Dermis

The dermis or corium is a layer of skin between the epidermis (with which it makes up the cutis) and subcutaneous tissues, that primarily consists of dense irregular connective tissue and cushions the body from stress and strain. It is divided into two layers, the superficial area adjacent to the epidermis called the papillary region and a deep thicker area known as the reticular dermis.[1] The dermis is tightly connected to the epidermis through a basement membrane. Structural components of the dermis are collagen, elastic fibers, and extrafibrillar matrix.[2] It also contains mechanoreceptors that provide the sense of touch and thermoreceptors that provide the sense of heat. In addition, hair follicles, sweat glands, sebaceous glands (oil glands), apocrine glands, lymphatic vessels, nerves and blood vessels are present in the dermis. Those blood vessels provide nourishment and waste removal for both dermal and epidermal cells.

Dermis
Skin
Cross-section of human skin
Normal Epidermis and Dermis with Intradermal Nevus 10x
Cross section of skin under the microscope
Details
Part ofSkin
Identifiers
MeSHD020405
TAA16.0.00.010
THH3.12.00.1.03001
FMA70323
Anatomical terminology

Structure

The dermis is composed of three major types of cells:[3] fibroblasts, macrophages, and mast cells.

Apart from these cells, the dermis is also composed of matrix components such as collagen (which provides strength), elastin (which provides elasticity), and extrafibrillar matrix, an extracellular gel-like substance primarily composed of glycosaminoglycans (most notably hyaluronan), proteoglycans, and glycoproteins.[3]

Layers

Blausen 0802 Skin DermalCirculation
Illustration of dermal circulation and layers

Papillary dermis

The papillary dermis is the uppermost layer of the dermis. It intertwines with the rete ridges of the epidermis and is composed of fine and loosely arranged collagen fibers.[2]

The papillary region is composed of loose areolar connective tissue. This is named for its fingerlike projections called papillae, that extend toward the epidermis and contain either terminal networks of blood capillaries or tactile Meissner's corpuscles.[4]

Reticular dermis

The reticular dermis is the lower layer of the dermis, found under the papillary dermis, composed of dense irregular connective tissue featuring densely packed collagen fibers. It is the primary location of dermal elastic fibers.[2]

The reticular region is usually much thicker than the overlying papillary dermis. It receives its name from the dense concentration of collagenous, elastic, and reticular fibers that weave throughout it. These protein fibers give the dermis its properties of strength, extensibility, and elasticity. Within the reticular region are the roots of the hair, sebaceous glands, sweat glands, receptors, nails, and blood vessels. The orientation of collagen fibers within the reticular dermis creates lines of tension called Langer's lines, which are of some relevance in surgery and wound healing.[5]

Dermal papillae

Dermal papillae
Gray936
Papilla of the hand, treated with acetic acid. Magnified 350 times.

A. Side view of a papilla of the hand.
a. Cortical layer.
b. Tactile corpuscle.
c. Small nerve of the papilla, with neurolemma.
d. Its two nervous fibers running in spiral coils around the tactile corpuscle.
e. Apparent termination of one of these fibers.

B. Tactile papilla seen from above so as to show its transverse section.
a. Cortical layer.
b. Nerve fiber.
c. Outer layer of the tactile body, with nuclei.
d. Clear interior substance.
Details
Identifiers
Latinpapillae dermis
MeSHD020405
TAA16.0.00.010
THH3.12.00.1.03001
FMA70323
Anatomical terminology

The dermal papillae (DP) (singular papilla, diminutive of Latin papula, 'pimple') are small, nipple-like extensions (or interdigitations) of the dermis into the epidermis. At the surface of the skin in hands and feet, they appear as epidermal or papillary ridges (colloquially known as fingerprints).

