The Language of Dermatology
Tim Lambert, DOMunson Family Practice Residency
OBJECTIVES
• Understand primary and secondary dermatologic lesions
• Improve ability to properly describe dermatologic lesions or rashes
• Learn about dermatolgy resources
Dermatologic Nomenclature
• Primary Lesions• Secondary Lesions• Patterns• Distribution and Arrangement• Color
Primary Lesions
• Macule and patch
• Papule
• Nodule
• Tumor
• Pustule
• Plaque
• Wheal
• Vesicle and bulla
• Plaque
Macules and patches
• Macules do not rise above the level of the skin and can not be felt. They are recognized as a change in skin color.
• Patches are larger macules.
Papules and nodules
• Papules are palpable solid, round or ellipsoidal lesions that may involve the epidermis, dermis or subcutaneous tissue.
• Nodules are larger papules
Nodules
Solid lesion > 1 cm in size
Tumor
Pustules
• Pustules are epidermal or upper dermal collections of pus.
• Deeper lesions are referred to as abscesses
Plaques
• Plaques are raised lesions that have a flat top. The rise in elevation is much less than the width of the lesions.
Wheals
• Wheals are rounded or flat topped, pale red papules or plaques caused by extravasation of fluid into extracellular space.
Wheels/Dermatographia
Vesicles
• A vesicle is a lesion formed by fluid creating a cleavage plane beneath the stratum corneum.
• Bullae are larger vesicles.
Bullae
Burrow
Telangiectasia
Secondary Lesions
• Scale• Lichenification• Crusting• Excoriation• Fissure• Erosion• Ulceration
• Fungating• Keloid• Atrophy• Petechiae• Purpura• Ecchymoses
Examples of Scales
Scale
• Desquamation (skin coming off in scales) • Psoriasiform (large white or silver flakes) • Pityriasiform (branny powdery scale) • Lichenoid (apparent scale is tightly adherent to skin surface) • Keratotic (horny scale) • Exfoliation (peeling skin) • Maceration (moist peeling skin) • Verrucous (warty) • Descriptive terms for scale include: • Desquamation (skin coming off in scales) • Psoriasiform (large white or silver flakes) • Pityriasiform (branny powdery scale) • Lichenoid (apparent scale is tightly adherent to skin surface) • Keratotic (horny scale) • Exfoliation (peeling skin) • Maceration (moist peeling skin) • Verrucous (warty)
Lichenification
• Lichenification is caused by chronic rubbing, which results in palpably thickened skin with increased skin markings and lichenoid scale. It occurs in chronic atopic eczema and lichen simplex.
Crusting
• Crust occurs when plasma exudes through an eroded epidermis. It is rough on the surface and is yellow or brown in colour. Bloody crust appears red, purple or black.
Excoriation
• An excoriation is a scratch mark. It may be linear or a picked scratch (prurigo). Excoriations may occur in the absence of a primary dermatosis.
Fissure
•A fissure is a thin crack within epidermis or epithelium, and is due to excessive dryness.
Erosion
• Erosion is caused by loss of the surface of a skin lesion; it is a shallow moist or crusted lesion.
Ulcer
•An ulcer is full thickness loss of epidermis or epithelium. It may be covered with a dark-coloured crust called an eschar.
Fungating
• Refers to a large malignant tumour that is erupting like a mushroom or fungus.
Keloid
• A scar is enlarged or has grown excessively.
Atrophy
Atrophy thinned skin.
Petechiae and Purpura
Ecchymosis
Patterns and Distribution
• Annular• Nummular• Linear• Oval• Target• Serpiginous• Reticulate• Stellate
Annular
• Annular lesions are empty circles and ring- like in appearance
Nummular
• Nummular lesions take on the appearance of a filled circle or coin
Linear
• Linear lesions are long relative to their width and generally straight
Oval
• Oval shaped lesion
Target
• Target lesions are made up of concentric rings of red and white coloration with a bullseye appearance
Stellate
• Stellate lesions are “star like” usually by radial spread from a central focus
Reticulate
• Lesions with a lace-like appearance
Serpigenous
• Lesions which are linear and wavy or snake-like in appearance
LESION DISTRIBUTION
• HANDS• FACE• EXTENSOR• FLEXURAL• SCALP• AXILLAE• FEET• NAIL• GENITAL• INGUINAL
LESION ARRANGEMENT
• Grouped• Disseminated• Dermatomal• Confluent• Symmetric• Photosensitive
Grouped
• Multiple similar lesions occurring together in a localized body location
Disseminated
Lesions which are scattered randomly and covering all or most of the body
Dermatomal
• Following the path of a peripheral sensory nerve
Confluent
• The process of smaller lesions growing until they merge together
Symmetry
• Lesions are mirror images of each other on opposite sides of the body
Photosensitive
• Lesions limited to the sun exposed regions of the body
COLOR
• Hypo pigmented• Hyper pigmented• White• Black• Blue• Yellow• Violaceous• Variegated
Hypopigmented
Hyperpigmentation
White
Black
Blue
Red
Green
Yellow
Violaceous
Varigated
Dermatology Nomenclature tool: http://www.pediatrics.wisc.edu/education/derm/tutorials.html
Dermatology References
Required Derm module: Access through GME Resident or https://www.aad.org/education/basic-dermatology-curriculum
The End