basic skin lesions
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TRANS #1
June 18, 20
BASIC SKIN LESIONS|| Dr. Guzman
TRANSCRIBERS: Daguno
TOPIC OUTLINE
I. Three Corners to Make a Useful Skin Examination
a. Morphology
i. Primary Skin Lesions
ii. Secondary Skin Lesions
b. Distribution
c. Configuration
II. Patterns of Skin Lesions
III. Colors in Dermatology
IV. Important Signs in Dermatology
1. Morphology(shape)
2. Configuration(arrangement)
3. Distribution(site)
MORPHOLOGY
Primary Skin Lesions (unmodified lesions)
Schemat ic representat ion of several comm on primary skin lesions
o Macule
change in the color of the skin
flat and cannot be palpated
Bates: up to 1 cm in diameter
Harrisons and Doc Guzman: less
than 2 cm
Freckles
o Patch
Bates: macule greater than 1 cm
Harrisons and Doc Guzman:greater than 2 cm
Caf-Au -Lai t Sp ot
o Papule
small, solid, raised lesion that has
distinct borders may have a variety of shapes in
profile (domed, flat-topped,
umbilicated) and may be associated
with secondary features such as
crusts or scales
Bates: up to 1 cm
Harrisons and Doc Guzman:less
than 0.5 cm
Psorias is
o Nodule
knot-like, firm lesion raised above
the surface of the surrounding skin
deeper and firmer than a papule
0.5 to 5.0 cm
Dermatof ibroma
3 CORNERS TO MAKE A USEFUL SKIN EXAMINATION
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MEDICINE I BASIC SKIN LESIONS
TRANSCRIBERS: Daguno
o Tumor
solid, raised growth in the skin or
subcutaneous tissue
larger than a nodule (more than 5.0
cm)
Xanthoma
o Plaque
large, flat-topped, raised lesion
often formed by coalescence of
papules
edges may either be distinct or
gradually blend with surrounding
skin
more than 1.0 cm
Psorias is
o Vesicle
small, elevated lesion filled with
serous fluid
Bates: up to 1.0 cm
Harrisons and Doc Guzman:less
than 0.5 cm
Herpes simplex
o Bulla
bigger vesicle
Bates: 1.0 cm or larger
Harrisons and Doc Guzman: more
than 0.5 cm
Insect bite
o Pustule
vesicle with pus (yellow
proteinaceous fluid filled with
neutrophils) does not necessarily signify the
existence of an infection
Fol l icu l i t is Pustu lar psorias is
(infected) (sterile)
o Wheal
raised erythematous, edematous
papule or plaque, usually
representing short-lived
vasodilation and vasopermeability
somehow irregular, relatively
transient superficial area of edema
(in the upper epidermis)
Urticaria
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MEDICINE I BASIC SKIN LESIONS
TRANSCRIBERS: Daguno
o Burrow
minute, slightly raised, linear
lesions produced by infestation of
the skin and formation of tunnels
Scabies
o Telangiectasia
dilated, superficial blood vessel
may occur as isolated phenomenon
or as part of a generalized disorder,
such as ataxia telangiectasia
Spider angioma Spider ve in
Secondary Skin Lesions (modified by scratching orinfection)
o Lichenification
visible and palpable thickening of
the epidermis and roughening of
the skin seen with exaggeration of
normal skin lines / furrows
(accentuated skin-fold markings)
often due to chronic rubbing or
scratching of an area
Neurodermat i t is
o Scale
excessive accumulation of
desquamated layers of stratum
corneum (appearing as flakes or
plates)
desquamation occurs when there
are peeling sheets of scale
following acute injury to the skin
Dry skin Ichthyosis vu lgar is
o Crust
dried residue of plasma or exudate
on the skin (serum, pus, or blood)
may be either yellow (i.e. serous
crust) or red (i.e. hemorrhagic crust Note: Crusting is different from
scaling. By appearance alone, one
can usually be distinguished from
the other.