Blood vessels in the dermal papillae nourish all hair follicles and bring nutrients and oxygen to the lower layers of epidermal cells. The pattern of ridges they produce in hands and feet are partly genetically determined features that develop before birth. They remain substantially unaltered (except in size) throughout life, and therefore determine the patterns of fingerprints, making them useful in certain functions of personal identification. [6]

The dermal papillae are part of the uppermost layer of the dermis, the papillary dermis, and the ridges they form greatly increase the surface area between the dermis and epidermis. Because the main function of the dermis is to support the epidermis, this greatly increases the exchange of oxygen, nutrients, and waste products between these two layers. Additionally, the increase in surface area prevents the dermal and epidermal layers from separating from each other by strengthening the junction between them. With age, the papillae tend to flatten and sometimes increase in number. [7]

Dermal papillae also play a pivotal role in hair formation, growth and cycling. [8]

In mucous membranes, the equivalent structures to dermal papillae are generally termed "connective tissue papillae", which interdigitate with the rete pegs of the superficial epithelium.

See also

References

  1. ^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology (10th ed.). Saunders. Pages 1, 11–12. ISBN 0-7216-2921-0.
  2. ^ a b c Marks, James G; Miller, Jeffery (2006). Lookingbill and Marks' Principles of Dermatology (4th ed.). Elsevier Inc. Page 8–9. ISBN 1-4160-3185-5.
  3. ^ a b malvi (4 March 2011). "The Ageing Skin - Part 1 - Structure of Skin and Introduction - Articles". PharmaXChange.info.
  4. ^ http://microvet.arizona.edu/Courses/vsc422/secure/VSC422AppledHistologyLabHandout.pdf
  5. ^ Ross M, Pawlina W (2011). Histology: A Text and Atlas (6th ed.). Lippincott Williams & Wilkins. p. 498. ISBN 978-0-7817-7200-6.
  6. ^ "Dermal papillae". Probert Encyclopaedia. Archived from the original on 2011-06-08. Retrieved February 2010. Check date values in: |accessdate= (help)
  7. ^ "Friction Skin". Ridges and Furrows. Retrieved February 2010. Check date values in: |accessdate= (help)
  8. ^ Lin, Chang-min; et al. (October 2008). "Microencapsulated human hair dermal papilla cells: a substitute for dermal papilla?". Archives of Dermatological Research. Springer. 300 (9): 531–535. doi:10.1007/s00403-008-0852-3. PMID 18418617.
Abrasion (medical)

An abrasion is a partial thickness wound caused by damage to the skin and can be superficial involving only the epidermis to deep, involving the deep dermis. Abrasions usually involve minimal bleeding. Mild abrasions, also known as grazes or scrapes, do not scar or bleed because the dermis is left intact, but deep abrasions that disrupt the normal dermal structures may lead to the formation of scar tissue. A more traumatic abrasion that removes all layers of skin is called an avulsion.

Abrasion injuries most commonly occur when exposed skin comes into moving contact with a rough surface, causing a grinding or rubbing away of the upper layers of the epidermis.

Eosinophilic dermatosis

Eosinophilic dermatosis is a form of dermatosis characterized by a preponderance of eosinophils in the dermis or epidermis.Although it does not always imply a specific etiology, it is still commonly used as a classification in dermatology when more information about the condition is not known.

Epidermis

The epidermis is the outermost of the three layers that make up the skin, the inner layers being the dermis and hypodermis. The epidermis layer provides a barrier to infection from environmental pathogens and regulates the amount of water released from the body into the atmosphere through transepidermal water loss. The epidermis is composed of multiple layers of flattened cells that overlie a base layer (stratum basale) composed of columnar cells arranged perpendicularly.

The rows of cells develop from stem cells in the basal layer. Cellular mechanisms for regulating water and sodium levels (ENaCs) are found in all layers of the epidermis.The word epidermis is derived through Latin from Ancient Greek epidermis, itself from Ancient Greek epi, meaning 'over, upon' and from Ancient Greek derma, meaning 'skin'. Something related to or part of the epidermis is termed epidermal.

The human epidermis is a familiar example of epithelium, particularly a stratified squamous epithelium

Familial myxovascular fibromas

Familial myxovascular fibromas present with multiple verrucous papules on the palms and fingers, which on biopsy show focal neovascularization and mucin-like changes in the papillary dermis.

