CALEB KADIMA.
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 Cafe-au-lait spot
eruption
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
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 Hemangioma
carcinoma
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
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 Tinea pedis candidiasis
epidermis
Erosions do not
penetrate below the
dermoepidermal
junction and therefore
heal without scarring
Eg:- tinea
pedis,candidiasis,ecze
ma-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,decubi
tus
chancroid
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 Burn scar
zoster
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,poi
kiloderma 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,palmoplan
tar pustulosis.
Truncal
Extensor-psoriasis
Flexor-atopic dermatitis
Intertriginous-
candidiasis.
Localized- cellulitis
Generalized- exanthema,
drug eruptions.
B/L symmetrical- vitiligo
Universal-alopecia
universalis.
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