Morphology of skin lesions Morphology of skin lesions Dr Mesfin Hunegnaw Dr Mesfin Hunegnaw Consultant Dermatologist & Venerologist Consultant Dermatologist & Venerologist AAU, Medical faculty AAU, Medical faculty Dept. of Dermtovenerology Dept. of Dermtovenerology
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Morphology of skin lesionsMorphology of skin lesionsDr Mesfin HunegnawDr Mesfin Hunegnaw
Dept. of DermtovenerologyDept. of Dermtovenerology
Morphology of skin lesionsMorphology of skin lesions
Includes:Includes: Type of the lesion,Type of the lesion, Size of the lesion,Size of the lesion, Shape of the lesion,Shape of the lesion, Distribution and arrangement,Distribution and arrangement, Margination.Margination.
1-Macule:1-Macule: ‘‘macula’: ‘spot’macula’: ‘spot’ Flat, change in skin colour,Flat, change in skin colour, No elevation or depression,No elevation or depression, Not identified by mere touch,Not identified by mere touch, <1.0 cm= macule,<1.0 cm= macule, >1.0cm>1.0cmpatch.patch.
Macule…Macule…
As a result of:As a result of: Hyper pigmentationHyper pigmentation - Cafe-au-lait spots,- Cafe-au-lait spots, - Post inf. hyper pigmentation.- Post inf. hyper pigmentation. Hypo pigmentationHypo pigmentation - post inf. Hypopigmentation,- post inf. Hypopigmentation, - Leprosy,- Leprosy, - Vitiligo.- Vitiligo.
Macule…Macule…
Vascular abnormalityVascular abnormality - Erythema Vs pupura- Erythema Vs pupuraMacules + fine scales= maculosquamousMacules + fine scales= maculosquamous - P.versicolor- P.versicolor - P.rosea- P.rosea TelangiectasiaTelangiectasia: permanent dilatation of : permanent dilatation of
capillariescapillaries
PurpuraPurpura
Macules of café au lait spots in NFMacules of café au lait spots in NF
Patch of vitiligoPatch of vitiligo
Patch of leprosy in 27 yrs EthiopianPatch of leprosy in 27 yrs Ethiopian
Patch of leprosy in 43 yrs EthiopianPatch of leprosy in 43 yrs Ethiopian
TelangectasiaTelangectasia
2-Papule2-Papule ‘‘Papula’: ’pimple’Papula’: ’pimple’ Small solid elevation,Small solid elevation, Most of the its part is above the plane unlike nodule,Most of the its part is above the plane unlike nodule, <0.5cm in diameter,<0.5cm in diameter, Epidermal, dermal or combined changes.Epidermal, dermal or combined changes.
DPN in 48 yrs old Ethiopian DPN in 48 yrs old Ethiopian
Papules of SMx in 25yrs EthiopianPapules of SMx in 25yrs Ethiopian
Papules of mastocytosis in 1 yr EthiopianPapules of mastocytosis in 1 yr Ethiopian
Same…Same…
3-Nodule3-Nodule ‘‘Nodulus’: ‘small knot’Nodulus’: ‘small knot’ Palpable, solid, round lesion (big papule).Palpable, solid, round lesion (big papule). Felt > seen.Felt > seen. According to anatomy:According to anatomy: -Epidermal….V. vulgaris,-Epidermal….V. vulgaris, -Epidermo-dermal: Melanoma,-Epidermo-dermal: Melanoma, -Dermal: dermato-fibroma,-Dermal: dermato-fibroma, -Dermal-SC: Granuloma annulare-Dermal-SC: Granuloma annulare -SC: lipoma.-SC: lipoma.Can have different consistancy: hard/soft.Can have different consistancy: hard/soft.Color and shape can also be different.Color and shape can also be different.
??
SC nodulesSC nodules
Keloid noduleKeloid nodule
Nodules of leprosy in 45 yrs EthiopianNodules of leprosy in 45 yrs Ethiopian
‘‘Vesicula’- ‘little bladder’Vesicula’- ‘little bladder’ ‘‘Bulla’- ‘bubble’Bulla’- ‘bubble’ Vesicle: small raised fluid filled lesion;<0.5cm in Vesicle: small raised fluid filled lesion;<0.5cm in
diameter.diameter. Bullae:> 0.5cm in diameter.Bullae:> 0.5cm in diameter. Cleavage at various levels of superficial skin.Cleavage at various levels of superficial skin.
