BASIC SKIN LESIONS

Dr. Sara
Dr. HameedUllah
Dr. Asad
 OUTLINE

• General features of any skin lesion

• Types of skin lesions
Primary
Secondary
Special
• Configuration of skin lesions
• Distribution of skin lesions
 FEATURES OF A SKIN LESION

• Size
• Type
• Shape & Symmetry
• Color and Pigmentation
• Surface area
• Distribution
 TYPESOF LESIONS
Basic skin lesions are broadly
categorized as :

1. Primary Lesions
2. Secondary Lesions
3. Special Lesions
Primary
□ Lesions: Lesions occurring on non
pathological skin which has not been altered by trauma,
manipulation (scratching, scrubbing) or natural
regression over time.
□ Secondary Lesions: Modification of primary skin

lesions that result from traumatic injury,

evolution from primary lesion or other external
factors.
□ Special Skin Lesions: Specific for certain disease.
 PRIMARY SKINLESIONS
 Macule  Bulla
□ Pa t  Pustule
c hPapule 
 Plaque  Absces
 □ s ys
C Weal
 Nodule t
Vesicle
 MACULE

• A flat, circumscribed non

palpable lesion that differs in
colour from the surrounding
skin.
• T hey are <1cm in size.
• They can be of any colour or
shape.
 TYPES OF
MACULES
1) Hypopigmented: due to decrease in the number of
melanocyte or amount of pigment they produce.

Pityriasis Versicolor Nevus Anemicus

2) Depigmented: Due to complete loss of melanocytes e.g. Vitiligo.

3) Hyperpigmented: Due to excess of Melanin in skin e.g. Ephelides

Vitiligo Ephilides
 PATCH
A large macule is called
patch (>1cm in size).
E g : Vitiligo,melasma
.
VITILIGO PATCH
 PAPULE

•An elevated palpable

solid lesion that is less
than 1cm in diameter.
•Papules may be of
various colours
and shapes
 EXAMPLES..

Molluscum Skin tags

contagiosum
 EXAMPLES CONT…

Folliculitis Acn
e
 SHAPES OF PAPULES
• Dome shaped- Trichoepithelioma

• Flat topped- Lichen planus.

• Umblicated- Molluscum
contagiosum.
• Acuminate- Condylomata
acuminata
• Verrucous-verruca vulgaris.
 PLAQUE

•An elevated circumscribed

lesion greater than 1 cm in
diameter. Its surface is
usually flat. Papules may
coalesce together to form
plaques .
EXAMPLES OF PLAQUES
PSORIASIS
TINEA CORPORIS
 NODULE

• A solid palpable lesion in the dermis or

subcutis,
which can be observed as an or can be
elevation palpated.
• Size is usually greater than 0.5cm.
• It is the depth of involvement that differentiates
a nodule from a large papule.
 EXAMPLES OF NODULE

 Erythema nodosum
 Neurofibromatosis
 Acne
 EXAMPLESOF NODULE
Prurigo nodularis Neurofibromatosis
 VESICLE
• A small, fluid filled circumscribed elevation
less than 1 cm in diameter.
• The fluid may be clear, serous or hemorrhagic.
• Examples are
 Viral infections (Chickenpox, HZ, Herpes
(Oral and Genital).
 Contact Dermatitis
 Dermatitis Herpetiformis
 Insect Bites.
 EXAMPLES OF VESICLE
CHICKEN POX HERPES ZOSTER
 BULLA

• A fluid filled elevation more

than 1 cm in diameter. It can be multilocular
circumscribed
(due to coalesced vesicles) or unilocular.
EXAMPLES OF BULLA

Bullous pemphigoid Pemphigus vulgaris

 PUSTUL
E
•It is circumscribed lesion which
contains purulent material.
• It may be due to infection
or may be sterile.
ACNE
Pustular psoriasis

Folliculitis
 ABSCESS
□A localized collection
of pus
deep in dermis or
subcutaneous tissue
□D u e to deep seated
location pus may not be
visible on skin surface
but would show sign of
inflammation.
 WEAL
• It is a transient swelling of
skin due to dermal and
hypodermal edema often
pale centrally with an
erythematous rim.
• E x a mp l e : Urticaria
 Examples of Weal
Urticaria Dermographism
 CYST
• Any closed cavity or sac
with an epithelial,
endothelial or
membranous lining,
containing fluid or semi
solid material.
• E x a m p le :-
Mucous retention
Cyst,epidermoid 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 flake of stratum
corneum
•Examples:
Psoriasis,ichthyosis
I CHTHYOSIS VULGARIS
 TYPES OF SCALES

• COLLARETE
Peripherally attached and centrally detached scale at
edge of inflammatory lesion

• FURFURACEOUS
Fine and loose

• ICHTHYOTIC
Thick and polygonal
SCALING IN SHEETS(DESQUAMATION )
SCARLET FEVER(HANDS AND FEET)
 CRUST
• Dried exudate of body
fluids (blood / serous
fluid) wh i c h may be
of different colour
Exampleof
crusting Impetig o
 EROSION
• A focal loss of epidermis.
• Erosions do not penetrate below the dermo epidermal
junction and therefore heal without scarring.
• E.g.:
Immunobullous disorders,
tinea pedis,
candidiasis,
herpes simplex.
EROSION
 ULCER

• A focal loss of epidermis and/or

dermis often with the loss of
underlying tissues.
• Scarring depends on the depth of the
ulcer
• E.g. –
Chancroid,
Pyoderma gangrenosum (punched
out ulcers)
Decubitus ulcers
PYODERMA GANGRENOSUM
 FISSURE
It is a linear cleft in the skin through the epidermis
and part of dermis, may be single or multiple
ranging from microscopic to a few millimeters
having well defined margins.

