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Lesions of skin

This document describes and classifies various types of skin lesions. It discusses primary lesions including macules, papules, plaques, nodules, wheals, vesicles, bullae, pustules and cysts. It also covers secondary lesions such as crusts, scales, erosions, ulcers, fissures and scars which result from changes to primary lesions. Tertiary lesions involve further modifications of primary or secondary lesions over time. Each lesion is defined and examples are provided.

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Lesions Of Skin Dr.Gurjot Singh Marwah JUNIOR RESIDENT (Dept. of Dermatology) M.G.M Hospital, Aurangabad
Types Of Lesions Primary Lesions Secondary Lesions Tertiary Lesions
Primary Lesions Definition : lesion occurring on non pathological skin which have not been altered by trauma, manipulation (scratching, scrubbing), or natural regression over time.
Examples • Macule • Papule • Patch ??? • Plaque • Nodule • Wheal • Vesicle • Bulla • Pustule • Cyst
Macule • Definition : Flat, circumscribed skin discoloration that lacks surface elevation or depression, less than 1 cm in diameter*
• TYPES 1)Hypopigmented : due to decrease in number of melanocytes or the amount of pigment they produce E.g. : tuberous sclerosis , nevus achromicus , etc nevus achromicus
2)Depigmented : due to complete loss of melanocytes E.g.: vitiligo , halonaevus 3)Hyperpigmented : due to excess of melanin in skin A)brown or black : due to excess of melanin in epidermis E.g.: freckles or chloasma
B)Bluish-grey : due to increase melanin in dermis ( tyndall effect ) E.g : Mongolian spot, nevus of Ota
C)Erythema: increased blood flow through the skin causing capillary dilatation E.g : macular viral and drug rash D)Purpura/Ecchymosis: extravasation of RBCs in Dermis (large purpura : ecchymosis) E.g : thrombocytic purpura Schamberg’s purpura
Papule Solid , well circumscribed elevated lesion, less than one cm in diameter Formed by 1)hyperplasia of epidermis , dermis or both E.g : verruca vulgaris 2)Metabolic deposits or cellular infiltrates E.g : xanthelasma
SHAPE COLOUR
Shape • Pointed : Follicular Lichen planus • Papulosquamous : Guttate Psoriasis • Dome : Molluscum contagiosum • Flat topped : lichen plannus
Colour • Red : Psoriasis • Pearly white : molluscum contagiosum • Violaceous : Lichen planus • Coppery : seccondary syphilis • Yellowish : Xanthelasma • Blue/Black : Mallignant Melanoma • Purpuric : henoch-schönlein purpura
Plaque •Elevated well circumscribed more than 1 cm in diameter ,occupying relatively large surface area in comparison with its height above the skin surface
Types Scaly Plaque : Psoriasis , P.Rosea • Lichenified plaque : Lichen Simplex Chronicus • Erythematous plaque : Tuberculoid leprosy
Patch • Patch / Large macule ???
Nodule • Palpable solid round lesion ,usually larger than 1cm in diameter .occupying relatively larger vertical diameter as compared to suface diameter. • PAPULE NODULE • SEEN BETTER FELT BETTER
• E.g : erythema nodosum,Lipoma,Sebaceous cyst kerato acanthoma,xanthelasma,
Wheals • Evanescent , edematous , platue-like elevations of various sizes • Usually oval or arcuate , pink to red , surrounded by a flare of macular erythema • Caused by transient vascular reaction in the upper dermis mainly due to vasodilatation and increased permeability of capillaries • It is the characteristic lesion of urticaria
Wheals
Vesicle AND Bullae • Elevated ,superficial well circumscribed lesion containing clear fluid , less than 0.5 cm in diameter • A vesicle larger than 0.5 cm is known as Bullae • They can arise by separation of skin at different levels i.e a) interepidermal eg bullous impetigo b) supra basal e.g Pemphigus vulgaris c) dermoepidermal eg erythema multiforme
• Lesions may be • A) tense : Pompholyx • Flaccid : Pemphigus Vulgaris • Umblicated : varicella zoster
Pustule • Well-circumscribed, elevated lesion containing visible purulent exudate • Pustules are characteristic of pustular psoriasis, pyoderma, rosacea
Cyst • A sac that contains liquid or semisolid material in a well-defined cavity • 2 most common type- • A) Epidermal cyst: lined with squamous epithelium and produce keratinous material • B) pilar cyst: originate from hair follicle lined with multilayered epithelium
