BASIC LESIONS IN DERMATOLOGY

According to morphology

 SKIN LESIONS ARE CLASSIFIED

AS:
1. PRIMARY LESION
2. SECONDARY LESION
3. SPECIAL LESION
Primary lesions Secondary lesions Special lesions

Macule Crust Comedo

Papule Scar Burrow

Plaque Ulcer Target lesion

Nodule Erosion Telangiectasia

Vesicle Excoriation Millium

Bulla Lichenification

Pustule Atrophy

Cyst Scales

Wheal Fissure
 MACULE
Circumscribed alteration in skin colour without any
change in texture.

Types:
1. Hypopigmented macule

2. Hyperpigmented macule

3. Depigmented macule
4. Purpura
5. Erythema
HYPOPIGMENTED MACULE

• Decrease in number of melanocytes or decrease

in amount of pigments they produce
• Eg Tuberous sclerosis

Tuberous sclerosis: Ash Leaf hypopigmented macules

HYPERPIGMENTED MACULE
 These macules are produced by excessive
melanin in the skin
 Eg:Freckles

Freckles:Small pale brown macules on the face

DEPIGMENTED MACULE
 Total absence of melanocytes
 Eg: Vitiligo

Vitiligo:Chalk white depigmented macule

PURPURA
 Extravasation of red cells in the dermis produce
purpuric macules
 They do not blanch on pressure

 Larger lesions are called Echymosis

 Eg: thrombocytopenic

purpura

Macule of senile purpura

ERYTHEMA
 An increased blood flow through skin caused by
capillary dilatation produce erythematous
macules.
 Eg: viral and drug rashes,cellulitis

cellulitis
 PAPULE
A circumscribed palpable elevation less than 0.5cm
in diameter.
Papules may be derived from hyperplasia of
epidermis dermis or both or may be the result of
extraneous elements like metabolic deposits or
cellular infiltrate
1.Lichen planus: flat 2.Molluscum contagiosum: pearly white
topped papules dome shaped umbilicated macules
3. Psoriasis: erythematous papules 4. Acrochordon pedunculated papules
Verruca vulgaris: multiple small closely packed projected elevations(vegetations)
 NODULE
A solid mass in the skin which can be palpated.
It is more than 0.5cm in size.

It may involve epidermis and dermis,dermis and

subcutis or subcutis alone.
Depth of the nodule differentiate it from papule.

Depending on the anatomic components nodules

are divided in to:
1.epidermal:nodular basal cell carcinoma
keratoacanthoma
 2.dermal:metastatic carcinoma
lymphoma
histoid leprosy
dermatofibroma
 3.subcutaneous :lipoma
erythma nodosum
xanthomas
 Nodules are described as hard, firm, soft, tender, painless,
fleshy, fixed and mobile.
 The surface of the nodules could be ulcerated,fungating ,smooth
or keratotic.
 NODULE

Neurofibromatosis
FIRM NODULE OF DERMATOFIBROMA
 PLAQUE

Anelevated area of skin usually defined as 0.5 cm or

more in size.

It
may be formed by extension or coalescence of either
papules.

Eg: Psoriasis
PSORIASIS:ERYTHEMATOUS PLAQUE WITH LAYERS OF SILVERY SCALES
 PLAQUE

Atrophic depigmented scaly plaques of Tuberculoid leprosy:Well defined

discoid lupous erythematosus erythematous plaque
 VESICLE AND BULLA

 Visible accumulation of fluid within or beneath the

epidermis is called vesicle.

 It is less than 0.5 in size.

 Vesicle more than 0.5cm is called bulla.

 Vesicle and bulla can arise by separation of skin in
different levels:
1. below the stratum corneum:impetigo contagiosa,

: pemphigus foliaceus
2.just above basal layer:pemphigus vulgaris
3.dermoepidermal junction: bullous pemphigoid
 Lesions may be
TENSED bullous pemphigoid
FLACCID pemphigus
UMBLICATED varicella

 Vesicles and bulla may rupture to form erosions

or crust
 VESICLE AND BULLA

Umblicated veicle in varicella Bullous pemphigoid:tense bulla,

vesicles,crusted erosions.
 PUSTULE
•Visible accumulation of free pus.

It may occur within a pilosebaceous follicle or sweat

duct or on glabrous skin.

Eg: pyoderma, folliculitis

 PUSTULE

Two pustules representing superficial pyoderma Follicular pustule due to furuncle

 CYST
 A closed cavity or sac within an epithelial,
endothelial or membranous lining containing
fluid or semisolid material.
 Two most common cutaneous cyst

 Epidermal:cyst lined with squamous

epithelium produce keratinous material.
 Pilar cyst:originates from hair follicle lined
with multilayered epithelium
 CYST

Cystic hidradenoma: A bluish colored Sebaceous cyst

resilient cyst filled with a mucous-like
material on the cheek
 WHEAL
 A transient area of dermal or dermal and
hypodermal oedema white compressible and
usually evanscent.
 Wheals results from a transient vascular reaction
in the upper dermis in which there is both
vasodilatation and increased permeability of the
capillaries give rise to odema.
 Wheals are produced as allergic response to
various agents like food, drugs, insect bite,
pollengrains
 Dermographism: firm stroking produces a
raised wheal surrouned by flare
 Characteristic feature of urticaria
 ULCER

 A loss of dermis, epidermis and may involve underlying

tissue.
 Ulcers always heal with scar.

