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. 2015 Sep-Oct;48(5):324-9.
doi: 10.1590/0100-3984.2014.0028.

Study of the skin anatomy with high-frequency (22 MHz) ultrasonography and histological correlation

Elisa de Oliveira Barcaui  1 , Antonio Carlos Pires Carvalho  2 , Juan Piñeiro-Maceira  3 , Carlos Baptista Barcaui  4 , Heleno Moraes  5
Affiliations

Study of the skin anatomy with high-frequency (22 MHz) ultrasonography and histological correlation

Elisa de Oliveira Barcaui et al. Radiol Bras. 2015 Sep-Oct.

Abstract
in English, Portuguese

The present essay is aimed at getting the radiologist familiar with the basic histological skin structure, allowing for a better correlation with sonographic findings. A high-frequency (22 MHz) ultrasonography apparatus was utilized in the present study. The histological analysis was performed after the skin specimens fixation with formalin, inclusion in paraffin blocks and subsequent staining with hematoxylin-eosin. The authors present a literature review showing the relationship between sonographic and histological findings in normal cutaneous tissue, and discuss the technique for a better performance of the sonographic scan. High-frequency ultrasonography is an excellent tool for the diagnosis of different skin conditions. However, as this method is operator-dependent, it is crucial to understand the normal skin structure as well as the correlation between histological and sonographic findings.

O objetivo deste trabalho é familiarizar o radiologista com a estrutura histológica cutânea, o que torna possível uma melhor correlação dos achados ultrassonográficos da pele. Para o exame radiológico foi utilizado aparelho de ultrassom de alta frequência (22 MHz). O exame histológico foi realizado após fixação do material em formol, inclusão em parafina e coloração com hematoxilina-eosina. Os autores fazem uma revisão da literatura, demonstram a relação dos achados ultrassonográficos e histológicos do tecido cutâneo normal e discutem a técnica para o melhor aproveitamento do exame ultrassonográfico da pele. O ultrassom de alta frequência representa uma excelente ferramenta no diagnóstico das diferentes alterações cutâneas. Como o método é operador-dependente, é crucial o perfeito entendimento da pele normal e sua equivalência histológica/ultrassonográfica.

Keywords: Dermatology; Histology; Skin; Ultrasonography.

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Figures

Figure 1
Figure 1
Non glabrous skin anatomy. A: Normal skin histology. B: High-frequency ultrasonography (HFUS), crosssectional view. Epidermis (e), dermis (d) and subcutaneous tissue (sc) with presence of fibrotic septa (arrow).
Figure 2
Figure 2
HFUS, cross sectional view, anterior region of the right forearm in consanguineous patients with a single skin phototype. A: 3-year-old patient. Thin epidermis and 1.45 mm-thick dermis. B: 25-year-old patient. Dermis measuring 1.22 mm in thickness. C: 55-year-old patient. Epidermal thickening and 1.03 mm-thick dermis.
Figure 3
Figure 3
A: Histology. Epidermis (e), low-echogenicity subepidermal band corresponding to elastosis present in the connective tissue (asterisk). B: HFUS, crosssectional view.
Figure 4
Figure 4
Glabrous skin. A: Histology. Thicker corneous layer and presence of stratum lucidum (asterisk). B: HFUS, cross-sectional view. Hyperechoic epidermis with bilaminar appearance (arrow).
Figure 5
Figure 5
Scalp. A: Histology, longitudinal section. B: HFUS, longitudinal view. Epidermis (e), dermis (d), oblique hypoechoic bands corresponding to hair follicles (arrows).
Figure 6
Figure 6
HFUS, longitudinal view, scalp. Male, 41-year-old patient. Variation of the skin thickness and in the number of hair follicles. A: Frontal region. B: Occipital region. Dermis (asterisks), hair follicle (diamonds).
Figure 7
Figure 7
Hair shaft. A: Histology. Cortexcuticle- medulla structure. B: Longitudinal view, trilaminar.
Figure 8
Figure 8
Normal ungual unit, longitudinal section. A: Histological section. B: HFUS. Ventral plate (downward arrow), dorsal plate (upward arrow), ungual matrix (asterisk), ungual bed (bold circle).
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