Abscess • An abscess is a collection of pus below the skin • Pus in an abscess is invisible but clinically be interpreted as sign of inflammation in the overlying skin • • Abscess cavities do not have well-defined lining as cyst
Secondary lesions: modification of primary skin lesions that result from traumatic injury , evolution from primary lesion , or other external factors • Crust • Scale • Erosion • Ulcer • Fissure • Scar • Atrophy • Telangiectasia
Crust • A collection of cellular debris ,dried serum,pus or blood and sometimes bacterial debries • antecedent primary lesion is usually a vesicle,bulla or pustule
Types • Golden yellow,soft friable : Impetigo • Yellowish : Flavus • Thick hard and tough : third degree burns • Lamillated,elevated, black or green : syphillus (oyster shell)
Erosion • Partial focal loss of the epidermis alone. Heals without a scar • Eg herpes zooster, TEN,Erosion interdigitale
Scale • Abnormal shedding or accumulation of the stratum corneum in visible flakes is called scaling • Formed due to - a) formation of epidermal cells is rapid OR b) process of normal keratinisation is interferred with
Types • Fine and delicate : P.versicolor • Coarse : eczema • Stratified : Psoriasis
Ulcer • A full-thickness, focal loss of epidermis along with parts of dermis ,heals with scarring • E.g : bed sores , Syphillus Diabetic foot
Fissure • Linear cleft in the skin through the epidermis and part of dermis may be single or multiple ranging from microscopic to a few millimeters having well defined margins They occur most commonly when skin is dry and thickened due to inflamation Pain is often produced by movement of part, Which opens or deepens the fissure Commonest sites a) tips and flexural creases of thumb , finger and palms b) edges of heel c)clefts between fingers and toess d) angle of mouth,the lips,nares auricles and anus
Scar • A collection of new connective tissue, that replaces lost substances in the demis or deep dermal tissues • They may be atrophic or hypertrophic • Hypertrophic scars / Keloid develop when fibrous components predominate
Excoriation And Abrasion Punctate or linear abrasion produced by mechanical means Usually involving only the epidermis Caused by scratching with fingernails in a variety of disease E.g : atopic dermatitis , Scabies If the damage is due to constant friction or mechanical trauma the word Abrasion may be used
Atrophy Reduction in the components of a tissue,Organ or part of body In skin 1) Epidermal Atrophy results from decrease in epidermal cells .Gives rise to frequently transparent epidermis and alteration of skin surface i.e(loss of normal skin lines and fine wrinkling 2) Dermal Atrophy results from decrease in the reticular or papillary dermis .Clinically seen as depression of skin
• Usually dermal and epidermal atrophy seen together E.g : D.L.E,Lichen sclerosus et atrophicus 3)Atrophy of paniculus caused due to lipoatrophy. Clinically seen as deep depression
Lichenification • Focal area of thickened skin produced by chronic scratching or rubbing • Clinically triad of accentuation of skin markings ,thickening of epidermis and Hyperpigmentation • Eg : lichen Simplex Chronicus usually seen superimposed on pruritic conditions
Telangiectasia • Small, dilated ,superficial blood vessels that disappear with pressure • E.g : Scleroderma , Rosacea
Special Lesions • Lesions that are pathognomic to certain skin conditions
COMEDO:Non inflamatory lesions of acne resulting from impaction of pilosebaceous gland • OPEN COMEDO • Impaction occurs in dilated follicular orifice • Visible as black keratinous mass i.e. blackhead • Closed Comedo • Impaction occurs lower down in follicular orifice • They are not dilated • Lesions appear slightly lighter than skin colour i.e. whitehead
Target lesions • Pathognomic to erythema multiforme Three zones1) central, dark sometimes blistered 2)surrounded by,pale edematous zone 3)rimmed by, zone of erythema
Milia • Milia are small superficial cyst with an epidermal lining • Commonly seen in neonates • Especially in periorbital areas
Burrow Serpinginous tunnel in the skin made by scabies mite. About 5mm in length Scabies
Lesions of skin