Topic 18 - Secondary lesions of the skin Secondary skin lesions evolve from primary lesions.

They include: 1) Scales/desquamation 2) Erosion, excoriation 3) Fissure, rhagades 4) Ulcer 5) Fistula 6) Crust 7) Scar (cicatrices) 8) Atrophy 9) Lichenification Scales/desquamation Cornified epi. cells, detached fragments of the stratum corneum. Indicates a disorder in epidermal maturation and keratinization. Their shedding is called exfoliation Pityriasiform: fine scales (dandruff) Psoriasiform: white, noncoherent scales Small-lamellar: eczema Ichtyosiform: large scales (ichtyosis) Exfoliative: large sheet-like (scarlet fever) Collarette: scales surrounding a lesion (pityriasis rosea) Color: silvery-white (psoriasis), oily,yellow (seborrhoic dermatitis)

A keratosis is a horn-like thickening of the stratum corneum. Hyperkeratosis, parakeratosis, dyskeratosis Acanthosis thickening of the inner layer of the skin Erosion, excoriation Erosion: Erosion supf. skin defect. A focal loss of epidermis above the basement mem. Erosions do not penetrate below the dermo-epidermal junction and therefore heal W/O scarring. Excoriation: An ulcer or erosion produced by scratching loss of papillary dermis/scarring Fissure, rhagades Fissure painful deep linear opening (slit) in the skin (epidermis and dermis). Rhagades cracks or tears caused by stretching of brittle skin (skin folds mouth corner, hands) Excoriations

Ulcer Skin defect with loss of epidermis & upper papillary dermis, may extend deeper into the subcutis Always occurs with pathologically altered tissue, scar forms (wound: defect on normal tissue) Crust Secretion dries on the skin surface. May look like a scale Secretion: Blood: red-brown Serum: yellow Purulent exudate: honey colored Strepto, Yellow-green Staphylo. With necrosis: ecthyma Scar/Cicatrices Permanent fibrous tissue replacing normal tissue destroyed by injury or disease Result from the process of healing/repair by replacement with connective tissue. Hypertrophic scar/keloid Athropic-thin and wrinkled scar Atrophy Thinning of the dermis, epidermis and loss of appendages. Loss of normal skin markings with thinning of epidermis (ischemia) or dermis (due to collagen loss). Regressive changes Senile or actinic atrophy Appear thin and translucent, and lose normal surface markings. Blood vessels may be easy to see in both epidermal and dermal atrophy. Lichenification Chr. thickening (hyperplasia) of the epidermis with accentuation of normal skin markings (major skin lines) that is not visible on normal skin Cobblestone like surface result of chr. rubbing scratching Others A sinus is a cavity or channel that permits the escape of pus or fluid. A stria (stretch mark) is a streak-like linear atrophic pink, purple or white lesion of the skin caused by changes in the connective tissue. Necrosis - rapid death of cells Necrobiosis - slow death of tissue, a cell, or a group of cells. Pigmentation, either more or less than surrounding skin, can develop after lesions heal