morphologic skin lesions
TRANSCRIPT
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MORPHOLOGIC
SKIN LESIONS
DR TAHIR KAMAL
FCPS, D.Dsc (UK),
M.A.A.C.S (USA)
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MORPHOLOGIC SKIN LESIONS
1. Raised
2. Depressed
3. Flat
4. Surface change
5. Fluid filled
6. Vascular
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Morphologic lesions
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RAISED LESIONS
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PAPULE:
A papule is a solid , elevated lesion
less than 0.5 cm in size in which a signific-
ant portion projects above the plane of surrounding skin.
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Papules surmounted with scales
are called Papulo-squamous
lesions.
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Shapes & surfaces of papule:
Sessile, pedunculated, dome-shaped
Flat topped, rough , smooth , filiform,
mammilated, acuminate, umblicated .
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PAPULEPapules in lichen planus
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PLAQUE
A solid plateau-like elevation that
occupies a relatively large surface
area in comparison with its height
above the normal skin level and
has a diameter larger than 0.5 cm
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NODULE
A circumscribed, solid, round or
ellipsoidal palpable lesion larger
than 0.5 cm in size.
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Types of nodule:
Epidermal
Epidermal-dermal
Dermal
Dermal-subdermal
Subcutaneous
Others ( tumor, gumma )
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Surface of nodule may be:
Smooth
Keratotic
Ulcerated
fungating
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Nodule
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Nodular basal cell carcinoma
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CYST:
A cyst is an encapsulated cavity
or sac lined with a true epithelium
that contains fluid or semisolid
material ,cell & cell products such
as keratin.
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A cyst
Cystic hidradenoma
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WHEAL
A wheal is the swelling of skin
that is characteristically
evanescent , disappearing within
hours.
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A wheal
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SCAR
A scar arises from proliferation of
fibrous tissue that replaces previously normal collagen after a
wound or ulceration breaches the reticular dermis.
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Types of scars:
Hypertrophic scar
Keloid scar
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SCAR
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COMEDO
A comedo is a hair follicle infundibulum
that is plugged with keratin and lipids.
Types:
1-Open comedo
2-Closed comedo
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COMEDO
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DEPRESSED
LESIONS
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EROSION
An erosion is a moist , circumscribed ,
Depressed lesion that results from loss
of a portion or all of the viable epidermal
Or mucosal epithelium.
e.g. TEN
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EROSION
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ULCER
An ulcer is a defect in which the epidermis
and at least the upper (papillary) dermis
Has been removed.
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ULCER
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ATROPHY
Atrophy refers to diminution in size of a
Cell, tissue , organ , or part of the body.
- Epidermal atrophy
- Atrophy of panniculus
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ATROPHY
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POIKILODERMA
It refers to combination of atrophy ,
telangiectasias and various pigmentary
changes over skin.
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poikiloderma
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SINUS
A sinus is a tract connecting deep
Suppurative cavities to each other
Or to the surface of skin.
Contents :
pus , fluid, keratin etc.
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sinus
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STRIAE
Striae are linear depression of the skin that
usually measure several cm in length and
result from changes to reticular collagen
that occur with rapid stretching of the skin.
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striae
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BURROW
A burrow is a wavy , thread like tunnel
through the outer portion of epidermis
excavated by a parasite.
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BURROW
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SCLEROSIS
It refers to a circumscribed or diffuse
hardening or induration in the skin
that is a result of dermal fibrosis.
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SCLEROSIS
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FLAT AND
MACULAR
LESIONS
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MACULE
A macule is a flat lesion , even with the
surface level of surrounding skin, perceptible
as an area of colour different from the
surrounding skin or mucous membranes
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A macule may be:
Hyperpigmented
Hypopigmented
Depigmented
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MACULE
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PATCH
it is a flat area of the skin or mucous
membrane with a different colour from
its surroundings > 0.5 cm in size.
