Comprised of living dynamic tissues, our skin is not quite the same from one day to the next. Let’s discover some additional truths about our skin.

 

Skin is a Massive Organ

The prevailing consensus has been that skin is our body’s largest organ. Some researchers affirm that skin accounts for one seventh, or about 15%, of our body weight2, 3 If this is true, the skin of an adult who weighs 150 pounds (68 kg) accounts for about 22.5 pounds (10.2 kg).4 

Not everyone agrees on the weight of skin within the scientific research and medical community. Those who don’t, maintain instead that skin’s weight is estimated to be 6 to 11 pounds (2.7 to 5 kg), or about 6% of body weight.5, 6, 7, 8, 9  

It is important to note that when research articles and studies mention the skin as one of the human body’s largest organs, they are typically referring to estimations of skin’s size in terms of the space it occupies, i.e. mass and surface area, rather than its actual weight due to gravity. In scientific contexts, the terms “weight’ and “mass” are related but have distinctly different meanings. Suffice it to say, in settings where gravity remains constant, such as on the surface of our planet, weight is directly proportional to mass. Due to this, “weight” and “mass” are often used interchangeably to denote an object’s heaviness.10, 11, 12, 13

When considering the weight of skin, several factors contribute to determining its true measurement. Body weight, height, and average skin thickness are all variables used to accurately calculate the weight of skin.9 However, we need to understand what actually constitutes skin before we can ascertain its weight. Let’s look at what tissue layers define skin.

According to renowned research dermatologist, the late Dr. Morris Leider, if the skin is taken to include the entire panniculus adiposus (the fatty subcutaneous white adipose tissue (sWAT) that sits above the muscle14, 15; a term rarely used in reference to human skin and appears to have been largely abandoned), then skin’s weight is estimated to be 20 pounds, or 15% or one seventh of body weight. However, if the skin is taken to include only the “whole skin” and not the “panniculus adiposus”, then skin’s weight is estimated to be 9 pounds, or 6% or one sixteenth of body weight. This likely accounts for the wide discrepancy of conflicting estimates found in the literature regarding the average weight of human skin (20+ pounds versus 7 to 9 pounds).9

Dr. Morris Leider concluded that skin consisted mainly of epithelial tissue, connective tissue, and a little fat tissue. He described “whole skin” as comprising three layers: epidermis (0.012 cm), dermis (0.2 cm), and hypodermis (0.008 cm).9 This appears to be supported by more recent research indicating that the dermis is composed of the papillary dermis layer, reticular dermis layer, and dermal white adipose tissue (dWAT) layer.16 The dermal white adipose tissue layer has been historically termed subcutis and hypodermis.17 Dermal white adipose tissue differs morphologically from the deeper subcutaneous white adipose tissue (sWAT). Dermal white adipose tissue is concentrated around hair shafts and follicles, sebaceous glands, and arrector pili muscles.18 

Even at 6% of body weight, skin outweighs the next widely accepted heaviest human organ, the liver. The weight of our liver is positively correlated with our body weight19, comprising approximately 2% of our total body weight, which averages about 3.3 pounds.20

Modern research has unveiled compelling evidence that may support the classification of an expansive, highly innervated and connected network of structures as an organ.21, 22, 23 These structures collectively would be larger and heavier than skin. Nomenclature poses a serious challenge, as this group of structures has many names, and its name changes based on the particular aspect in focus.24, 25 When referring to its connective tissue components, it has been called “fascia”, “solid fascia”, or “solid fascial tissue”. When discussing its fluid components, it has been called “fluid fascia”, “liquid fascia”, or “liquid fascial tissue”. Blood vessels, lymphatic vessels, and interstitium are examples of solid fascia. Interstitial fluid, blood, lymph, and cerebrospinal fluid are examples of liquid fascia.26, 27, 28, 29, 30, 31, 32, 33   While solid fascial tissue surrounds, supports, divides, penetrates, and connects all the different regions of the body from head to toe, liquid fascial tissue nourishes, permeates, and transports messages.34, 35

Scholars have diligently pursued the task of defining fascia. More recently, groups of academics have put forth scientific definitions. At this time, no unanimous definition of fascia has been formally established and agreed upon internationally.36 It is generally accepted that fascia maintains a continuous path without interruption and features overlapping layers with different characteristics and properties.37 Fascia is a three-dimensional polymorphic continuum and may encompass all tissue structures capable of responding to mechanical stimuli.38, 39 Fascia forms one cohesive structure that facilitates all body systems to operate in an integrated manner.40 The fascial continuum (the interconnected network of fascia) continuously receives and transmits mechanometabolic information, influencing the shape, physiology, and health of the entire body. Every tissue categorized as "specialized connective tissue" originating from both the ectoderm and mesoderm is integrated into the fascial system. These include blood, cartilage, bone, adipose tissue, and lymphatic tissue. Interestingly, the epidermis and dermis are tissues considered aspects of the fascial continuum.33, 35