Hair

Hair is a protein filament that grows from follicles found in the dermis. Hair is one of the defining characteristics of mammals.

The human body, apart from areas of glabrous skin, is covered in follicles which produce thick terminal and fine vellus hair. Most common interest in hair is focused on hair growth, hair types, and hair care, but hair is also an important biomaterial primarily composed of protein, notably alpha-keratin.

Attitudes towards different forms of hair, such as hairstyles and hair removal, vary widely across different cultures and historical periods, but it is often used to indicate a person's personal beliefs or social position, such as their age, sex, or religion.

Human skin

The human skin is the outer covering of the body and is the largest organ of the integumentary system. The skin has up to seven layers of ectodermal tissue and guards the underlying muscles, bones, ligaments and internal organs. Human skin is similar to most of the other

mammals skin, and it is very similar to pig skin. Though nearly all human skin is covered with hair follicles, it can appear hairless. There are two general types of skin, hairy and glabrous skin (hairless). The adjective cutaneous literally means "of the skin" (from Latin cutis, skin).

Because it interfaces with the environment, skin plays an important immunity role in protecting the body against pathogens and excessive water loss. Its other functions are insulation, temperature regulation, sensation, synthesis of vitamin D, and the protection of vitamin B folates. Severely damaged skin will try to heal by forming scar tissue. This is often discolored and depigmented.

In humans, skin pigmentation varies among populations, and skin type can range from dry to non-dry and from oily to non-oily. Such skin variety provides a rich and diverse habitat for bacteria that number roughly 1000 species from 19 phyla, present on the human skin.

Integumentary system

The integumentary system comprises the skin and its appendages acting to protect the body from various kinds of damage, such as loss of water or damages from outside. The integumentary system includes hair, scales, feathers, hooves, and nails. It has a variety of additional functions; it may serve to waterproof, and protect the deeper tissues, excrete wastes, and regulate body temperature, and is the attachment site for sensory receptors to detect pain, sensation, pressure, and temperature. In most land vertebrates with significant exposure to sunlight, the integumentary system also provides for vitamin D synthesis.

Intradermal injection

Intradermal injection, often abbreviated ID, is a shallow or superficial injection of a substance into the dermis, which is located between the epidermis and the hypodermis. This route is relatively rare compared to injections into the subcutaneous tissue or muscle. ID injections are used only when certain therapies, such as tuberculin and allergy tests, require the specific benefits of this route of administration. Specific benefits are a higher immune responses for vaccinations, immunology and novel cancer treatments and faster drug uptake, since for certain small and well soluble proteins or molecules, ID route of administration is associated with fast uptake systemically compared to subcutaneous injections, applied in novel closed loop insuline infusion systems. Additionally, the body's reaction to substances is more easily visible since it is closer to the surface.

Lamina densa

The lamina densa is a component of the basement membrane zone between the epidermis and dermis of the skin, and is an electron-dense zone between the lamina lucida and dermis, synthesized by the basal cells of the epidermis, and composed of (1) type IV collagen, (2) anchoring fibrils made of type VII collagen, and (3) dermal microfibrils.