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Patch
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ERYTHEMA
Erythema is blanchable change in the
colour of the skin or mocous membranes
that is due to dilatation of arteries and
veins in the papillary and reticularis dermis.
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ERYTHRODERMA
it is generalised deep redness of the
skin Involving more than 90% of the
body surface within days to weeks .
Scaling and desquamation generally
follows.
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SURFACE
CHANGE
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SCALE
It is a flat plate or flake arising from the
outer most layer of the stratum corneum.
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Scale
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Types of scale :
Crack like
Exfoliative
Follicular
Gritty
Ichthyosiform
Keratotic
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Pityriasiform
Psoriasiform
Seborrheic
lamellar
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CRUST
Crusts are the hardened deposits that
result when serum, blood, or purulent
exudate dries on the surface of the skin.
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EXCORIATION :
Excoriations are surface exavations of
the epidermis that result from scratching
and are frequent findings in patients
experiencing pruritis .
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FISSURE :
A fissure is the linear loss of continuity of
the skin surface or mucosa that results from excessive tension or
decreased elasticity of involved area.
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LICHENIFICATION :
Repeated rubbing of skin may induce a
reactive thickening of epidermis with
changes in underlying collagen.
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Lichenification
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KERATODERMA
It is excessive hyperkeratosis of the stratum
corneum that results in yellowish thickening
of the skin.
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ESCHAR:
The presence of eschar implies tissue
necrosis, infarction , deep burns, gangrene
or other ulcerating process.
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eschar
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FLUID FILLED
LESIONS
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VESICLE AND BULLA:
A vesicle is a fluid filled cavity or elevation less than 0.5 cm.
Whereas a bulla measures larger than 0.5 cm.
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PUSTULE:
A circumscribed raised cavity in the epidermis or infundibulum
containing pus. The purulent exudate composed of leukocytes
with or without cellular debris , may contain bacteria or sterile.
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FURUNCLE:
It is a deep necrotizing folliculitis with
Suppuration.
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VACULAR
LESIONS
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PURPURA :
Extravasation of red blood from cutaneous vessels into skin or
mucous membrane results in reddish purple lesion.
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Petechie:Small , pinpoint pupuric macules.
Ecchymoses:Larger , bruise like pupuric patches.
Plapable purpura:If a lesion is pupuric and palpable.
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TELANGIECTASIA :
It is persistent dilatations of small
capillaries in the superficial dermis
that are visible as fine , bright, non_
pulsatile red lines or net like pattern
on skin.
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SHAPE
ARRANGEMENT,
AND DISTRIBUTION
OF LESION
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SHAPE OF SKIN LESION:
Annular
Round/nummular/discoid
Polycyclic
Arcuate
Linear
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Serpiginous
Targetoid
Whorled
Reticular
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Nummular
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ARRANGEMENT
Single
Grouped/ herpetiform
scattered
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Arrangement of lesionsa) (b) Grouped pigmented areas in a speckled lentiginous naevus. (c) Grouped vesicles in herpes simplex. (d) Grouped lesions within a mosaic plantar wart
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Distribution of multiple
lesions : Dermatomal/zosteriform
Blaschkold
Lymphangitic
Sun exposed
Sun protected
Truncal
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Intertiginous
Localized
Generalized
Bilateral/ symmetrical
Universal
Extensor
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Pointers &
Pitfalls in
Dermatologic
Diagnosis
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Approach each and every evaluation with patience and
thorough diagnosis.
Beware of snap, curbside, or doorway diagnosis.
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Examine the entire mucocutaneous surface as well as
hair and nails.
A new or changing mole should be carefully evaluated.
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Generalized pruritus of more than one month’s duration
mandates a complete systemic workup.
Drug induced eruptions can mimic most skin conditions.
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Beware of the atypical diagnosis. Atypical ‘’this’’ may be
‘’typical’’ that to someone
who has seen it before.
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THANK
YOU!