skin lesions

PRESENTED BY:- DR. AAKANKSHA SINGH.

When describing a skin lesion,it is important to note the following features:-

1)size2)type3)shape and symmetry4)colour and pigmentation5)surface area6)Distribution over the body surface

Types of lesion Basic skin lesions are broadly categorized as :

1. Primary2. Secondary3. special

Primary lesions :- Basic reaction patterns of skin with a definite morphology.

Secondary lesion :- Develop during the evolutionary process of skin disease or are created by scratching or infection.

special skin lesion :- Specific for certain disease.

Primary Skin LesionsMaculePatchPapuleplaquenoduleVesicleBullaPustuleAbscessWhealCyst

MaculeA flat circumscribed

lesion showing change in color without change in its consistency. Macules are non- palpable.

They are 0.5cm-1cm in size.

Discoloration may be brown, blue ,red and hypopigmented or hyperpigmented

Brown coloured maculesBeckers neveus Freckle

Fixed drug eruption

Cafe-au-lait spot

Blue coloured maculesMongolian spot Blue naevus

ink(tattoo)

Drug eruptions Secondary syphilis

Red coloured macules

HypopigmentedTinea versicolor

PATCHA large macule is

called patch (>1cm in size).

May have scaling.Eg :- Vitiligo,

melasma, pityriasis alba

PapuleA small, solid lesion,

<0.5 cm in diameter, raised above the surface of surrounding skin & hence palpable.

Papules may be of various colors.

Flesh colored,yellow or white colored papulesMolluscum contagiosum

Skin tags

Brown colored papules

Melanoma Dermatofibroma

Red colored papuleAcne

folliculits

Insect bite

Blue colored papulesBlue nevus Lichen planus

violaceous papules)

PlaqueIt is an indurated

area of skin larger than 0.5 cm in diameter which may be raised or depressed from skin surface.

Examples of plaquePsoriasis Lichen planus

Tinea corporis

Other examples of plaquePityriasis roseaSeborrheic dermatitisTinea pedisEczema

NoduleA large ( 0.5 – 5.0 cm ), firm lesion raised

above the surface of surrounding skin.It is the depth of involvement that

differentiates a nodule from a large papule.Could be warm, soft,fluctuant,movable,fixed

or painful.Surface-smooth,keratotic,ulcerated or

fungating.

Examples of noduleBasal cell carcinoma

Hemangioma

Prurigo nodularis neurofibromatosis

Other examples of nodule

XanthomaKeratoacanthomaMelanoma

VesicleA small, fluid filled

lesion, <0.5 cm in diameter, raised above the plane of surrounding skin. Fluid is often visible and the lesions are translucent

Examples of vesicleChicken pox Herpes zoster

Other examples of vesicleImpetigoInsect biteHerpes simplexDermatitis herpetiformis

bullaA fluid filled, raised,

often a translucent lesion >0.5cm in diameter

Examples of bullaBullous pemphigoid Fixed drug reaction

PustuleA vesicle filled with

pusIt is formed due to

collection of inflammatory exudate rich in leucocytes.

It may contain bacteria or may be sterile.

Acne Pustular psoriasis

Folliculitis Scabies

AbscessA localized

collection of pus deep in dermis or subcutaneous tissue

Due to deep seated location pus may not be visible on skin surface but would show sign of inflammation.

WhealIt is a transient

swelling of skin disappearing within 24 hrs.

It is formed due to sudden extravasation of fluid in the dermis.

Eg: urticaria

Examples of whealUrticaria dermographism

CystIt is a spherical or

oval sac or an encapsulated cavity containing fluid or semi solid material.

It is lined with true epithelium.

Eg:- mucous retention cyst

Secondary Skin LesionsScale CrustErosionFissureSinusScarAtrophyLichenification

ScaleExcess dead

epidermal cells that are produced by abnormal keratinization and shedding

Eg: Psoriasis, Icthyosis

Types of scalesFine to stratified

•Erythema craquele(dense scale)

•Psoriasis(silvery scale)

Ichthyosis vulgaris

Tinea versicolor(fine)

Scaling in sheets(desquamation)

Scarlet fever(hands and feet)

Staphylococcal scalded skin syndrome

Kawasaki syndrome

Other types of scalesCrack like - eczema

craquele.Exfoliative- drug rxn.Follicular- keratosis

pilaris.Gritty- actinic keratosis.Ichthyosiform-

ichthyosis vulgaris.Keratotic/

hyperkeratotic- cutaneous horn.