List of skin conditions

Many conditions affect the human integumentary system—the organ system covering the entire surface of the body and composed of skin, hair, nails, and related muscle and glands. The major function of this system is as a barrier against the external environment. The skin weighs an average of four kilograms, covers an area of two square meters, and is made of three distinct layers: the epidermis, dermis, and subcutaneous tissue. The two main types of human skin are: glabrous skin, the hairless skin on the palms and soles (also referred to as the "palmoplantar" surfaces), and hair-bearing skin. Within the latter type, the hairs occur in structures called pilosebaceous units, each with hair follicle, sebaceous gland, and associated arrector pili muscle. In the embryo, the epidermis, hair, and glands form from the ectoderm, which is chemically influenced by the underlying mesoderm that forms the dermis and subcutaneous tissues.The epidermis is the most superficial layer of skin, a squamous epithelium with several strata: the stratum corneum, stratum lucidum, stratum granulosum, stratum spinosum, and stratum basale. Nourishment is provided to these layers by diffusion from the dermis, since the epidermis is without direct blood supply. The epidermis contains four cell types: keratinocytes, melanocytes, Langerhans cells, and Merkel cells. Of these, keratinocytes are the major component, constituting roughly 95 percent of the epidermis. This stratified squamous epithelium is maintained by cell division within the stratum basale, in which differentiating cells slowly displace outwards through the stratum spinosum to the stratum corneum, where cells are continually shed from the surface. In normal skin, the rate of production equals the rate of loss; about two weeks are needed for a cell to migrate from the basal cell layer to the top of the granular cell layer, and an additional two weeks to cross the stratum corneum.The dermis is the layer of skin between the epidermis and subcutaneous tissue, and comprises two sections, the papillary dermis and the reticular dermis. The superficial papillary dermis interdigitates with the overlying rete ridges of the epidermis, between which the two layers interact through the basement membrane zone. Structural components of the dermis are collagen, elastic fibers, and ground substance. Within these components are the pilosebaceous units, arrector pili muscles, and the eccrine and apocrine glands. The dermis contains two vascular networks that run parallel to the skin surface—one superficial and one deep plexus—which are connected by vertical communicating vessels. The function of blood vessels within the dermis is fourfold: to supply nutrition, to regulate temperature, to modulate inflammation, and to participate in wound healing.The subcutaneous tissue is a layer of fat between the dermis and underlying fascia. This tissue may be further divided into two components, the actual fatty layer, or panniculus adiposus, and a deeper vestigial layer of muscle, the panniculus carnosus. The main cellular component of this tissue is the adipocyte, or fat cell. The structure of this tissue is composed of septal (i.e. linear strands) and lobular compartments, which differ in microscopic appearance. Functionally, the subcutaneous fat insulates the body, absorbs trauma, and serves as a reserve energy source.Conditions of the human integumentary system constitute a broad spectrum of diseases, also known as dermatoses, as well as many nonpathologic states (like, in certain circumstances, melanonychia and racquet nails). While only a small number of skin diseases account for most visits to the physician, thousands of skin conditions have been described. Classification of these conditions often presents many nosological challenges, since underlying etiologies and pathogenetics are often not known. Therefore, most current textbooks present a classification based on location (for example, conditions of the mucous membrane), morphology (chronic blistering conditions), etiology (skin conditions resulting from physical factors), and so on. Clinically, the diagnosis of any particular skin condition is made by gathering pertinent information regarding the presenting skin lesion(s), including the location (such as arms, head, legs), symptoms (pruritus, pain), duration (acute or chronic), arrangement (solitary, generalized, annular, linear), morphology (macules, papules, vesicles), and color (red, blue, brown, black, white, yellow). Diagnosis of many conditions often also requires a skin biopsy which yields histologic information that can be correlated with the clinical presentation and any laboratory data.

Nevus of Ota

Nevus of Ota (also known as "congenital melanosis bulbi", "nevus fuscoceruleus ophthalmomaxillaris", "oculodermal melanocytosis", and "oculomucodermal melanocytosis") is a blue hyperpigmentation that occurs on the face, most often appearing on the white of the eye. It was first reported by Dr. M.T. Ota of Japan in 1939.Nevus of Ota is caused by the entrapment of melanocytes in the upper third of the dermis. It is found only on the face, most commonly unilaterally, rarely bilaterally and involves the first two branches of the trigeminal nerve. The sclera is involved in two-thirds of cases (causing an increased risk of glaucoma). It should not be confused with Mongolian spot, which is a birthmark caused by entrapment of melanocytes in the dermis but is located in the lumbosacral region. Women are nearly five times more likely to be affected than men, and it is rare among Caucasian people. Nevus of Ota may not be congenital, and may appear during puberty.