If ongoing research confirms that the epidermis, dermis, and adipose tissues forming the skin are indeed classified as fascial tissues, it would lead to the recognition of skin as an integral part of the fascial system and a component of the fascial organ.36, 39 This shift would challenge the traditional view of skin as an independent organ and emphasize its collaboration with other body structures to facilitate body movement, performance adjustment, body awareness, and control.41 

There has been much discussion recently about the discovery of a “new” organ called the interstitium.42, 43, 44  The interstitium, as noted earlier, is an aspect of fascia. The interstitium is a solid, continuous, fibrous, collagenous, connective tissue matrix structure of interconnected fluid-filled compartments throughout the body that spans organ boundaries. Interstitial fluid is the liquid in the interstitial structure.27, 30, 31, 45

The fibrous connective tissues of fascia are estimated to weigh 27.5 pounds (12.5 kg), constituting approximately 17% of our total body weight.46, 47 In addition to this structural component, humans carry significant volumes of liquid fascia, including interstitial fluid, blood, lymph, and cerebrospinal fluid, which collectively can account for greater than 40% of total body weight. Interstitial fluid alone can represent 15 to 40% of body weight, and blood volume contributes around 7%.39, 48, 49  Considering fascia as an organ, its mass would encompass the combined weight of both its fibrous connective tissue and liquid components, and surpass 40% of total body weight. While this estimation focuses on the fibrous connective tissues and liquid components of fascia, it excludes other tissue groups such as bone, skin, and adipose tissue, which some researchers regard as part of the fascial continuum.38, 50 White adipose tissue by itself can account for up to 70% of total body weight in people with morbid obesity.51 Nevertheless, this assessment may indicate that fascia far exceeds the mass of any other individual organ.

While the concept of fascia as one massive sensory organ has garnered considerable attention and appears to be supported by emerging research, it remains the subject of ongoing scientific debate, research, and investigation. As additional insights unfold about fascia, the previously presented information may not comprehensively capture the evolving scientific understanding.

Until more is known, it is intriguing to consider the potential that skin, which we already regard as significant, might be part of an even larger organ and system. Further research is needed to fully define fascia, including examining its integration with the skin, and to explore how the fascial continuum may impact human health, movement, and overall wellbeing.

 

Skin Naturally Let’s Go of the Past

In the time it took you to read this far, your body actively shed well over 30,000 individual dead skin cells from the surface of your skin.52 This natural process is called desquamation and normally occurs continuously and invisibly.53 The exact number of dead skin cells shed by a person varies and depends on a variety of factors including overall health, size, race,54 age, and environmental conditions.55, 56

On average, it is estimated that adults shed 30 to 40 thousand dead skin cells per minute, 1.8 to 2.4 million dead skin cells per hour, and 43 to 57 million dead skin cells per day.57 Some researchers have estimated that humans actually shed closer to 500 million dead skin cells in a day. According to them, if you were to gather the skin flakes shed by the average adult in just one hour, your collection would weigh between 30 to 90 milligrams, which is equivalent to 0.03 to 0.09 grams, or approximately 0.001 to 0.003 ounces.58, 59. Just imagine, the shed skin flakes you accumulate in a day could weigh anywhere from 720 to 2,160 milligrams, which is equivalent to 0.72 to 2.16 grams, or roughly 0.024 to 0.072 ounces. To put this in perspective, if your daily accumulation of shed skin flakes weighs 2 grams, that’s roughly the weight of half a teaspoon of dry rice. Maybe a future science project for your school-aged loved one.

Did you know? Your dead skin cells serve as food for microscopic organisms, known as microorganisms, living within the pores on your face (Demodex folliculorum, also known as face mites or follicle mites)60 and within the fabrics of your home (Demartophagoides farinae and Dermatophagoides pteronyssinus, better known collectively as house dust mites)61, 62, 63. Interestingly, house dust mites can also be found on your face, around the sebaceous glands, and on hair follicles. They're quite prevalent, inhabiting the skin of 23 to 100% of healthy individuals.64 Astonishingly, just a day’s worth of shed skin can feed up to one million house dust mites.65

 

Skin Experiences Lifetime Renewal

Skin, thankfully, regenerates continuously throughout life, by way of a biological process called epidermal turnover. In a healthy individual, desquamation and epidermal turnover are in balance. The period of time from when new skin cells are born as keratinocytes in the basal layer of the epidermis, to when they are shed from the skin’s surface, as corneocytes, is referred to as epidermal turnover time, or skin cell turnover time.66

Skin cell turnover time is affected by a vast variety of factors and varies individually. Diet and nutrition,67, 68 race,69 age,70 level of sun exposure,55  skin’s location on the body,71  environmental season and conditions,56  stress levels and immune response,72, 73  hormones,74  and overall health all play important roles in promoting healthy skin cell turnover.