Blister…Blister… Cleavage can be due to:Cleavage can be due to: -Intracellular edema--HS-Intracellular edema--HS -Intercellular edema--ACD-Intercellular edema--ACD -Achantholysis--P.vulgaris-Achantholysis--P.vulgaris According location of cleavage:According location of cleavage: -Subcorneal: Impetigo, Subcorneal pustulosis…-Subcorneal: Impetigo, Subcorneal pustulosis… -Intraepidermal: P.vulgaris -Intraepidermal: P.vulgaris -Subepidermal: B.pemphigoids-Subepidermal: B.pemphigoids -Dermal: Dystrophic epidermolysis bullosa.-Dermal: Dystrophic epidermolysis bullosa.
Blister….Blister….
According to contentAccording to content:: -Fluid: p.vulgaris-Fluid: p.vulgaris
-Pus: impetigo-Pus: impetigo
-Blood: B.pemphigoids-Blood: B.pemphigoids
Photo toxic blistersPhoto toxic blisters
HZHZ
HZ in 32 yrs Ethiopian pt with HIVHZ in 32 yrs Ethiopian pt with HIV
HSHS
HZHZ
5-Pustule5-Pustule
Small pus containing swelling.Small pus containing swelling. Usually ass. with infection—from papules or vesiclesUsually ass. with infection—from papules or vesicles But they may develop by their own—acne, non But they may develop by their own—acne, non
pyogenic bacteriapyogenic bacteria Can be sterile---pustular psoriasis.Can be sterile---pustular psoriasis.
Pustules & plaques in 33 yrs EthiopianPustules & plaques in 33 yrs Ethiopian
Palmoplantar pustulosis in Ethiopian pt.Palmoplantar pustulosis in Ethiopian pt.
6-Wheal6-Wheal
Also called urticaria,Also called urticaria, Round or flat topped red, purple papule/plaque that Round or flat topped red, purple papule/plaque that
disappears in a day or twodisappears in a day or two Due to edema in the upper dermis.Due to edema in the upper dermis. If lower SC = AngioedemaIf lower SC = Angioedema
insect biteinsect bite
WhealWheal
7-Scale (squames)7-Scale (squames)
‘‘Squama’ – ‘sacle’Squama’ – ‘sacle’ Flakes of stratum corneumFlakes of stratum corneum Increased Rate of production of epidermal cells and the Increased Rate of production of epidermal cells and the
outermost desquamation layers of skinoutermost desquamation layers of skinscalescale
- Brown, dark red: blood.- Brown, dark red: blood.
HZ,crustHZ,crust
Impetigo,crustImpetigo,crust
Crusts in Ethiopian ptCrusts in Ethiopian pt
Crusts in Ethiopian ptCrusts in Ethiopian pt
Crusts in Ethiopian ptCrusts in Ethiopian pt
Crusts in Ethiopian ptCrusts in Ethiopian pt
10-Lichenification10-Lichenification
Grouped papules asso. with exaggeration Grouped papules asso. with exaggeration of skin markings and thickening: LSC.of skin markings and thickening: LSC.
Lichenified eczemaLichenified eczema
11-Erosion, ulcer, wound11-Erosion, ulcer, wound Different types of tissue loses varying in their depth Different types of tissue loses varying in their depth
and breadthand breadth
11.1-Erosion:11.1-Erosion:
- Superficial loss of tissue- Superficial loss of tissue
- Confined to the epidermis- Confined to the epidermis
11.2-Ulcers11.2-Ulcers ‘‘Ulcus’- ’sore’Ulcus’- ’sore’ Larger defect involving the dermis and SCLarger defect involving the dermis and SC Occurs in damaged skinOccurs in damaged skin Slow healer, always scarSlow healer, always scar
-3-3rdrd de.burn de.burn
-Decubitus ulcer-Decubitus ulcer
11.3-Wound11.3-Wound Traumatic defect in normal skinTraumatic defect in normal skin Heals rapidly, less scaringHeals rapidly, less scaring
-Injury-Injury
-Surgery-Surgery
Erosion.pemphigusErosion.pemphigus
ulcerulcer
Ethiopian pt with ulcerEthiopian pt with ulcer
Erosions in Ethiopian pt with SSSSErosions in Ethiopian pt with SSSS
Erosions, Crusts & bullae in Ethiopian ptErosions, Crusts & bullae in Ethiopian pt
12-Excoriation, fissure12-Excoriation, fissure
12.1-Excoriation12.1-Excoriation Small superficial defect at epidermis, papillary dermis,Small superficial defect at epidermis, papillary dermis, Local trauma Local trauma scratching scratching itchy skin conditionsitchy skin conditions
12.2-Fissures12.2-Fissures Deep linear lesionsDeep linear lesions -T.ungum-T.ungum -Intertrigo-Intertrigo
ExcoriationsExcoriations
Ethiopian pt with PPEEthiopian pt with PPE
Ethiopian pt with PPEEthiopian pt with PPE
Ethiopian pt ?Ethiopian pt ?