Nitrofurazone

Nitrofurazone (INN, trade name Furacin) is an antimicrobial organic compound belonging to the nitrofuran class. It is most commonly used as a topical antibiotic ointment. It is effective against gram-positive bacteria, gram-negative bacteria, and can be used in the treatment of trypanosomiasis. Its use in medicine has become less frequent, as safer and more effective products have become available. Nitrofurazone is listed under California Prop 65, and has demonstrated clear evidence to be mutagenic and carcinogenic during animal studies, and has been discontinued for human use in the USA. The substance is pale yellow and crystalline. It was once widely used as an antibiotic for livestock.

Osteoderm

Osteoderms are bony deposits forming scales, plates or other structures based in the dermis. Osteoderms are found in many groups of extant and extinct reptiles and amphibians, including lizards, crocodilians, frogs, temnospondyls (extinct amphibians), various groups of dinosaurs (most notably ankylosaurs and stegosaurians), phytosaurs, aetosaurs, placodonts, and hupehsuchians (marine reptiles with possible ichthyosaur affinities).

Osteoderms are uncommon in mammals, but have occurred in many xenarthrans (armadillos and the extinct glyptodonts and ground sloths). Osteoderms have clearly evolved independently in many different lineages, and these varied structures should be thought of as anatomical analogues, not homologues, and do not necessarily indicate monophyly. In many cases, osteoderms may function as defensive armor. Osteoderms are composed of bone tissue, and are derived from a scleroblast neural crest cell population during embryonic development of the organism. The scleroblastic neural crest cell population shares some homologous characteristics associated with the dermis.The osteoderms of modern crocodilians are heavily vascularized, and can function as both armor and as heat-exchangers, allowing these large reptiles to rapidly raise or lower their temperature. Another function is to neutralize acidosis, caused by being submerged under water for longer periods of time and leading to the accumulation of carbon dioxide in the blood. The calcium and magnesium in the dermal bone will release alkaline ions into the bloodstream, acting as a buffer against acidification of the body fluids.

Skin

Skin is the soft outer tissue covering of vertebrates with three main functions: protection, regulation, and sensation.Other animal coverings, such as the arthropod exoskeleton, have different developmental origin, structure and chemical composition. The adjective cutaneous means "of the skin" (from Latin cutis, skin). In mammals, the skin is an organ of the integumentary system made up of multiple layers of ectodermal tissue, and guards the underlying muscles, bones, ligaments and internal organs. Skin of a different nature exists in amphibians, reptiles, and birds. All mammals have some hair on their skin, even marine mammals like whales, dolphins, and porpoises which appear to be hairless.

The skin interfaces with the environment and is the first line of defense from external factors. For example, the skin plays a key role in protecting the body against pathogens and excessive water loss. Its other functions are insulation, temperature regulation, sensation, and the production of vitamin D folates. Severely damaged skin may heal by forming scar tissue. This is sometimes discoloured and depigmented. The thickness of skin also varies from location to location on an organism. In humans for example, the skin located under the eyes and around the eyelids is the thinnest skin in the body at 0.5 mm thick, and is one of the first areas to show signs of aging such as "crows feet" and wrinkles. The skin on the palms and the soles of the feet is 4 mm thick and is the thickest skin on the body. The speed and quality of wound healing in skin is promoted by the reception of estrogen.Fur is dense hair. Primarily, fur augments the insulation the skin provides but can also serve as a secondary sexual characteristic or as camouflage. On some animals, the skin is very hard and thick, and can be processed to create leather. Reptiles and fish have hard protective scales on their skin for protection, and birds have hard feathers, all made of tough β-keratins. Amphibian skin is not a strong barrier, especially regarding the passage of chemicals via skin and is often subject to osmosis and diffusive forces. For example, a frog sitting in an anesthetic solution would be sedated quickly, as the chemical diffuses through its skin. Amphibian skin plays key roles in everyday survival and their ability to exploit a wide range of habitats and ecological conditions.

