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Skin lesions

basic skin lesions BY Dr.Aakanksha Singh,Resident SKIN & VD

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Skin lesions

  2. 2. When describing a skin lesion,it is important to note the following features:- 1)size 2)type 3)shape and symmetry 4)colour and pigmentation 5)surface area 6)Distribution over the body surface
  3. 3. Types of lesion Basic skin lesions are broadly categorized as : 1. Primary 2. Secondary 3. special
  4. 4. 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.
  5. 5. Primary Skin Lesions Macule Patch Papule plaque nodule Vesicle Bulla Pustule Abscess Wheal Cyst
  6. 6. Macule A 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
  7. 7. Brown coloured macules Beckers neveus Freckle Fixed drug eruption Cafe-au-lait spot
  8. 8. Blue coloured macules Mongolian spot Blue naevus ink(tattoo)
  9. 9. Drug eruptions Secondary syphilis Red coloured macules
  10. 10. Hypopigmented Tinea versicolor
  11. 11. PATCH A large macule is called patch (>1cm in size). May have scaling. Eg :- Vitiligo, melasma, pityriasis alba
  12. 12. Papule A small, solid lesion, <0.5 cm in diameter, raised above the surface of surrounding skin & hence palpable. Papules may be of various colors.
  13. 13. Flesh colored,yellow or white colored papules Molluscum contagiosum Skin tags
  14. 14. Brown colored papules Melanoma Dermatofibroma
  15. 15. Red colored papule Acne folliculits Insect bite
  16. 16. Blue colored papules Blue nevus Lichen planus violaceous papules)
  17. 17. Plaque It is an indurated area of skin larger than 0.5 cm in diameter which may be raised or depressed from skin surface.
  18. 18. Examples of plaque Psoriasis Lichen planus Tinea corporis
  19. 19. Other examples of plaque Pityriasis rosea Seborrheic dermatitis Tinea pedis Eczema
  20. 20. Nodule A 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.
  21. 21. Examples of nodule Basal cell carcinoma Hemangioma Prurigo nodularis neurofibromatosis
  22. 22. Other examples of nodule Xanthoma Keratoacanthoma Melanoma
  23. 23. Vesicle A 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
  24. 24. Examples of vesicle Chicken pox Herpes zoster
  25. 25. Other examples of vesicle Impetigo Insect bite Herpes simplex Dermatitis herpetiformis
  26. 26. bulla A fluid filled, raised, often a translucent lesion >0.5cm in diameter
  27. 27. Examples of bulla Bullous pemphigoid Fixed drug reaction
  28. 28. Pustule A vesicle filled with pus It is formed due to collection of inflammatory exudate rich in leucocytes. It may contain bacteria or may be sterile.
  29. 29. Acne Pustular psoriasis Folliculitis Scabies
  30. 30. Abscess A 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.
  31. 31. Wheal It is a transient swelling of skin disappearing within 24 hrs. It is formed due to sudden extravasation of fluid in the dermis. Eg: urticaria
  32. 32. Examples of wheal Urticaria dermographism
  33. 33. Cyst It 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
  34. 34. Secondary Skin Lesions Scale Crust Erosion Fissure Sinus Scar Atrophy Lichenification
  35. 35. Scale Excess dead epidermal cells that are produced by abnormal keratinization and shedding Eg: Psoriasis, Icthyosis
  36. 36. Types of scales Fine to stratified •Erythema craquele(dense scale) •Psoriasis(silvery scale)
  37. 37. Ichthyosis vulgaris
  38. 38. Tinea versicolor(fine)
  39. 39. Scaling in sheets(desquamation) Scarlet fever(hands and feet)
  40. 40. Staphylococcal scalded skin syndrome Kawasaki syndrome
  41. 41. Other types of scales Crack like - eczema craquele. Exfoliative- drug rxn. Follicular- keratosis pilaris. Gritty- actinic keratosis. Ichthyosiform- ichthyosis vulgaris. Keratotic/ hyperkeratotic- cutaneous horn.