14-Scar14-Scar
Happens when tissue defect is healed by fibrous tissue Happens when tissue defect is healed by fibrous tissue replacementreplacement
Can be : FlatCan be : Flatgood surgerygood surgery
DepressedDepressedacneacne
ElevatedElevatedhypertrophiedhypertrophied
keloid keloid
15-Atrophy15-Atrophy
Thinning of the skin.. Epidermis, dermis or both Thinning of the skin.. Epidermis, dermis or both Epidermal: Thinning of epidermisEpidermal: Thinning of epidermis Transparent—visible vesselsTransparent—visible vessels Loss of skin textureLoss of skin texture Dermal: loss of CTDermal: loss of CT :Depression :Depression
Atrophy,steroidAtrophy,steroid
II-DistributionII-Distribution
Area of predilectionArea of predilection
Can be :Can be : LocalizedLocalized Widespread/disseminated :Chicken poxWidespread/disseminated :Chicken pox Diffuse—involving wider area with no intervening Diffuse—involving wider area with no intervening
normal skin: erysipelas normal skin: erysipelas
III-ArrangementIII-Arrangement
Solitary Vs multipleSolitary Vs multiple Multiple ones : grouped Vs random arrangementMultiple ones : grouped Vs random arrangement Grouped: HS, DH…Grouped: HS, DH… Linear: epidermal nevusLinear: epidermal nevus Segmental….HZSegmental….HZ Follow skin folds……P.roseaFollow skin folds……P.rosea
Grouped lesions.HSGrouped lesions.HS
Epidermal naevus,linearEpidermal naevus,linear
Linear arrangement,HZLinear arrangement,HZ
IV-SizeIV-Size
Exact measurement of the lesions on Exact measurement of the lesions on cm or mmcm or mm
Two perpendicular diameters –one Two perpendicular diameters –one representing the max. lesion sizerepresenting the max. lesion size
V-MarginsV-Margins
Border of the lesionBorder of the lesion Sharp Vs indistinctSharp Vs indistinct Active/scaly----fungal infn.Active/scaly----fungal infn.
Raised margins, granuloma a.Raised margins, granuloma a.
DiascopyDiascopy -Glass spatula-Glass spatula -Lab. Slides-Lab. Slides Erythma Vs purpuraErythma Vs purpura
Instrumental…Instrumental… Wood’s lampWood’s lamp -Uses black light-Uses black light -Hair, skin diseases-dermatophytes of the hair shaft-Hair, skin diseases-dermatophytes of the hair shaftP.versicolour, Erythrasma…P.versicolour, Erythrasma… -Urine exam for porphyria-Urine exam for porphyria UltrasoundUltrasound -Penetrate 2-3mm-Penetrate 2-3mm -Ass. skin thickness—sceleroderma-Ass. skin thickness—sceleroderma -Ass of effect of steroids on the skin-Ass of effect of steroids on the skin -Flow of blood-Flow of blood PhotographyPhotography
MicroscopyMicroscopy
KOH:KOH: different fungal infections different fungal infections Gram stainGram stain with culture and sensitivity with culture and sensitivity Dark field:Dark field: T.pallidum detection. T.pallidum detection. Tzank preparation:Tzank preparation: HS,HZ HS,HZ
Routine histologyRoutine histology Immunoflorescent microscopyImmunoflorescent microscopy ImmunohistochemistoryImmunohistochemistory Electron microscopeElectron microscope
SerologySerology
Used for evaluation of infectious and Used for evaluation of infectious and autoimmune diseasesautoimmune diseases
BiopsyBiopsy Doubt about diagnosis-biopsy should be doneDoubt about diagnosis-biopsy should be done The slightest doubt that a lesion could be a malignancy The slightest doubt that a lesion could be a malignancy
is an indication for biopsyis an indication for biopsy Area: fresh lesion,where healing is goodArea: fresh lesion,where healing is goodTechniquesTechniques Simple excision (excisional biopsy)Simple excision (excisional biopsy) .for simple lesions.for simple lesions Punch biopsyPunch biopsy Shave,tangential biopsyShave,tangential biopsy CurretageCurretage ElectrosurgeryElectrosurgery