Impet igo
o Erosion
nonscarring loss of the superficial
epidermis (appearing as slightly
depressed areas of skin) without an
associated loss of dermis
with moist surface that does not
bleed
Apthous stomat i t is
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MEDICINE I BASIC SKIN LESIONS
TRANSCRIBERS: Daguno
o Ulceration
deeper loss / necrosis of the
epidermis and dermis (sometimes,
even the underlying subcutaneous
tissue)
Syphi l i t ic chancre
o Excoriation
linear, angular erosions caused by
scratching or rubbing
traumatized or abraded skin
Cat scratches
o Atrophy thinning or absence of the
epidermis or subcutaneous fat
may appear as depression with
intact epidermis (i.e. loss of dermal
or subcutaneous tissue) or as sites
of shiny, delicate, wrinkled lesions
(i.e. epidermal atrophy)
Atrophoderma
o Scar
increased connective tissue that
arises from injury or disease
sites may be erythematous,
hypopigmented, or hyperpigmented
(depending on age or character)
sites on hair-bearing areas may be
characterized by destruction of hair
follicles
Hypert rophic scar f rom stero id in ject ion
o Fissure
linear crack / cleavage in the skin
that extends into the dermis
often resulting from excessive
dryness
Athletes foot
o Eschar
hard plaque covering an ulcer
implies extensive tissue necrosis,
infarcts, deep burns, or gangrene
Meningococcemia
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MEDICINE I BASIC SKIN LESIONS
TRANSCRIBERS: Daguno
o Keloid
exaggerated connective tissue
response of injured skin
(hypertrophic scarring)
extends beyond the edges of the
initiating injury / original wound
Keloid (ear lobe)
o Petechiae, Purpura, and Ecchymoses
terms referring to bleeding that
occurs in the skin
petechiae: smaller lesions
purpura & ecchymoses:larger
lesions
Note:Purpura may be palpable in
certain situations (e.g. necrotizing
vasculitis). Petechiae, purpura,
and ecchymoses do not blanch
when pressed. If uncertain, press
on the lesions carefully with a glass
side. Be careful not to break the
slide or cut the patient.
Petechiae Purpura
(Thrombocytopenia) (Henoch-Schnlein Purpura)
Ecchymoses(Acute myelogenous leukemia)
DISTRIBUTION
Photodistributed
o pattern follows the sun-exposed skin
o typical areas of involvement: forehead, uppe
ears, nose, cheeks, upper lip, neck,
forearms, and dorsum of the hands
Polymorphous l ight erupt ion
Intertriginous
o involves skin creases and folds
o areas of involvement: axillae, crural fold,
gluteal crease, and possibly the
inframammary fold
Hailey-Hailey Disease
Lymphangitic
o appears along the path of the lymph
channels of the leg or arm
Cellulit is
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MEDICINE I BASIC SKIN LESIONS
TRANSCRIBERS: Daguno
Dermatomal
o involves area of skin supplied with sensory
innervation by a particular nerve root
o does not cross the midline of the body
Herpes zoster (Shingles)
Palms and/or soles
Secondary syphi l is
Pitted keratolys is
Acral
o areas of involvement: distal aspects of the
head (ears, nose) and the extremities
(hands, fingers, feet, toes)
Chilblains (Perniosis )
Scattered
o skin lesions occurring across many body
locations can appear to be distributedrandomly or haphazardly
Neurof ibromatosis
Symmetric
o skin lesions found symmetrically on the
extremities can be indicative of diagnoses of
many etiologies, including infectious,
metabolic, genetic, and inflammatory causes
Stasis dermatit is
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MEDICINE I BASIC SKIN LESIONS
TRANSCRIBERS: Daguno
Widespread
o involves the entireor almost the entire
body
Erythematous drug erupt ion
CONFIGURATION
Conf igurat ion Disease Figure
Flat-topped Lichen planus
Dome-shapedLymphomatoid
papulosis
Slightly elevated Panniculitis
AcuminateAcute spongiotic
dermatitis
