P2b - Skin lesions

Arrangement of lesions - generalized

Covering most of the body surface

Erythema - differentiation

Definition: is redness of the skin or mucous membranes, caused by hyperemia (increased blood flow) in superficial capillaries Erythema​ is defined as redness that blanches on pressure, and indicates dilated capillaries. It should be distinguished from: Purpura​ which is red, purple, orange or brown, and does not fade on pressre; and Teleangicctasia​ which describes small dilated blood vessels visible to the naked eye.

Atrophy

Depression of the surface due to thinning of the epidermis of dermis. Blood vessels are easily seen under the skin. and there is often fine surface wrinkling.

Crust

Dried serum, pus or blood. Clinically a crust may be confused with keratin but there should be a history of weeping, pus or bleeding. An attempt should be made to remove the crust to determine whether an ulcer or erosion is underneath

Fissure

Linear split in the epidermis or dermis at - an orifice (angle of mouth or anus) - over a joint - along a skin crease due to abnormal keratin.

Excoriation

Localized damage to the skin due to scratching and consists of linear or pinpoint erosions or crusts. "scratch mark"

Lichenification

Prolonged, intense scratching eventually thickens the skin and produces tightly packed sets of papules; looks like surface of moss (or lichen) Thickening of the epidermis with increased skin marking due to persistent scratching - found in atopic eczema or lichen simplex

Molluscum contagiosum

STD caused by a virus wart-like growths that look like small pimples filled with kernels of corn

Exudate

Serum, blood or pus that has accumulated on the surface either from an erosion or ruptured blister/pustule

Arrangement of lesions - Serpiginous

Snake like

Eschar

So, eschar is circumscribed, adherent, hard, black crust on the surface on the skin. The presence of an eschar implies tissue necrosis, infarction, deep burns, gangrene, or other ulceration process.

Normal surface

Stratum corneum and epidermis normal; change in elevation and/or colour only.

Warty/papillomatous

Surface consisting of minute finger-like or round projections.

Irisform lesions

erythema multiforme a skin condition of unknown cause; it is a type of erythema possibly mediated by deposition of immune complexes (mostly IgM-bound complexes) in the superficial microvasculature of the skin and oral mucous membrane that usually follows an infection or drug exposure. Appearance: Erythema multiforme minor—

Ulcers

full thickness loss of the epidermis and some dermis, which will heal with scarring. There will be surface exudate (serum, pus) or crusts Should then be removed

Scar

healed dermal lesion secondary to - trauma, - surgery, - infection - lack of blood supply

Poikiloderma

irregular, mottled condition of the skin refers to the combination of atrophy, telangiectasia, and varied pigmented changes (hyper and hypo) over an area of the skin (f.e. chronic radio dermatitis - pic)

herpes zoster

is a viral disease characterized by a painful skin rash with blisters in a localized area.[2][6] Typically the rash occurs in a single, wide stripe either on the left or right side of the body or face

Dematomal/zosteriform distribution

is characteristic by the unilateral lesions lying in the distribution of a single spinal afferent nerve root, the classic example is herpes zoster

Pink - red - purple

is due to blood Within dilated blood vessels: blanches on pressure = ​erythema​. Outside blood vessels: does not blanche on pressure = ​purpura​. Colour changes from red to purple, to orange brown to brown as haemoglobin is changed to haemosiderin.

Purpura

is extravasation of red blood from cutaneous vessels into skin or mucous membranes results in reddish purple lesions divided into Petechiae - small pinpoint purpuric macules Ecchymoses - larger, bruise - like purpuric patches

Polycystic

is formed by coalescing circles, rings, or incomplete rings Example: Urticaria Subacute cutaneous LE

Erythroderma

is generalized deep redness of the skin involving more than 90% of the body surface within days to weeks

Keratoderma

is hyperkeratosis of the stratum corneum that results in a yellowish thickening of the skin, usually on the palms and soles

Eruption (or rash)

large, widespread skin involvement

Ecchymoses

larger blue or purplish patches on the skin (bruises)

Umbilicated

lesion with central depression Surface contains a round depression in the center, characteristic of molluscum contagiosum or herpes simplex.

Patch

more 1 cm Flat lesions due to localized colour change only - the surface is always normal

Arrangement of lesions - grouped

multiple lesions grouped in one area

Annular

or ring shaped signify that the edge of the lesion differs from the centre, either by being raised, scaly, or differing in colour Example: - Granuloma annulare - Tinea corporis

Nummular

or round, discoid, coin shaped - are usually round or oval lesions with uniform morphology from the edge to the centre Example: Nummular eczema Discoid Lupus

Comedone

plugged sebaceous follicle mass of sebum, keratin, and debris blocking the opening of a hair follicle

Wheal

raised red skin lesion due to interstitial fluid transient swelling due to dermal oedema which should last less than 24 hours at any side

Arrangement of lesions- Unilateral

restricted to one side only (herpes zoster - some birthmarkes)

Lesion

small area of disease

Petechiae

small, pinpoint hemorrhages

Surface features

smooth​, no irregularity felt; • uneven​, found with fine scaling or some warty lesions; • rough​, should feel like sandpaper, and is characteristic of keratin/horn or crust.

