Skin Lesions

>>firstidentifylesion:
1. Macule
a. Circumscribed,FLATlesionthatdiffersfromsurroundingskinbecauseof
itsCOLOR
b. Capillarydilatation(erythema);extravasatedRBC(purpura),
telangiectasia(PERMANENTdilatationscapillaries),petechiae(small
pinpointpurpura),sugillations(swollenblackandbluemarks)
c. applicationofpressurewithtwoglassslidesoranunbreakableclearlens(
diascopy)onaredlesionisasimpleandreliablemethodfor
differentiatingrednessduetovasculardilatation(erythema)fromredness
duetoextravasatederythrocytesorerythrocyteproducts(purpura).Ifthe
rednessremainsunderthepressureoftheslide,thelesionispurpuric.
d.
2. Papule
a. Smallsolidelevatedlesionlessthan1cm
b. Obliquelightingwithaflashlightinadarkenedroomisoftennecessaryto
detectslightelevation
c. SHAPEAcuminated(pointed)miliariarubra,surmountedwithscale
(secondarysyphilis),domeshaped(molluscumcontagiosum)
d. COLORRedpapules(psoriasis),coppercolor(secondarysyphilis),with
violaceoushue,netlikewhitemarkings(lichenplanus),yellowpapules
(xanthomosis)
3. Plaque
a. Mesalikeelevationthatoccupiesalargersurfaceareaincomparisonwith
itsheight
4. Nodule
a. Epidermal(verrucavulgaris,keratocoacanthoma,basalcellcarcinoma),
epidermaldermal(compoundnevi,malignantmelanoma,invasive
squamouscell),dermal(dermatofibromas),dermalsubdermal,
subcutaneous
5. Wheal
a. roundedorflattoppedpapuleorplaquethatischaracteristically
evanescent,disappearingwithinhours
b. resultfromedemaintheupperportionofthedermis
c. Thewhealproducedinresponsetothestrokingofareddishbrownor
brownishmacule(Darier'ssign)ispathognomonicofurticariapigmentosa
(mastocytosis)
d.
6. Vesicleandbullae
a. Elevated,fluidfilledlessthan0.5cmvesicle,morethanbullae
b. Arisefromcleavagefromvariouslevelsoftheskin

7. Erosions
a. Lossofallportionofviableepidermis
8. Pustules
a. circumscribed,raisedlesionthatcontainsapurulentexudate
9. Cyst
10. Atrophy
a. diminutioninthesizeofacell,tissue,organ,orpartofthebody.
Epidermalatrophyreferstothinningoftheepidermisandisassociated
withadecreaseinthenumberofepidermalcells
11. Ulcers
a. destructionoftheepidermisandatleasttheupper(papillary)dermis
12. scar
13. sclerosis
a. circumscribedordiffuseHARDENINGoftheskin
14. calcinosis
a. hardnodulesorplaques(dermisorsubcutaneoustissue)withorwithout
alterationinskinsurface
15. desquamation
a. abnormalsheddingofstratumcorneum(usuallyepidermiscompletely
replacedafter27days)
>>thendetermineSHAPE,ARRANGEMENTINRELATIONTOEACHOTHER
ANDEXTENT
1. Linear
a. May suggest exogenous cause
b. Koebner phenomenon trauma is followed by new lesion in
otherwise healthy skin (lesion would be identical to those
seen in traumatized skin)
2. Annular
a. Most acute erythemas associated with inflammation
b. Iris/ bulls eye lesion characteristic of erythema
multiforme syndrome
3. Grouped
a. Little diagnostic value unless there is a pattern
4. Reticular
a. Netlike/lacy
b. Livedo reticularis
Distribution of skin lesion can be localized, regionalized, generalized