Basic Skin Lesions

7/23/2019 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


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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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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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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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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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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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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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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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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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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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

Basic Skin Lesions

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