Dermis and hypodermis

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The skin represents the external covering of the whole body. Its thickness varies according to different body regions, reaching a maximum thickness at the palm of the hand and the sole of the foot. The skin is divided into two different layers; the external layer is the epidermis, consisting of squa-mous multistratified epithelium that continues deeply with the dermis, a layer of connective tissue made of cells and collagen fibers lying in an amorphous interstitial substance. The dermis contains blood vessels, nerves, lymphatics, hair follicles and glands.

The hypodermis is found even more deeply and it is made of a tissue rich in collagen fibers and connected to the dermis by fibrous branches. The hypodermis has a complicated structure containing adipose storage inside the subcutaneous adipose tissue. The hypodermal thickness varies according to the examined region and to the patient's personal constitution [14,23].

Detailed US exploration of the skin is now possible due to high frequency and high resolution transducers. The skin appears as a hyperechoic superficial band of variable thickness and homogeneous structure where it is not possible to differentiate the epidermis from the dermis by ultrasound. The hypodermis, on the contrary, is easily identifiable: it appears as a deep hypoechoic layer, characterized by intersecting curvilinear septa, that correspond to supporting fibrous branches, containing blood vessels well-depicted by color Doppler techniques. The hypodermis is separated from the underlying muscular layer by the superficial aponeurotic fascia, appearing as a double hyperechoic line (Fig. 3.26). Dynamic examination is useful to differentiate adipose from muscular tissue [32].

To diagnose skin disease, the main investigation tends to be clinical examination, eventually supported by histological analysis; US can be useful as a follow-up examination when assessing systemic diseases with skin involvement, such as systemic sclerosis (scleroderma).

Subcutaneous tissue ultrasound examination can also be useful in the diagnosis and staging of some neoplastic lesions such as melanoma, glomus tumours and hemangiomas. It is also used for anthropometric studies in sports medicine to calculate the fat-free mass, which represents an important indicator of physical condition for athletes.


Normal ultrasound appearance of epidermis-dermis (E), hypodermis (H) and superficial aponeurotic fascia (A)


Normal ultrasound appearance of epidermis-dermis (E), hypodermis (H) and superficial aponeurotic fascia (A)


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