 Boarders of the ulcer may be rolled, punched out, jagged

or angular.
 Base may be clean , ragged, necrotic.
 Discharge may be purulent, granulomatous

 Surrounded area may be red, purple, pigmented,

indurated,sclerotic
Eg: vasculitic ulcer,
 Pyoderma Gangrenosum large ulcer with a
Stasis ulcer with surrounding ragged base and heaped-up pink
hyperpigmentation and induration erythematous border on the leg
 SCAR

Replacement by fibrous tissue of another tissue that

has been destroyed by disease or injury
Types
•Hypertrophic scar: elevated in the form of papules
or plaques
•Atrophic scar: thin depressed planes
•Cribriform scar: perforated with multiple pits on it
Keloid: scar that continue to grow and extend into
the surrounding normal skin
 SCAR

Atrophic scar
Hypertrophy scar
KELOID
 CRUST

Crusts consist of dried sebum and exudate.

Crusts are a result of disruption of stratum

corneum.

Crusts are secondary to primary lesions such as

vesicles pustules etc.
 CRUST

Impetigo:honey coloured crusts

 EROSION

Loss of epidermis which heals without scarring occurs in

epidermal blistering.

Eg:pemphigus vulgaris.

PEMPHIGUS VULGARIS
 SCALE

A flate plate or flake of stratum corneum

Eg: psoriasis
icthyosis
 EXCORIATION

Loss of skin substances produced by scratching

Commonly seen in pruritic dermatitis such as atopic

dermatitis
 LICHENIFICATION
Thickening of the epidermis in response of
prolonged rubbing.
Coarsening of skin surface marking on background
of dry and erythematic skin.
Skin become thickened and
hyperkeratotic.

lichen simplex chronicus

 FISSURE

Any linear gap or slit in the skin surface.

results from excessive tension or decrease elasticity
of involved tissue.
Eg: fissure on the palms associated with contact
dermatitis.
 ATROPHY

A loss of tissue from one or more of the

epidermis,dermis or subcutaneous tissue.

There may be fine wrinkling and increased

transluscency
 ATROPHY

Atrophic scar of pseudopelade of Brocq

 BURROW

A small tunnel in the skin that houses a parasite.

Burrow about length 5mm on fingers ,wrist or gentalia are
diagnostic of scabies.
Longer burrow about (5 to 10cm) on the feet are seen in
creeping eruption caused by migration of hookworm larvae.

Burrow
 COMEDO

A plug of keratin and sebum in a dilated

pilosebacious orifice.
Types:
•Open comedo the impaction occurs in dilated
follicular orifice.
-Clinically visible as black keratinous mass
•Closed comedo -follicular openings are not dilated -
impaction occur low down in the follicular canal
Closed comedo Open comedo
 MILIUM
A tiny white cyst containing lamellated keratin
They may occur on the face, periorbital region
they arise on blistered or damaged skin
eg: dystrophic epidermolysis bullosa or
porphyria

Milia:small spherical
white lesion
 TELANGIECTASIS

Distinctly visible dilated capillaries.

Seen in Scleroderma,
Steroid induced atrophy,
Actinic and radiation damage
 TARGET(IRIS) LESIONS
Less than 3 cm in diameter

Three or more zone,

central area of dusky erythema,

middle paler zone of oedema

outer ring of erythema

with well defined edge.

These are pathognomic
of erythema multiforme

TYPICAL LESION IN ERYTHEMA MULTIFORME

CONFIGURATION OF SKIN LESIONS
 Linear :resembling a straight line.
a single lesion may assume a linear shape or a
number of lesions may arrange in linear pattern.

Linear verrucous epidermal nevus

 Annular:ring shaped
Annular or arciform lesions are characteristic of
granuloma annulare, the annular erythemas,
annular purpura, tertiary syphilis, borderline
leprosy.

Tinea faciei:annular
plaque
 Reticular: net like or lacy in appearance
eg:livedo recticularis cutis marmorata, Oral
lichen planus

Reticular pattern
 Serpiginious: snake like
eg:cutaneous larva migrans
Arcuate:
arc like lesion
Eg urticaria,

Polycyclic:formed from coalescing circles or ring lesion

Eg: Subacute lupus erythematosus
Grouped lesions
 Grouped vesicles: herpes simplex and herpes
zoster
 Corymbiform:verucca vulgaris:
 Unpatterned grouped lesions: verruca plana,

lichen planus,urticaria and lymphangioma

:circumscriptum
Reference:
IADVL text book of dermatology
ROOK’S text book of dermatology
Fitzpatrick 8th edition
THANK YOU