PapillatedNipple-like,
intradermal nervus
Digitated Finger-like, wart
UmbilicatedMolluscum
contangiosum
Annular
o seen in a ring shape
Tinea corpor is
Discrete
o tend to remain separate
o helpful descriptive term but has little specific
diagnostic significance
Vesicles of Varicella
Clustered
o grouped together
Vesicles of Varicella
Confluent
o tend to run together
Macular lesions of Kawasaki d isease
Dermatomal / Zosteriform
o lesions that follow a dermatome
Zoster i form nevus
PATTERNS OF SKIN LESIONS
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MEDICINE I BASIC SKIN LESIONS
TRANSCRIBERS: Daguno
Eczematoid
o inflamed lesions with a tendency toward
clustering, oozing, or crusting
Atopic dermat i t is
Follicular
o sometimes helpful to determine if lesions
specifically involve the hair follicle
Fol l icu l i t is
Guttate
o look as though someone took a dropper anddropped this lesion on the skin
Gutta te psorias is
Iris or target
o series of concentric rings with dark or
blistered center
Erythema mult i forme
Linear
o occur in a line or band-like configuration
Poison ivy dermat i t is
Multiform
o lesions of variety of shapes
Erythema mult i forme
Reticular
o net-like lesions that can be seen in a variety
of circumstances
Livedo ret icu lar is
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MEDICINE I BASIC SKIN LESIONS
TRANSCRIBERS: Daguno
Serpiginous
o wander as though following the track of a
snake
Urticaria
Universalis
o widespread disorder that affects the entire
skin
Alopecia universa l is
Scarlatiniform
o have the pattern of scarlet fever (with
numerable small red papules that are widely
and diffusely distributed)
o Note: The term scarlatiniform DOES NOT
mean that the patient has scarlet fever,
although by definition all patients with scarlet
fever have a scarlatiniform rash.
Serum sickness
Strawberry tongue
o with resemblance to the well-known berry
Scarlet fever
Morbilliform
o with rash that looks like measles
o rash consists of macular lesions that are red
and are usually 2-10 mm in diameter but
may be confluent in places
Measles Drug react ion to Di lant in
Satellite lesions
o describe a portion of the rash of cutaneous
candidiasis in which a beefy red plaque may
be found surrounded by numerous, smaller
red macules located adjacent to the body of
the main lesions
Candidal diaper dermatit is
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MEDICINE I BASIC SKIN LESIONS
TRANSCRIBERS: Daguno
Patterns of intentional or unintentional injury
o Skin lesions in cases of child abuse or other
intentional injury or cases of unintentional
injury
Basi lar sku l l f racture(Battle sign)
Color Examples
RedVascular lesions(e.g. port wine stain, psoriasis)
BlueBlue nevusMongolian spot
Yellow Xanthoma
White Vitiligo
BlackMelanocytic nevusMelanoma
Purple /Violaceous
Lichen planus
Koebner Phenomenon / Isomorphic Response
o appearance of lesions along a site of injury
Scaly psoria t ic lesions
along the line of ventral hernia repair
Auspitz Sign
o appearance of a tiny bleeding point after
removing a scale from psoriasis lesion
Psorias is lesion and Auspi tz sign
Dariers Sign
o occurrence of erythema and edema (due to
mast cell degranulation with histamine
release) upon stroking a lesion of urticarial
pigmentosa (a form of cutaneous
mastocytosis)
COLORS IN DERMATOLOGY
IMPORTANT SIGNS IN DERMATOLOGY
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MEDICINE I BASIC SKIN LESIONS
TRANSCRIBERS: Daguno
Nikolsky Sign
o appearance of new blisters upon rubbing
normal skin beside a blister
Dermatographism
o appearance of edema and erythema (that
looks like writings on the skin) when the
normal skin is stroked
Button-hole Sign
o If you try to push it, it goes inside the skin.
Neurof ibroma
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