** only titles in BOLD Underline were mentioned by the doctorThe Primary Lesions Primary lesions are physical changes in the skin considered to be caused directly by the disease process. Types of primary lesions are rarely specific to a single disease entity. 1. MACULE A macule is a change in the color of the skin (hypo or hyper). It is flat, if you were to close your eyes and run your fingers over the surface of a purely macular lesion, you could not detect it. A macule greater than 0.5 cm. may be referred to as a patch. 2. PAPULE A papule is a solid raised lesion that has distinct borders and is less than 1 cm in diameter. Papules may have a variety of shapes in profile (domed, flat-topped, umbilicated) and may be associated with secondary features such as crusts or scales. e.g acne vulgaris papules 3. NODULE A nodule is a raised solid lesion more than 1 cm. Deeply seeded may be in the epidermis, dermis, or subcutaneous tissue. e.g leprosy nodules, nodular acne 4. PLAQUE A plaque is a solid, raised, flat or rough lesion greater than 1 cm. in diameter with defined edges. 5. VESICLE Vesicles are small raised lesions (blisters) less than 0.5 cm. in diameter that are filled with clear fluid. 1 PUSTULE Pustules are small circumscribed elevated lesions that contain pus. TELANGIECTASIA 2 .. with infestation by the scabitic mite or by cutaneous larva migrans). it is larger than a nodule. BULLAE Bullae are large circumscribed fluid-filled lesions (blisters) that are greater than 1 cm. 12. WHEAL TRANSIENT solid swelling resembling an orange skin e. (Please bear in mind this definition does not at all mean that the lesion is a neoplasm. BURROW Burrows are linear lesions produced by infestation of the skin and formation of tunnels (e. TUMOR A tumor is a solid mass of the skin or subcutaneous tissue.e.g.g cellulitis.g acne pustule 8. dermaitis 6. e.g urticaria 9.) 11.g herpes simplex. 7. They may develop spontaneously or from a papule. in diameter. ERYTHEMA An area of redness or duskiness e. drug reaction 10. They are most commonly infected (as in folliculitis) but may be sterile (as in pustular psoriasis). e. trauma.g eczema or dermatitis. or may be caused by external forces such as scratching. vesicle.g scabies.EXUDATE Fluid content of a broken papule.g Impetigo. 1. If we remove the crust we will find the erosion underneath e. The two terms refer to different phenomena and are not interchangeable. bulla or pustule. The distinction between a primary and secondary lesion is not always clear. dermatitis 2. eczema. One can usually be distinguished from the other by appearance alone. The Secondary Lesions Secondary lesions may evolve from primary lesions. Impetigo Crusting is the result of the drying of plasma or exudate on the skin. CRUST: Friable mass of a completely dried exudate. Please remember that crusting is different from scaling.Impetigo 3. infection.Telangiectasia are the permanent dilatation of superficial blood vessels in the skin and may occur as isolated phenomena or as part of a generalized disorder. such as ataxia telangiectasia. EXUDATE SCAB CRUST EROSION “result from removing the crust” 4. ULCER 3 . SCAB A mass of an incomplete dried exudate e. or the healing process. g scabies 6. Maybe flat or hypertrophic Scars may have secondary pigment characteristics 7. SCALE Heaped up stratum corneum cells fromed in many common skin diseases e.g ecthyma ** N. SCAR The end result of a healed ulcer The permanent fibrotic changes that occur on the skin following damage to the dermis.Deeper loss of skin and mucosa. CYST: subcutaneous lump containing fluid or semisolid material 9. extending below the dermo-epidermal junction. EXCORIATION (Scratch) Irregular mark on the skin resulting from epidermal loss caused by scratching 4 . (firm solid over growth of fibrous tissue) 8. KELOIDS Keloids are an exaggerated connective tissue response of injured skin that extend beyond the edges of the original wound.B an erosion will heal without scaring 5. (necrosis of the epidermis and dermis and sometimes of the underlying subcutaneous tissue) This heals with scarring e. HYPOPIGMENTATION 13. HYPERPIGMENTATION 15. 21. 5 . LICHENIFICATION "Lichenification" refers to a thickening of the epidermis seen with exaggeration of normal skin lines. "Purpura" and "ecchymoses" are terms that refer to larger lesions. and purpura do not blanch when pressed. and ecchymoses. EROSION Erosions are slightly depressed areas of skin in which part or all of the epidermis has been lost. 16. It is usually due to chronic rubbing or scratching of an area. angular stomatitis in vitamin B deficiency 11. If there is any question.g candidal intertrigo. infarcts or gangrene. In certain situations purpura may be palpable. ATROPHY Loss of substance of the skin showing palpable thinness 12. PETECHIAE. purpura. AND ECCHYMOSES Three terms that refer to bleeding that occurs in the skin are petechiae. Usually ACCENTUATE TO NORMAL SKIN LINES. Don't break the slide or cut the patient. PURPURA. 