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CHAPTER 1 BASIC SCIENCE OF THE EPIDERMIS 7
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CHAPTER 2 Basic Science of the Dermis
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Leslie Baumann, MD Sogol Saghari, MD
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The dermis lies between the epidermis and the subcutaneous fat It is responsible for the thickness of the skin, and as a result plays a key role in the cosmetic appearance of the skin The thickness of the dermis varies over different parts of the body and the size doubles between the ages of 3 and 7 years and again at puberty With aging, this basic layer decreases in thickness and moisture The dermis, which is laden with nerves, blood vessels, and sweat glands, consists mostly of collagen The uppermost portion of this layer, which lies beneath the epidermis, is known as the papillary dermis and the lower portion is known as the reticular dermis Smaller collagen bundles, greater cellularity, and a higher density in its vascular elements characterize the papillary dermis as compared to the reticular dermis Fibroblasts are the primary cell type in the dermis They produce collagen, elastin, other matrix proteins, and enzymes such as collagenase and stromelysin These structural components will be discussed individually because each exhibits significant characteristics that influence the function of the skin Immune cells such as mast cells, polymorphonuclear leukocytes, lymphocytes, and macrophages are also present in the dermis The junction between the epidermis and dermis is known as the dermal epidermal junction (DEJ) (Fig 2-1) Much
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FIGURE 2-2 Collagen is formed when three chains come together to form a triple helix is known about the attachment proteins found in the basement membrane of the DEJ At this point there are no known cosmetic implications for this area, as such a discussion is beyond the scope of this book Instead, this chapter will focus on the components of the dermis that are known to be important in aging aspects of collagen health or replacement will be discussed separately in upcoming chapters; however, it is necessary first to gain an understanding of the structure and function of collagen Collagen is actually a complex family of 18 proteins, 11 of which are present in the dermis Collagen fibers are always seen in the dermis in the final, mature state of assembly as opposed to elastin, the immature fibers of which are seen in the superficial dermis with the more mature fibers found in the deeper layer of the dermis Each type of collagen is composed of three chains (Fig 2-2) Collagen is synthesized in the fibroblasts in a precursor form called procollagen Proline residues on the procollagen chain are converted to hydroxyproline by the enzyme prolyl hydroxylase This reaction requires the presence of Fe++, ascorbic acid (vitamin C), and -ketoglutarate Lysine residues on the procollagen chain are also converted to hydroxylysine; in this case, by the enzyme lysyl hydroxylase This reaction also requires the presence of Fe ++ , ascorbic acid, and -ketoglutarate It is interesting to note that a deficiency of vitamin C, which is an essential mediating component in these reactions, leads to scurvy, a disease characterized by decreased collagen production
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COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE 8
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Collagen, one of the strongest natural proteins and the most abundant one in humans as well as in skin, imparts durability and resilience to the skin It has been the focus of much antiaging research and the target of several skin products and procedures The importance of collagen is emphasized in the literature regarding many of the topical agents that are touted to increase collagen synthesis such as glycolic and ascorbic acids Resurfacing techniques such as the CO2 laser and dermabrasion are intended to change collagen structure, thereby improving skin texture Various forms of collagen are injected into the dermis to replace damaged collagen and to reverse the signs of aging Finally, topical retinoids have been shown to reduce the collagen damage that occurs because of sun exposure These sundry
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