E.g.; Eczema(fingertips),Intertrigo
FISSURE
 SCAR
□I t is replacement of
normal skin by fibrous
tissue that has been
destroyed by injury
or disease.
□S c a r s may be

1)Hypertrophic
2)Atrophic
3)Keloid
□E g :- acne, burns,
herpes zoster,
Scar of Herpes Zoster

Burn Scar
 HYPERTROPHIED SCAR

 REMAINS WITHIN BOUNDARIES OF ORIGINAL

WOUND SITE
 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,
lipoatrophy
LIPOATROPY
 LICHENIFICATION

• Focal area of thickened

skin produced by
chronic scratching or
rubbing.
• Clinically triad of
accentuation of skin
markings, thickening of
epidermis and
hyperpigmentation.

• E.g.
CHRONIC ACTINIC
DERMATITIS
 SPECIAL SKIN LESIONS

• Bu r row • P u rp u r a
• Comedone • In fa r ct
• Milia • Horn
• Telangiectasia • Calcinosis
• Poikiloderma • Striae
• Sclerosis
BURROW
It is small tunnel in the
skin houses a
that Example
parasite. tunnel in
serpentine
scabies.
SCABIES BURROW
COMEDONE

□I t is a tiny plug present

at opening of hair
follicle formed by
keratin and sebum
□I t is of two types:
Open comedone (black
head)
Closed comedone (white
head)
MILIUM

• It is a tiny
superficial cyst with
epidermal lining.
• Milia are seen on
face at periorbital
region.
 TELENGIECTASIA
□I t is visible dilataion
of capillaries of skin
which blanch on
pressure.
□E g :-
Dermatomyositis,
Systemic sclerosis.
 POIKILODERMA

• It is a combination of
reticulate telangiectasia,
pigmentary changes and
atrophy.
E.g.:-
• Dermatomyositis,
• Poikiloderma of civatte
 PURPURA
• Extravasation of red blood cells from
cutaneous vessles in skin & mucous
membrane.
• Diascopy- non blanchable.
Variants:
• Petechiae(1-2mm in diameter)
• Echymosis(>2mm in diameter)
 INFARCT

• Area of cutaneous
necrosis
• Tender, irregularly
shaped dusky red-grey
macule or firm plaque
 HORN:
Hyperkeratotic conical mass of
cornified cells , arising over an
abnormally differentiating epidermis

CALCINOSIS :
Deposits of calcium in the dermis or
subcutaneous tissue may be appreciated
as hard , whitish nodules or plaques ,
with or without visible alteration of
skin’s surface. Calcinosis : in
dermatomyositis
 STRIAE
These are linear depression of the
skin that usually measure several
cms in length. Result from changes
in reticular dermis that occur with
rapid stretching of the skin.

SCLEROSIS
Diffuse or circumscribed
induration or hardening of the skin
that results from dermal fibrosis.
Skin may feel board- like,
immobile and difficult to pick up.
CONFIGURATION OF
LESIONS
 CONFIGURATION OF LESIONS

 Annular
 Round/Discoid
 Polycyclic
 Arcuate
 Linear
 Reticulate
 Livedo
 Serpiginous
 Target
 Stellate
 Digitate
 Whorled
 ANNULAR SKIN LESIONS

 Open circles with different central

skin colour as compared to the rim.
 Granuloma annulare
 Tinea corporis
ANNULAR SKIN LESIONS
ANNULAR SKIN LESIONS
 ROUND /DISCOID LESIONS

 Disc shaped
 Nummular eczema
 Discoid lupus
 DISCOID LESIONS

Discoid lesions
 POLYCYCLIC SKIN LESIONS

 Urticaria
 Subacute cutaneous lupus erythematosus
POLYCYCLIC SKIN LESIONS
 ARCUATE(INCOMPLETE CIRCLES)

Urticaria
 LINEAR LESIONS

 Kobner’s
phenomenon
 Lichen nitidus
 Scabies burrow
 KOEBNER’S PHENOMENON:
The Koebner’s phenomenon (KP), first described in 1876
by Heinrich Koebner, is the appearance of new skin
lesions at the site of trauma.

Psoriasis, Lichen planus and vitiligo.