Generally, skin growth in infants is faster than skin growth in adults. The skin cell turnover time in infants is shorter than the skin cell turnover time in adults.75 As individuals age, skin cell turnover time gradually increases, resulting in a slower turnover rate. In young adults, skin cell turnover time typically ranges from 20 to 28 days.76, 77 In later adulthood, skin cell turnover time averages 30 to 40 days.71, 78 In even older adults, skin cell turnover time can extend to an average of 40 to 60 days.77

 

Let’s Take a Look at Skin Thickness

Skin’s thickness varies, depending on where it is on our body, what demands are made upon it, our sex, and our age. The skin of the eyelids is the thinnest,79 at approximately 0.5 mm thick,80 about the thickness of a stack of five standard size regular copy papers.81 The skin of the heels of feet can be as much as 4 mm thick,4, 8 about the thickness of two stacked nickels.82 Younger people generally have thicker skin than older people.83 Males generally have thicker skin than females.84

 

Skin Partners With Trillions of Microorganisms

Our human skin is home to trillions of living, diverse, resident, and transient microorganisms, forming distinct and intricate ecological communities.85  Among these are those previously mentioned Demodex mites.86 On just a typical square centimeter of skin are an estimated one billion living microbes, covering the surface and extending into the skin’s appendages.85 Bacteria comprise the majority of skin microorganisms.87

The microorganisms living on skin are referred to as the skin microbiota. Together, the skin microbiota, along with their genetic material, structural components, metabolic byproducts, and surrounding environment, form what is known as the skin microbiome.88 A healthy skin microbiome involves a balanced interplay of interactions between the genetic information of bacteria, eukarya (e.g. fungi, candida, and small arthropods such as Demodex mites), viruses, archaea, and bacteriophages with that of the human host.64, 89, 90, 91 The skin microbiome varies significantly between individuals and is as distinct and individualized as a fingerprint.92

The composition of skin microbiota at any given site primarily depends on the skin's physiology at that location.86 Resident skin microbiota have adapted to survive by utilizing resources present in sweat, sebum, and the stratum corneum, as skin lacks many nutrients beyond basic proteins and lipids.93 They thrive in areas where local environmental conditions are most favorable to their growth. Such conditions include the moist/humid, dry, and sebaceous microenvironments found across the skin. Specific microorganisms are associated with each of these environments. For instance, the skin microbiota found in moist/humid regions, like the interdigital spaces, armpits, navel, and groin, differ from those inhabiting dry areas, such as the forearms and legs, as well as from those present in sebaceous zones, like the face, chest, and back. Other factors influencing microbial colonization and establishment include skin thickness, density of hair follicles and glands,64 skin topography, epithelial cell type, underlying vasculature, endocrine system function, pheromones,87 and presence of local predators and pathogens. Additionally, individual factors such as health, race, gender, age, lifestyle (e.g., occupation, hygiene habits, skin product and medication usage, and diet), environment (e.g., climate, geographical location, pollution, and ultraviolet radiation), and genetic makeup can influence the composition of the skin microbiota.94

While research on the skin microbiome is still in its infancy, studies have shown that skin microorganisms influence a vast array of interrelated processes.95 These include the maintenance of skin homeostasis,96 training and modulation of the immune system, protection against invading pathogens,90 natural product metabolism97 (e.g. breaking down dead corneocytes, sebum, and sweat components and converting them into amino acids, proteins, and various free fatty acids94), wound repair,89 providing nutrients (vitamin synthesis), and regulating epidermal differentiation.98

Not all interactions with skin microbiota exclusively benefit us. Under normal conditions, certain bacteria pose no pathogenic threat as long as proper hygiene practices are upheld and the normal resident flora, immune responses, and skin barrier function remain intact. However, following disruptions, bacterial populations can seize the opportunity to colonize, proliferate, and induce disease. For instance, while Staphylococcus epidermidis typically exists as a skin commensal (a microorganism whose interactions on the skin cause no harm and may even provide some benefits)99, it can act as an opportunistic pathogen in individuals with compromised immune systems.85 Our understanding of the effects of all skin microorganisms remains incomplete, and the effects we are aware of likely do not grasp the entire scope of their influence.100 

Our human body is host to numerous microbiomes, not just the one living on and within the skin. Each microbiome resides in various regions such as the ear, eye, mouth, nasopharynx, genitourinary tract, breast, gastrointestinal tract (gut; the body’s largest microbiome), and potentially even the brain.101, 102, 103, 104 Together, these microbiomes constitute the human microbiome, also known as “the hidden organ”105 or “invisible organ”.106 Estimates for the number of microbial inhabitants in the human microbiome vary widely, ranging from 38 to 40 trillion92 to as high as 100 trillion.107, 108 This discrepancy may stem from differences in study methods, sample populations, and definitions of what constitutes the human microbiome. Advances in research techniques and technologies should lead to refined estimates over time.

