Med Surg 102 Primary and Secondary Skin Lesions Images

Pustule

raised, superficial, filled with purulent fluid, <1cm ex. acne

Petechiae

tiny, point-like, red purple, nonblanchable, 1-2mm diameter, associated with bleeding tendencies or emboli to skin

Crust

Dried serum, pus, or blood on the skin; slightly elevated; size and color vary ex. impetigo, herpes

Unstageable Pressure Ulcer

Full thickness tissue loss in which the base of the ulcer is completely covered by slough (yellow, tan, gray, green, or brown) and/or eschar (tan, brown, or black) in the wound bed. Until enough slough and/or eschar is removed to expose the base of the wound, the true depth and stage cannot be determined. However, it will be either a Stage III or IV. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as "the body's natural (biological) cover" and should not be removed.

Keloid, scar

Irregularly shaped, progressively enlarging, hypertrophied scar that grows beyond the boundaries of the wound ex. keloid after surgery

Ulcer

Loss of epidermis and dermis; concave shape ex. decubitis ulcer

Scale

Shedding of S.corneum leaves layers of keratinized cells; flaky skin, irregular borders, thick or thin, dry or oily ex. seborrheic dermatitis dandruff

Telangiectasia

fine, irregular red lines due to dilation of venules. When blanched refill erratically

Erosion

loss of epidermis; depressed, moist, glistening; caused by rupture of vesicle or bulla ex. ruptured vesicle

Vesicle

raised, circumscribed, superficial, filled with serous fluid, <0.5 cm ex. varicella

Cyst

raised, circumscribed, well-encapsulated in dermis or subcutaneous layer, filled with liquid or semi- solid material ex. sebaceous cyst, cystic acne

Nodule

raised, firm, 1-2 cm dia (Solid Elevated lesions) ex. erythema nodosum, squamous cell carcinoma

Papule

raised, firm, <0.5 cm diameter (Solid Elevated lesions), something you can feel, ex. warts

Tumor

raised, firm, >2cm dia. (Solid Elevated lesions) ex. neoplasm, carcinoma

Plaque

raised, firm, with a flat-topped rough surface, >0.5 cm diameter. Usually large surface area relative to height. (Solid Elevated lesions) ex. psoriasis

Wheal

raised, solid, transient, irregular-shaped area of cutaneous edema with variable diameter (Solid Elevated lesions) ex. hives, insect bites

Spider hemangioma

red central body with radiating spiderlike legs; arterial origin, blanchable. Caused by liver disease, vitamin B deficiency, or idiopathic.

Ecchymosis

red-purple non-blanchable lesion, >3mm patch, extravasation of blood into the tisue

Cicatrix

replacement of normal tissue with fibrous connective tissue following injury to the dermis ex. healed wound

Lichenification

thickening and roughening of epidermis secondary to rubbing itching or skin irritation ex. chronic dermatitis

Excoriation

trauma causes loss of epidermis; linear, hollowed out area

Atrophy

Thinning of the epidermis and loss of skin markings; skin may appear translucent and paper-like, ex: aged skin, arterial insufficiency

Patch

circumscribed, flat lesion >1cm diameter (Flat Lesion) ex. café au lait spot, vitiligo

Macule

circumscribed area of change, flat lesion <1cm diameter (Flat Lesion) ex. freckle

A of ABCDE Asymmetry - two halves not even

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B of ABCDE Border - irregular

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C of ABCDE Color - brown, blue, red, white, black

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D of ABCDE Diameter - >6mm

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E's of ABCDE Elevation/Enlargement

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Fissure

A linear crack from epidermis to the dermis ex. athletes foot (tinea pedis)

Stage 3 & 4 Pressure Ulcer Tunneling

A tunnel is a channel of tissue loss that can extend in any direction away from the wound through soft tissue and muscle. The tunnel or track may result in dead space which can delay wound healing. The depth of the tunnel can be measured using a gloved finger being careful to avoid injury.

Unstageable Pressure Ulcer Eschar

Full thickness tissue loss in which the base of the ulcer is completely covered by slough (yellow, tan, gray, green, or brown) and/or eschar (tan, brown, or black) in the wound bed. Until enough slough and/or eschar is removed to expose the base of the wound, the true depth and stage cannot be determined. However, it will be either a Stage III or IV. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as "the body's natural (biological) cover" and should not be removed.

Unstageable Pressure Ulcer Slough

Full thickness tissue loss in which the base of the ulcer is completely covered by slough (yellow, tan, gray, green, or brown) and/or eschar (tan, brown, or black) in the wound bed. Until enough slough and/or eschar is removed to expose the base of the wound, the true depth and stage cannot be determined. However, it will be either a Stage III or IV. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as "the body's natural (biological) cover" and should not be removed.

Stage 4 Pressure Ulcer

Full thickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present. These ulcers often include underminingSubmit and tunnelingSubmit. The depth of a Stage IV pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput, and malleolus do not have subcutaneous tissue and these ulcers can be shallow Stage IV ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon, or joint capsule) making osteomyelitis or osteitis likely to occur. Exposed bone/tendon is visible or directly palpable.

Stage 3 Pressure Ulcer

Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon, or muscle are not exposed. Some slough may be present. Stage III pressure ulcers may include undermining Submit and tunneling Submit. The depth of a Stage III pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput, and malleolus do not have subcutaneous tissue and Stage III ulcers can be shallow Areas of significant adiposity can develop extremely deep Stage III pressure ulcers Bone/tendon is not visible or directly palpable.

Stage 1 Pressure Ulcer

Intact skin with non-blanchable redness (erythema) of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. The area may be painful, firm, soft, warmer, or cooler as compared to adjacent tissue. Stage I pressure ulcers may be difficult to detect in individuals with dark skin tones. May indicate "at risk" persons.

Cherry Angioma

Papular and Round Red or Purple Noted on Trunk May blanch with pressure Normal age skin alteration

Stage 2 Pressure Ulcer

Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. Stage II pressure ulcers may also present as an intact or open/ruptured serum-filled or serosangineous-filled blister. Presents as a shiny or dry shallow ulcer without slough or bruising. This stage should not be used to describe skin tears, tape burns, incontinence- associated dermatitis, maceration, or excoriation.

Stage 3 & 4 Pressure Ulcer "undermining"

Undermining refers to tissue destruction underneath intact skin at the wound edge. Wound edges are not attached to the wound base. Rather, skin edges overhang the periphery of the wound. The pressure ulcer may be larger in area under the skin surface. The extent of undermining can be indicated by a line drawn on the skin.

hematoma

bruise that elevates the skin causing edema, warm to touch, caused by bleeding from small capillaries

Bulla

bulla >0.5 cm diameter, superficial ex. blister