Papillary dermis

Papillary dermis · Type III collagen Capillary loops IgA in DH

The thin, cell-rich and vessel-rich superficial dermis of fine type III and I collagen and delicate elastic fibres. It carries the capillary loops that nourish the avascular epidermis, the free nerve endings, and the Meissner corpuscles.

Traced from the start

  1. Stratum basale (germinativum)
  2. Lamina densa (type IV collagen basement membrane)Sublamina densa anchoring fibrils (type VII collagen)
  3. Papillary dermis

Detail

Matrix
Loosely arranged fine collagen fibres, mainly types III and I, with oxytalan elastic fibres running perpendicular to the junction
Nutrition
Capillary loops in each dermal papilla supply the whole epidermis by diffusion; the epidermis has no vessels and no lymphatics of its own
Nerves
Free nerve endings for pain and temperature reach into the epidermis; Meissner corpuscles occupy the papillae of glabrous skin
Graft plane
A split-thickness skin graft is harvested through this layer, leaving the deeper adnexa to re-epithelialise the donor site in 10-14 days

When it goes wrong

Granular IgA deposition at the tips of the dermal papillae (dermatitis herpetiformis)

Intensely itchy grouped vesicles on elbows, knees, buttocks and scalp; essentially always accompanied by coeliac disease, so test tissue transglutaminase antibodies; dapsone controls the rash but only a gluten-free diet treats the gut

Thermal injury reaching this layer but no deeper

Superficial partial-thickness burn: blisters, severe pain because the nerve endings survive, and healing in about two weeks without scarring

Practise this structure

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