Research indicates that the skin microbiome communicates with microbiomes of other areas in the body. Changes in one microbiome leads to shifts in others. For instance, if the bacteria in the nasopharynx change at the onset of a respiratory infection, the microorganisms in the skin, mouth, and gut also undergo change. Similarly, shifts in gut bacteria associated with conditions like diabetes alter the bacteria in the skin, mouth, and nasopharynx. Some scientists suspect that the immune system serves as the connecting link between microorganisms in different areas of the body. The vast magnitude of the human microbiome, coupled with its constant changes, will continue to present challenges for researchers studying it.92

Researchers in various fields of biology and ecology universally acknowledge the correlation between high biodiversity and the health and functionality of ecosystems.109 This correlation extends to the skin, where evidence suggests that microbial diversity alone can determine skin health.110 Increased diversity in skin microbiota is associated with improved physiological balance and homeostasis.96

While scientists continue to explore the impact of microbial diversity on skin and overall health, intentionally adopting practices to support and replenish a diverse and healthy skin microbiome is essential. These practices include minimizing the use of antibacterial products, maintaining a balanced diet, staying hydrated, managing stress, prioritizing sufficient sleep, regular exercise, gentle skincare routines, and spending time outdoors in nature. Consistent application of these holistic measures over time promotes skin microbiome health, resulting in reduced skin sensitivity, increased skin resilience, and overall enhanced wellbeing.

 

The Skin Has a Treasure Trove of Hidden Surfaces

If you were to take your adult skin and spread it out as you might a flat bed sheet, (hopefully not so enjoyable to think about) it would likely cover close to 2 square meters (22 square feet) of surface area.6 To help put this in perspective, the top of a single twin bed mattress is 75 inches long and 38 inches wide111 and has a surface area of approximately 1.8 square meters (19.8 square feet). In this scenario, the skin of an average-sized adult would completely cover and spill over the top surface of a twin bed.

It turns out, human skin differs significantly from a flat bed sheet. While the surface of a flat bed sheet is typically smooth, even, and uniform, with a consistent texture and appearance across its entirety, the surface of human skin is complex, irregular, and diverse. More like a tufted quilt, human skin exhibits unique patterning, texture, hidden surfaces, and the ability to stretch.112, 113, 114 

With approximately 5 million appendages such as hair follicles and sweat ducts, the epithelial surface area of the skin expands significantly. When considering the epithelial surface of these appendages, the true total skin surface area is estimated to be closer to 30 square meters (about 323 square feet). This entire surface area is accessible to our skin’s microbiota.64, 112 To these microorganisms, the skin's surface area resembles a colossal fabric that spans the top surface of seven king-size beds.

When considering topical medications or calculating heat and water loss, it's more appropriate to use the old estimate of 2 square meters for skin surface area. Unlike skin microbiota, topical products on the market today aren't able to penetrate hair follicles.64, 112

 

There we have it. Skin is remarkable and massively influential, so highly interconnected with every aspect of our body. Its adept ability to cooperate with trillions of diverse, non-human forms of energy profoundly impacts our health, wellbeing, and existence. By nurturing our skin, we embrace its complexity, cultivate our own unique makeup, foster vitality throughout our entire being, and steward the very essence of life itself.

Right now, beneath our skin’s surface, constant motion pulses throughout. A symphony of movement unfolds—a sophisticated dance in which harmony reigns supreme. Elements continuously align to debut a seamless flow of balance, synchronicity, and ease. Exquisite choreography dazzles with brilliance, yet eludes our gaze. Not all splendor is meant to be seen. Every act is deliberate, purposeful, and performed as an expression of love for life—truly a masterpiece of grand design. Our cells intertwine with counterparts, gracefully pirouetting through the stages of growth and transformation. From the gentle waltz of cell division to the elaborate leaps of differentiation and beyond, the collaboration of energy and information orchestrates a mesmerizing ballet that ushers in the eternal metamorphosis of the skin and ultimately ourselves.

 

 

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