PRESENTED BY:- DR. AAKANKSHA SINGH.
When describing a skin lesion,it is important to note the following features:-
1)size2)type3)shape and symmetry4)colour and pigmentation5)surface area6)Distribution over the body surface
Types of lesion Basic skin lesions are broadly categorized as :
1. Primary2. Secondary3. 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 LesionsMaculePatchPapuleplaquenoduleVesicleBullaPustuleAbscessWhealCyst
MaculeA 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 maculesBeckers neveus Freckle
Fixed drug eruption
Cafe-au-lait spot
Blue coloured maculesMongolian spot Blue naevus
ink(tattoo)
Drug eruptions Secondary syphilis
Red coloured macules
HypopigmentedTinea versicolor
PATCHA large macule is
called patch (>1cm in size).
May have scaling.Eg :- Vitiligo,
melasma, pityriasis alba
PapuleA 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 papulesMolluscum contagiosum
Skin tags
Brown colored papules
Melanoma Dermatofibroma
Red colored papuleAcne
folliculits
Insect bite
Blue colored papulesBlue nevus Lichen planus
violaceous papules)
PlaqueIt is an indurated
area of skin larger than 0.5 cm in diameter which may be raised or depressed from skin surface.
Examples of plaquePsoriasis Lichen planus
Tinea corporis
Other examples of plaquePityriasis roseaSeborrheic dermatitisTinea pedisEczema
NoduleA 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 noduleBasal cell carcinoma
Hemangioma
Prurigo nodularis neurofibromatosis
Other examples of nodule
XanthomaKeratoacanthomaMelanoma
VesicleA 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 vesicleChicken pox Herpes zoster
Other examples of vesicleImpetigoInsect biteHerpes simplexDermatitis herpetiformis
bullaA fluid filled, raised,
often a translucent lesion >0.5cm in diameter
Examples of bullaBullous pemphigoid Fixed drug reaction
PustuleA vesicle filled with
pusIt is formed due to
collection of inflammatory exudate rich in leucocytes.
It may contain bacteria or may be sterile.
Acne Pustular psoriasis
Folliculitis Scabies
AbscessA 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.
WhealIt 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 whealUrticaria dermographism
CystIt 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 LesionsScale CrustErosionFissureSinusScarAtrophyLichenification
ScaleExcess dead
epidermal cells that are produced by abnormal keratinization and shedding
Eg: Psoriasis, Icthyosis
Types of scalesFine to stratified
•Erythema craquele(dense scale)
•Psoriasis(silvery scale)
Ichthyosis vulgaris
Tinea versicolor(fine)
Scaling in sheets(desquamation)
Scarlet fever(hands and feet)
Staphylococcal scalded skin syndrome
Kawasaki syndrome
Other types of scalesCrack 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
CrustDried exudate of
body fluids (blood / serous fluid)
Which might be either yellow / red
Examples of crustingTinea capitis Impetigo
Erosion A focal loss of
epidermisErosions do not
penetrate below the dermoepidermal junction and therefore heal without scarring
Eg:- tinea pedis,candidiasis,eczema-tous disease, herpes simplex
Tinea pedis candidiasis
ulcerA focal loss of
epidermis and/or dermis
Scarring depends on the depth of the ulcer
Eg-chancroid,pyoderma gangrenosum,decubitus
chancroid
Pyoderma gangrenosum
decubitus
Radiodermatitis
Fissure It is a linear loss of
continuity of skin due to excessive tension.
Eg:- eczema(fingertips),intertrigo
Finger fissure d/t eczema
intertrigo
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
Acne scar
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.
BurrowComedoneMiliaTelengiectasiaPoikilodermaPurpurainfarct
BurrowIt is a serpentine
tunnel made by scabies mite in stratum corneum.
The open end of the tunnel has a papule.
ComedoneIt 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)
MiliumIt is a tiny
superficial cyst with epidermal lining. Milia are seen on face at periorbital region.
TelengiectasiaIt is visible dilataion
of capillaries of skin which blanch on pressure.
Eg:- Dermatomyositis, Systemic sclerosis.
PoikilodermaIt is a combination
of reticulate telengiectasia, pigmentary change and atrophy.
Eg:- Dermatomyositis,poikiloderma of civatte
PurpuraExtravasation of red
blood cells from cutaneous vessles in skin & mucous membrane.
Diascopy- non blanchable.
Infarct Area of cutaneous necrosis-
tender,irregularly shapedDusky red-grey macule or firm plaque
SHAPES OF PAPULES AND NODULESDome shaped-
Trichoepithelioma.Flat topped- verruca
plana.Umblicated- molluscum
contagiosum.Acuminate-
condylomata acuminataVerrucous-verruca
vulgaris.
Cont..Pedunculated- skin
tags.
CONFIGURATION OF LESIONSAnnular- 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 LESIONSGrouped/
herpetiform-HSV-1Scattered
DISTRIBUTION OF LESIONSDermatomal/
zosteriform.Blaschkoid-
following lines of skin cell migration during embryogenesis.
Longitudinal on limbsCircumferential on
trunk
Lymphangitic- strep. Or staph cellulitis.
Sun exposed-Photodermatitis,
PMLE, SCLESun protected-
parapsoriasis, mycosis fungoides.
Acral- chilblains,palmoplantar pustulosis.
TruncalExtensor-psoriasisFlexor-atopic dermatitisIntertriginous-
candidiasis.Localized- cellulitisGeneralized- exanthema,
drug eruptions.B/L symmetrical- vitiligoUniversal-alopecia
universalis.
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