  42. 42. Cont… Lamellar- lamellar ichthyosis. Pityriasiform- pityriasis rosea. Psoriasiform -psoriasis vulgaris. Seborrheic- seborrheic dermatitis. Wickham striae- lichen planus
  43. 43. Crust Dried exudate of body fluids (blood / serous fluid) Which might be either yellow / red
  44. 44. Examples of crusting Tinea capitis Impetigo
  45. 45. Erosion A focal loss of epidermis Erosions do not penetrate below the dermoepidermal junction and therefore heal without scarring Eg:- tinea pedis,candidiasis,eczem a-tous disease, herpes simplex Tinea pedis candidiasis
  46. 46. ulcer A focal loss of epidermis and/or dermis Scarring depends on the depth of the ulcer Eg- chancroid,pyoderma gangrenosum,decubitus
  47. 47. chancroid
  48. 48. Pyoderma gangrenosum decubitus
  49. 49. Radiodermatitis
  50. 50. Fissure It is a linear loss of continuity of skin due to excessive tension. Eg:- eczema(fingertips),intertrigo
  51. 51. Finger fissure d/t eczema intertrigo
  52. 52. 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
  53. 53. scar of herpes zoster Burn scar
  54. 54. Keloid:- area of overgrowth of fibrous tissue that usually develops after healing of skin injury &extends beyond the original defect
  55. 55. 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
  56. 56. Lichenification Repeated rubbing of skin results in thickening and hyperpigmentation of skin The skin markings become prominent. Eg:- Lichen simplex chronicus, Atopic dermatitis.
  57. 57. Burrow Comedone Milia Telengiectasia Poikiloderma Purpura infarct
  58. 58. Burrow It is a serpentine tunnel made by scabies mite in stratum corneum. The open end of the tunnel has a papule.
  59. 59. Comedone It 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)
  60. 60. Milium It is a tiny superficial cyst with epidermal lining. Milia are seen on face at periorbital region.
  61. 61. Telengiectasia It is visible dilataion of capillaries of skin which blanch on pressure. Eg:- Dermatomyositis, Systemic sclerosis.
  62. 62. Poikiloderma It is a combination of reticulate telengiectasia, pigmentary change and atrophy. Eg:- Dermatomyositis,poikilo derma of civatte
  63. 63. Purpura Extravasation of red blood cells from cutaneous vessles in skin & mucous membrane. Diascopy- non blanchable.
  64. 64. Infarct Area of cutaneous necrosis- tender,irregularly shaped Dusky red-grey macule or firm plaque
  65. 65. SHAPES OF PAPULES AND NODULES Dome shaped- Trichoepithelioma. Flat topped- verruca plana. Umblicated- molluscum contagiosum. Acuminate- condylomata acuminata Verrucous-verruca vulgaris.
  66. 66. Cont.. Pedunculated- skin tags.
  67. 67. CONFIGURATION OF LESIONS Annular- T. corporis, granuloma annulare. Round/ discoid- nummular eczema, discoid lupus. Polycyclic- urticaria, SCLE. Arcuate- urticaria.
  68. 68. Cont… Linear- scabies burrow, lichen nitidus. Kobners phenomenon. Reticular- livedo reticularis. Serpiginous- cutaneous larva migrans. Targetoid lesions- with 3 distinct zones. Erythema multiforme.
  69. 69. Cont… Whorled- incontinentia pigmenti.
  70. 70. ARRANGEMENT OF LESIONS Grouped/ herpetiform- HSV-1 Scattered
  71. 71. DISTRIBUTION OF LESIONS Dermatomal/ zosteriform. Blaschkoid- following lines of skin cell migration during embryogenesis. Longitudinal on limbs Circumferential on trunk
  72. 72. Lymphangitic- strep. Or staph cellulitis. Sun exposed- Photodermatitis, PMLE, SCLE Sun protected- parapsoriasis, mycosis fungoides. Acral- chilblains,palmoplantar pustulosis.
  73. 73. Truncal Extensor-psoriasis Flexor-atopic dermatitis Intertriginous- candidiasis. Localized- cellulitis Generalized- exanthema, drug eruptions. B/L symmetrical- vitiligo Universal-alopecia universalis.
  74. 74. THANK YOU