PRESENTED BY:- DR. AAKANKSHA SINGH.

When describing a skin lesion,it is important to

note the following features:-

1)size
2)type
3)shape and symmetry
4)colour and pigmentation
5)surface area
6)Distribution over the body surface
Types of lesion
Basic skin lesions are broadly categorized as :
1. Primary
2. Secondary
3. special
Primary lesions :- Basic reaction patterns of skin
with a definite morphology.

Secondary lesion :- Develop during the evolutionary

process of skin disease or are created by scratching or
infection.

special skin lesion :- Specific for certain disease.

Primary Skin Lesions
Macule
Patch
Papule
plaque
nodule
Vesicle
Bulla
Pustule
Abscess
Wheal
Cyst
Macule
A flat circumscribed lesion
showing change in color
without change in its
consistency. Macules are non-
palpable.
They are 0.5cm-1cm in size.
Discoloration may be brown,
blue ,red and hypopigmented
or hyperpigmented
Brown coloured macules
Beckers neveus Freckle

Fixed drug eruption Cafe-au-lait spot

Blue coloured macules
Mongolian spot Blue naevus

ink(tattoo)
Red coloured macules
Drug eruptions Secondary syphilis
Hypopigmented
Tinea versicolor
PATCH
A large macule is called
patch (>1cm in size).
May have scaling.
Eg :- Vitiligo, melasma,
pityriasis alba
Papule
A small, solid lesion,
<0.5 cm in diameter,
raised above the surface
of surrounding skin &
hence palpable.
Papules may be of
various colors.
Flesh colored,yellow or white
colored papules
Molluscum Skin tags
contagiosum
Brown colored papules
Melanoma Dermatofibroma
Red colored papule
Acne Insect bite

folliculits
Blue colored papules
Blue nevus Lichen planus
violaceous papules)
Plaque
It is an indurated area of
skin larger than 0.5 cm
in diameter which may
be raised or depressed
from skin surface.
Examples of plaque
Psoriasis Lichen planus

Tinea corporis
Other examples of plaque
Pityriasis rosea
Seborrheic dermatitis
Tinea pedis
Eczema
Nodule
A large ( 0.5 – 5.0 cm ), firm lesion raised above the
surface of surrounding skin.
It is the depth of involvement that differentiates a
nodule from a large papule.
Could be warm, soft,fluctuant,movable,fixed or
painful.
Surface-smooth,keratotic,ulcerated or fungating.
Examples of nodule
Basal cell carcinoma Hemangioma

Prurigo nodularis neurofibromatosis

Other examples of nodule
Xanthoma
Keratoacanthoma
Melanoma
Vesicle
A small, fluid filled
lesion, <0.5 cm in
diameter, raised above
the plane of surrounding
skin. Fluid is often
visible and the lesions
are translucent
Examples of vesicle
Chicken pox Herpes zoster
Other examples of vesicle
Impetigo
Insect bite
Herpes simplex
Dermatitis herpetiformis
bulla
A fluid filled, raised,
often a translucent
lesion >0.5cm in
diameter
Examples of bulla
Bullous pemphigoid Fixed drug reaction
Pustule
A vesicle filled with pus
It is formed due to
collection of
inflammatory exudate
rich in leucocytes.
It may contain bacteria
or may be sterile.
Acne Pustular psoriasis

Folliculitis Scabies
Abscess
A localized collection of
pus deep in dermis or
subcutaneous tissue
Due to deep seated
location pus may not be
visible on skin surface
but would show sign of
inflammation.
Wheal
It is a transient swelling
of skin disappearing
within 24 hrs.
It is formed due to
sudden extravasation of
fluid in the dermis.
Eg: urticaria
Examples of wheal
Urticaria dermographism
Cyst
It is a spherical or oval
sac or an encapsulated
cavity containing fluid
or semi solid material.
It is lined with true
epithelium.
Eg:- mucous retention
cyst
Secondary Skin Lesions
Scale
Crust
Erosion
Fissure
Sinus
Scar
Atrophy
Lichenification
Scale
Excess dead epidermal
cells that are produced
by abnormal
keratinization and
shedding
Eg: Psoriasis, Icthyosis
Types of scales
Fine to stratified
•Erythema craquele(dense •Psoriasis(silvery scale)
scale)
Ichthyosis vulgaris
Tinea versicolor(fine)
 Scaling in sheets(desquamation)
Scarlet fever(hands and feet)
Staphylococcal scalded skin syndrome