 RETICULATE SKIN LESIONS

 Fine lace like pattern

 Example :
Oral lichen planus
 LIVED
O
Chicken wire criss cross pattern
Examples;
Erythema abigne
Polyarteritis nodosa
LIVEDO RETICULARIS
 SERPIGINOUS(SNAKE LIKE)

Cutaneous larva migrans

 TARGET LESIONS

 Multiple concentric rings

 Example includes erythema multiforme
STELLATE LESIONS (STAR SHAPED )
DIGITATE LESIONS (FINGER SHAPED)
WHORLED LESIONS(SWIRLING PATTERN)
DISTRIBUTION OF
LESIONS
 DISTRIBUTION OF LESIONS

• Symmetrical Lesions • Blaschkoid distribution

• Asymmetrical Lesions • Lymphangitic distribution
• Lesions on Flexor Surfaces • Intertriginous
• Lesions on Extensor Surfaces • Localized
• Zosteriform/ Dermatomal distribution • Generalized
• Acral distribution • Isotonic
• Photo distribution • Isomorphic
 SYMMETRICAL DISTRIBUTION

 Erythema Nodosum
 Vitiligo
 Psoriasis
 Dermatitis herpatiformis
 Atopic dermatitis
 Syringomas
Symmetrical distribution
 ASYMMETRICAL DISTRIBUTION

 Dermatophytes infection
 Impetigo
 Contact dermatitis
 Fixed drug eruptions
ASYMMETRICAL DISTRIBUTION
 LESIONS ON EXTENSOR SURFACES

 Psoriasis
 Dermatitis herpetiformis
 Nummular eczema
 Erythema multiforme
LESIONS ON EXTENSOR SURFACES
 LESIONS ON FLEXOR SURFACES

 Atopic dermatitis
 Contact dermatitis
 Scabies
 Dermatophytes
 Hailey- Hailey disease
LESIONS ON FLEXOR SURFACES
 ZOSTERIFORM/DERMATOMAL
DISTRIBUTION

 Herpes zoster(shingles)
 Zosteriform naevus
 ZOSTERIFORM/
DERMATOMAL DISTRIBUTION
 BLASCHKOID DISTRIBUTION
 Blaschko’s lines, are
believed to trace the
migration of cells during
embryogenesis. They
follow a “V” shape over
the back, “S” shaped
whirls over the chest and
sides, and wavy shapes on
the head.

EXAMPLES:

 Hypomelanosis of Ito
HYPOMELANOSIS OF ITO
BLASCHKOID DISTRIBUTION IN

LINEAR LICHEN PLANUS

 LYMPHANGITIC
DISTRIBUTION

 Sporotrichosis
 Fish tank granulomas
 Lymphangitis
LYMPHANGITIC DISTRIBUTION
 LESIONS ON SUN EXPOSED AREAS

 Actinic prurigo
 Actinic keratosis
 Xeroderma pigmentosum
 Polymorphic light eruption
 SLE
LESIONS ON SUN EXPOSED AREAS
 ACRAL DISTRIBUTION

 Acral distribution of skin lesions involves

the distal aspects of the head (ears, nose)
and the extremities (hands, fingers, feet,
toes).

PERNIOSIS
TINEA NIGRA
PALMOPLANTAR PUSTOLOSIS
 ACRAL DESTRIBUTION


Perniosis
 INTERTRIGINOUS

 An intertriginous area is where two skin areas may

touch or rub together. Examples of intertriginous
areas are the axilla of the arm, the anogenital region,
skin folds of the breasts and between digits.
 CANDIDAL INTERTIGO
 INVERSE PSORIASIS
 HAILEY HAILEY
CANDIDAL INTERTRIGO
 LOCALIZED SKIN LESIONS

 Cellulitus
 Furuncle
 Carbuncle
 Warts
 CELLULITIS

Cellulitis is a common
bacterial skin infection of the
lower dermis and
subcutaneous tissue.
It results in a localized area of
red, painful, swollen skin, and
systemic symptoms. If left
untreated, cellulitis can be life-
threatening.
 CARBUNCLES:
A CARBUNCLE IS A CLUSTER OF
BOILS THAT HAVE MULTIPLE PUS
“HEADS.” THEY’RE TENDER AND
PAINFUL AND CAUSE A SEVERE
INFECTION WHICH COULD LEAVE A
SCAR.

Boils:
A boil, also called a furuncle, begins as a
painful infection of a single hair follicle.
Boils can grow to be larger than a golf
ball. • So carbuncle is multiple fruncle.
 GENERALIZED SKIN LESIONS

 Viral exanthem
 Drug reaction
DRUG REACTION
VIRAL EXANTHEM
 ISOTOPIC RESPONSE

 Occurrence of a new skin disease at the site of

another, unrelated and already healed skin disease.
 For example: psoriasis developing at the sites of
contact dermatitis.
 Pathergy test in case of Behcets disease is also an
isotopic response.
 ISOMORPHIC RESPONSE

 The appearance of a skin lesion at the site of trauma

that is morphologically similar to an existing skin
disease.
 Typically seen in psoriasis.
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