Cont…Lamellar- lamellar

ichthyosis.Pityriasiform-

pityriasis rosea.Psoriasiform -

psoriasis vulgaris.Seborrheic-

seborrheic dermatitis.Wickham striae-

lichen planus

CrustDried exudate of

body fluids (blood / serous fluid)

Which might be either yellow / red

Examples of crustingTinea capitis Impetigo

Erosion A focal loss of

epidermisErosions do not

penetrate below the dermoepidermal junction and therefore heal without scarring

Eg:- tinea pedis,candidiasis,eczema-tous disease, herpes simplex

Tinea pedis candidiasis

ulcerA focal loss of

epidermis and/or dermis

Scarring depends on the depth of the ulcer

Eg-chancroid,pyoderma gangrenosum,decubitus

chancroid

Pyoderma gangrenosum

decubitus

Radiodermatitis

Fissure It is a linear loss of

continuity of skin due to excessive tension.

Eg:- eczema(fingertips),intertrigo

Finger fissure d/t eczema

intertrigo

Scar It is replacement of

normal skin by fibrous tissue in the process of healing of damaged skin.

Scars are of two types- hypertrophic and atrophic.

Eg:- acne, burns, herpes zoster, keloid

Acne scar

scar of herpes zoster

Burn scar

Keloid:- area of overgrowth of fibrous tissue that usually develops after healing of skin injury &extends beyond the original defect

Atrophy • It is reduction in size

and number of skin cells.

• It may be limited to epidermis, dermis, or subcutaneous tissue.

• Eg:- leprosy, atrophoderma, lipoatrophy

Lichenification Repeated rubbing of

skin results in thickening and hyperpigmentation of skin

The skin markings become prominent.

Eg:- Lichen simplex chronicus, Atopic dermatitis.

BurrowComedoneMiliaTelengiectasiaPoikilodermaPurpurainfarct

BurrowIt is a serpentine

tunnel made by scabies mite in stratum corneum.

The open end of the tunnel has a papule.

ComedoneIt is a tiny plug

present at opening of hair follicle formed by keratin and sebum

It is of two types: Open comedone (black head) and Closed comedone (white head)

MiliumIt is a tiny

superficial cyst with epidermal lining. Milia are seen on face at periorbital region.

TelengiectasiaIt is visible dilataion

of capillaries of skin which blanch on pressure.

Eg:- Dermatomyositis, Systemic sclerosis.

PoikilodermaIt is a combination

of reticulate telengiectasia, pigmentary change and atrophy.

Eg:- Dermatomyositis,poikiloderma of civatte

PurpuraExtravasation of red

blood cells from cutaneous vessles in skin & mucous membrane.

Diascopy- non blanchable.

Infarct Area of cutaneous necrosis-

tender,irregularly shapedDusky red-grey macule or firm plaque

SHAPES OF PAPULES AND NODULESDome shaped-

Trichoepithelioma.Flat topped- verruca

plana.Umblicated- molluscum

contagiosum.Acuminate-

condylomata acuminataVerrucous-verruca

vulgaris.

Cont..Pedunculated- skin

tags.

CONFIGURATION OF LESIONSAnnular- T. corporis,

granuloma annulare.Round/ discoid-

nummular eczema, discoid lupus.

Polycyclic- urticaria, SCLE.

Arcuate- urticaria.

Cont…Linear- scabies

burrow, lichen nitidus. Kobners phenomenon.

Reticular- livedo reticularis.

Serpiginous- cutaneous larva migrans.

Targetoid lesions- with 3 distinct zones. Erythema multiforme.

Cont…Whorled-

incontinentia pigmenti.

ARRANGEMENT OF LESIONSGrouped/

herpetiform-HSV-1Scattered

DISTRIBUTION OF LESIONSDermatomal/

zosteriform.Blaschkoid-

following lines of skin cell migration during embryogenesis.

Longitudinal on limbsCircumferential on

trunk

Lymphangitic- strep. Or staph cellulitis.

Sun exposed-Photodermatitis,

PMLE, SCLESun protected-

parapsoriasis, mycosis fungoides.

Acral- chilblains,palmoplantar pustulosis.

TruncalExtensor-psoriasisFlexor-atopic dermatitisIntertriginous-

candidiasis.Localized- cellulitisGeneralized- exanthema,

drug eruptions.B/L symmetrical- vitiligoUniversal-alopecia

universalis.

THANK YOU