Friable

surface bleeds easily after minor trauma.

Burrow

threadlike tunnel through the outer portion of the epidermis excavated by a parasite. Burrows measure only a few mm in length - found along the sides of fingers or on front of the wrist in patients with scabies.

Yellow

usually due to lipids in skin

Arrangement of lesions - Disseminated

widespread discrete lesions

Colors of lesion

yellow brown white pink - red - purple

Brown lesions

due to melanin or haemosiderin following purpura.

Arrangement of lesions - discrete

(stakur) separated by normal skin from other similar lesions

Targetoid

, target like with at least three distinct zones (erythema multiforme)

White lesions

- due to loss of pigment - Partial or complete loss of pigment - can be distinguished by use of a Wood's light.

Sclerosis

- hardening or induration in the skin refers to circumscribed or diffuse hardening or induration in the skin that is a result of dermal fibrosis. It is detect more easily by palpation, on which the skin may feel board - like, immobile and difficult to pick up. Hyperpigmentation or hypopigmentation may also distinguish the area of induration from normal skin. The epidermis overlying sclerotic dermis may be atrophic. Sclerosis may extend deep into the pannus, fascia, muscle, or bone with resulting musculoskeletal deformity and loss of function. A clinical example is morphea.

Erosion

- partial loss of epidermis - which will heal without scarring Usually secondary to an intraepidermal blister which has burst, and with exudate on the surface.

Describing skin lesions - features to identify: (name 8)

1 sites involved and distribution; 2 erythematous or non-erythematous; 3 surface characteristics and palpation;4 types of lesion, including deep palpation; 5 colour; 6 borderofrash/lesionsandshape; 7arrangementoflesions; 8 specialsites,e.g.scalp,nails,mouthandgenitalia.

Pustule

< 1 cm A pus - filled lesion if in doubt prick lesion and pus comes out). Larger lesions are either abscesses or pseudocysts.

Macule

< 1 cm Flat lesions due to localized colour change only - the surface is always normal

Vesicle

< 1 cm Fluid - filled lesions (blisters)

Papule

< 1 cm Lesions that are - raised above the surface - or have scaly , crusted, keratinized or macerated surface Macerated: sem er bleyttur upp

Plaque

> 1 cm A raised flat- topped lesion where the diameter is more than thickness with scale, crust, keratin or maceration on the surface.

Bulla

> 1 cm Fluid - filled lesions (blisters)

Scaly surface

Abnormal stratum comeum due to accumulation of, or increased shedding of keratinocytes.

Keratin/horn

An accumulation of abnormal keratin which is usually rough on palpation and difficult to pick off. It is seen on solar keratoses, chronic eczema on the palms and soles, warts and coms.

Nodule

Any elevated lesion ( > I cm diameter) which has a rounded surface (i.eg.the thickness is similar to the​ diameter): often due to dermal pathology.

Arrangement of lesions - linear

Arranged in line

Cyst

Cavity lined with epithelium containing fluid, pus or keratin.

Granuloma annulare

Has a annular border is a fairly rare, chronic skin condition which presents as reddish bumps on the skin arranged in a circle or ring with central mucin

symmetrical lesion

Involving both sides of body to similar extent; usually due to endogenous causes (e.g. eczema, psoriasis, acne)

Sun exposed lesion - location

Involving face, „V" and back of neck, dorsum of hands (forearms). Note behind ears and under chin/eyebrows spared

Asymmetrical lesion

Involving predominantly one side only; usually due to external causes (e.g. bacterial or fungal infections, allergic contact eczema

Secondary lesions

These have developed from primary lesions Partial loss of epidermis - Erosion - Ulcers - Fissure - Atrophy

Urticaria

allergic reaction of the skin characterized by the eruption of pale red, elevated patches called wheals or hives Has a polycystic shape

tinea corporis

also known as ringworm, is a superficial fungal infection (dermatophytosis) of the arms and legs

Arcuate shape

arc- shaped is often a result of incomplete formation of an annular lesion Example: Urticaria Subacute cutaneous LE

Telangiectasia

are small dilated blood vessels[1] that can occur near the surface of the skin or mucous membranes, measuring between 0.5 and 1 millimeter in diameter.[2] These dilated blood vessels can develop anywhere on the body but are commonly seen on the face around the nose, cheeks and chin.

Arrangement of lesions -Annular

arranged in a ring