Skin condition

A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, hair, nails, and related muscle and glands. The major function of this system is as a barrier against the external environment.Conditions of the human integumentary system constitute a broad spectrum of diseases, also known as dermatoses, as well as many nonpathologic states (like, in certain circumstances, melanonychia and racquet nails). While only a small number of skin diseases account for most visits to the physician, thousands of skin conditions have been described. Classification of these conditions often presents many nosological challenges, since underlying causes and pathogenetics are often not known. Therefore, most current textbooks present a classification based on location (for example, conditions of the mucous membrane), morphology (chronic blistering conditions), cause (skin conditions resulting from physical factors), and so on.Clinically, the diagnosis of any particular skin condition is made by gathering pertinent information regarding the presenting skin lesion(s), including the location (such as arms, head, legs), symptoms (pruritus, pain), duration (acute or chronic), arrangement (solitary, generalized, annular, linear), morphology (macules, papules, vesicles), and color (red, blue, brown, black, white, yellow). The diagnosis of many conditions often also requires a skin biopsy which yields histologic information that can be correlated with the clinical presentation and any laboratory data. The introduction of cutaneous ultrasound has allowed the detection of cutaneous tumors, inflammatory processes, nail disorders and hair diseases.

Stretch marks

"Striae" is also a general term referring to thin, narrow grooves or channels, or a thin line or band especially if several of them are parallel or close together.Stretch marks, also known as striae, are a form of scarring on the skin with an off-color hue. Over time they may diminish, but will not disappear completely. Stretch marks form during rapid growth of the body, such as during puberty or pregnancy. In pregnancy they usually form during the last trimester, and usually on the belly, but also commonly occur on the breasts, thighs, hips, lower back and buttocks. These are known as striae gravidarum.Stretch marks are caused by tearing of the dermis. This is often from the rapid stretching of the skin associated with rapid growth or rapid weight changes. Stretch marks may also be influenced by hormonal changes associated with puberty, pregnancy, bodybuilding, or hormone replacement therapy.

There is no evidence that creams used during pregnancy prevent stretch marks. Once they have formed there is no clearly effective treatment, though various methods have been attempted and studied.

Subcutaneous injection

A subcutaneous injection is administered as a bolus into the subcutis, the layer of skin directly below the dermis and epidermis, collectively referred to as the cutis. Subcutaneous injections are highly effective in administering medications such as insulin, morphine, diacetylmorphine and goserelin. Subcutaneous (as opposed to intravenous) injection of recreational drugs is referred to as "skin popping." Subcutaneous administration may be abbreviated as SC, SQ, sub-cu, sub-Q, SubQ, or subcut. Subcut is the preferred abbreviation for patient safety.Subcutaneous tissue has few blood vessels and so drugs injected here are for slow, sustained rates of absorption. It is slower than intramuscular injections but still faster than intradermal injections.

Subcutaneous tissue

The subcutaneous tissue (from Latin subcutaneous, meaning 'beneath the skin'), also called the hypodermis, hypoderm (from Greek, meaning 'beneath the skin'), subcutis, or superficial fascia, is the lowermost layer of the integumentary system in vertebrates. The types of cells found in the hypodermis are fibroblasts, adipose cells, and macrophages. The hypodermis is derived from the mesoderm, but unlike the dermis, it is not derived from the dermatome region of the mesoderm. In arthropods, the hypodermis is an epidermal layer of cells that secretes the chitinous cuticle. The term also refers to a layer of cells lying immediately below the epidermis of plants.

The hypodermis is beneath the dermis which is beneath the epidermis. It is used mainly for fat storage.

A layer of tissue lies immediately below the dermis of vertebrate skin. It is often referred to as subcutaneous tissue though this is a less precise and anatomically inaccurate term. The hypodermis consists primarily of loose connective tissue and lobules of fat. It contains larger blood vessels and nerves than those found in the dermis.

Type I collagen

Type I collagen is the most abundant collagen of the human body. It forms large, eosinophilic fibers known as collagen fibers.

It is present in scar tissue, the end product when tissue heals by repair, as well as tendons, ligaments, the endomysium of myofibrils, the organic part of bone, the dermis, the dentin, and organ capsules.

Skin
Subcutaneous tissue
Adnexa
Physiology
Composition
Types
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Ophthalmic,
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Rectal (enteral)
Dermal
Injection,
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