Kawasaki syndrome
Other types of scales
Crack like - eczema
craquele.
Exfoliative- drug rxn.
Follicular- keratosis
pilaris.
Gritty- actinic keratosis.
Ichthyosiform-
ichthyosis vulgaris.
Keratotic/
hyperkeratotic-
cutaneous horn.
Cont…
Lamellar- lamellar
ichthyosis.
Pityriasiform- pityriasis
rosea.
Psoriasiform -psoriasis
vulgaris.
Seborrheic- seborrheic
dermatitis.
Wickham striae- lichen
planus
Crust
Dried exudate of body
fluids (blood / serous
fluid)
Which might be either
yellow / red
Examples of crusting
Tinea capitis Impetigo
Erosion
A focal loss of epidermis Tinea pedis candidiasis
Erosions do not
penetrate below the
dermoepidermal
junction and therefore
heal without scarring
Eg:- tinea
pedis,candidiasis,eczem
a-tous disease, herpes
simplex
ulcer
A focal loss of epidermis
and/or dermis
Scarring depends on the
depth of the ulcer
Eg-
chancroid,pyoderma
gangrenosum,decubitus
chancroid
Pyoderma decubitus
gangrenosum
Radiodermatitis
Fissure
It is a linear loss of continuity of
skin due to excessive tension.
Eg:- eczema(fingertips),intertrigo
Finger fissure d/t intertrigo
eczema
Scar Acne scar
It is replacement of
normal skin by fibrous
tissue in the process of
healing of damaged skin.
Scars are of two types-
hypertrophic and
atrophic.
Eg:- acne, burns, herpes
zoster, keloid
scar of herpes zoster Burn scar
Keloid:- area of overgrowth of fibrous tissue that
usually develops after healing of skin injury
&extends beyond the original defect
Atrophy
• It is reduction in size
and number of skin
cells.
• It may be limited to
epidermis, dermis, or
subcutaneous tissue.
• Eg:- leprosy,
atrophoderma,
lipoatrophy
Lichenification
Repeated rubbing of
skin results in
thickening and
hyperpigmentation of
skin
The skin markings
become prominent.
Eg:- Lichen simplex
chronicus, Atopic
dermatitis.
Burrow
Comedone
Milia
Telengiectasia
Poikiloderma
Purpura
infarct
Burrow
It is a serpentine tunnel
made by scabies mite in
stratum corneum.
The open end of the
tunnel has a papule.
Comedone
It is a tiny plug present
at opening of hair
follicle formed by
keratin and sebum
It is of two types: Open
comedone (black head)
and Closed comedone
(white head)
Milium
It is a tiny superficial
cyst with epidermal
lining. Milia are seen on
face at periorbital
region.
Telengiectasia
It is visible dilataion of
capillaries of skin which
blanch on pressure.
Eg:- Dermatomyositis,
Systemic sclerosis.
Poikiloderma
It is a combination of
reticulate telengiectasia,
pigmentary change and
atrophy.
Eg:-
Dermatomyositis,poikilo
derma of civatte
Purpura
Extravasation of red
blood cells from
cutaneous vessles in skin
& mucous membrane.
Diascopy- non
blanchable.
Infarct
Area of cutaneous necrosis- tender,irregularly shaped
Dusky red-grey macule or firm plaque
SHAPES OF PAPULES AND
NODULES
Dome shaped-
Trichoepithelioma.
Flat topped- verruca
plana.
Umblicated- molluscum
contagiosum.
Acuminate-
condylomata acuminata
Verrucous-verruca
vulgaris.
Cont..
Pedunculated- skin tags.
CONFIGURATION OF LESIONS
Annular- T. corporis,
granuloma annulare.
Round/ discoid-
nummular eczema,
discoid lupus.
Polycyclic- urticaria,
SCLE.
Arcuate- urticaria.
Cont…
Linear- scabies burrow,
lichen nitidus. Kobners
phenomenon.
Reticular- livedo
reticularis.
Serpiginous- cutaneous
larva migrans.
Targetoid lesions- with 3
distinct zones. Erythema
multiforme.
Cont…
Whorled- incontinentia
pigmenti.
ARRANGEMENT OF LESIONS
Grouped/ herpetiform-
HSV-1
Scattered
DISTRIBUTION OF LESIONS
Dermatomal/
zosteriform.
Blaschkoid- following
lines of skin cell
migration during
embryogenesis.
Longitudinal on limbs
Circumferential on trunk
Lymphangitic- strep. Or
staph cellulitis.
Sun exposed-
Photodermatitis,
PMLE, SCLE
Sun protected-
parapsoriasis, mycosis
fungoides.
Acral-
chilblains,palmoplantar
pustulosis.
Truncal
Extensor-psoriasis
Flexor-atopic dermatitis
Intertriginous-
candidiasis.
Localized- cellulitis
Generalized- exanthema,
drug eruptions.
B/L symmetrical- vitiligo
Universal-alopecia
universalis.
THANK YOU