23. petechiae. ESCHAR An eschar is a hard. FISSURE (Crack) LINEAR or irregular breach in the skin muscosa. press on the lesions carefully with a glass slide. ecchymoses. e. In all situations. usually darkened. the term "petechiae" refers to smaller lesions. plaque covering an ulcer implying extensive tissue necrosis.10. Generally. 24. 26. DERMATOMAL.Patterns and Distribution Not only is the appearance of lesions important. ECZEMATOID Eczematoid lesions are inflamed with a tendency toward clustering. oozing. but the pattern and distribution on the skin is as well. ANNULAR Annular lesions are seen in a ring shape. zosteriform lesions follow a dermatome. CLUSTERED Clustered lesions are those that are grouped together. 27. 28. The lesions of varicella zoster (also known as shingles) are the classic example. This is a helpful descriptive term but has little specific diagnostic significance. or crusting. Tinea corporis. erythema migrans (the lesion associated with lyme disease). They are commonly seen in herpes simplex or with insect bites. DISCRETE Discrete lesions tend to remain separate. 6 . but there are other lesions which may assume the same pattern. 29. and granuloma annulare are three common examples. CONFLUENT Confluent lesions tend to run together. ZOSTERIFORM Dermatomal. 25. for example. These lesions are frequently seen with erythema multiforme but not exclusively so. These have a dark or blistered center. and the systemic form of juvenile rheumatoid arthritis. IRIS OR TARGET LESIONS Iris lesions are also known as target lesions and are a series of concentric rings.30. or with livedo reticularis. This phenomenon is seen in a variety of conditions. 36. lichen nitidus. lichen planus. warts. FOLLICULAR It is sometimes helpful to determine if lesions specifically involve the hair follicle. also called the isomorphic response. 31. This descriptive term may apply to a wide variety of disorders. molluscum contagiosum. 7 . The former fades as the skin is warmed the latter becomes more florid.) 35. GUTTATE Guttate lesions look as though someone took a dropper and dropped this lesion on the skin. 32. MULTIFORM Patients with multiform lesions have lesions of a variety of shapes. 34. (One should be certain that the lesions are not following a dermatome. for example. Guttate lesions are characteristic of one form of psoriasis. refers to the appearance of lesions along a site of injury.g.. psoriasis. though that is not the only example. KOEBNER PHENOMENON The Koebner phenomenon. very commonly in newborns (or even grown children and adults) as cutis marmorata. 33. RETICULAR Reticular or net-like lesions can be seen in a variety of circumstances. LINEAR LESIONS Linear lesions occur in a line or band-like configuration. e. MORBILLIFORM The term "morbilliform" means that the patient has a rash that looks like measles. STRAWBERRY TONGUE Patients with scarlet fever. Note that the term scarlatiniform does not mean that the patient has scarlet fever. SATELLITE LESIONS The term is commonly used to describe a portion of the rash of cutaneous candidiasis in which a beefy red plaque may be found surrounded by numerous. The patient with a scarlatiniform rash has innumerable small red papules that are widely and diffusely distributed. although by definition all patients with scarlet fever have a scarlatiniform rash. Patients with a variety of other conditions such as Kawasaki disease. or drug reactions may have rashes with the same pattern. drug reactions. UNIVERSALIS Universalis refers to a widespread disorder that affects the entire skin. SERPIGINOUS Serpiginous lesions wander as though following the track of a snake. viral infections. the appearance is called "strawberry tongue. 39." 41. Kawasaki disease or other conditions may develop a distinctive appearance of their tongues. SCARLATINIFORM Scarlatiniform rashes have the pattern of scarlet fever. The rash consists of macular lesions that are red and are usually 2-10 mm in diameter but may be confluent in places. 40. smaller red macules located adjacent to the body of the main lesions.37. PATTERNS OF INTENTIONAL OR UNINTENTIONAL INJURY 8 . Patients with measles will have the rash but patients with Kawasaki disease. 38. 42. 43. Because of its resemblance to the well-known berry. or other conditions may also have a morbilliform rash. slap marks. 9 . etc. Abrasions are traumatically caused erosions.) or in cases of unintentional injury. burns.One important category of skin lesions involve the form that skin lesions may take in cases of child abuse or other intentional injury (bite marks. strap marks.