TRANS #1.

2-2
June 18, 2015
BASIC SKIN LESIONS || Dr. Guzman

I.

II.
III.
IV.

TOPIC OUTLINE
Three Corners to Make a Useful Skin Examination
a. Morphology
i. Primary Skin Lesions
ii. Secondary Skin Lesions
b. Distribution
c. Configuration
Patterns of Skin Lesions
Colors in Dermatology
Important Signs in Dermatology

3 CORNERS TO MAKE A USEFUL SKIN EXAMINATION

1.
2.
3.

Morphology (shape)
Configuration (arrangement)
Distribution (site)

Bates: macule greater than 1 cm

Harrisons and Doc Guzman:
greater than 2 cm

Caf-Au-Lait Spot

MORPHOLOGY

Patch

Primary Skin Lesions (unmodified lesions)

Papule

small, solid, raised lesion that has

distinct borders

may have a variety of shapes in

profile (domed, flat-topped,
umbilicated) and may be associated
with secondary features such as
crusts or scales

Bates: up to 1 cm

Harrisons and Doc Guzman: less

than 0.5 cm

Schematic representation of several common primary skin lesions

Psoriasis

Macule

change in the color of the skin

flat and cannot be palpated

Bates: up to 1 cm in diameter
Harrisons and Doc Guzman: less
than 2 cm

Nodule

knot-like, firm lesion raised above

the surface of the surrounding skin

deeper and firmer than a papule

0.5 to 5.0 cm

Freckles

Dermatofibroma

TRANSCRIBERS: Daguno

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BASIC SKIN LESIONS

Tumor

o
solid, raised growth in the skin or
subcutaneous tissue
larger than a nodule (more than 5.0
cm)

Bulla

bigger vesicle
Bates: 1.0 cm or larger
Harrisons and Doc Guzman: more
than 0.5 cm

Xanthoma
Insect bite

Plaque

large, flat-topped, raised lesion

often formed by coalescence of

papules

edges may either be distinct or

gradually blend with surrounding
skin

more than 1.0 cm

Pustule

vesicle with pus (yellow

proteinaceous fluid filled with
neutrophils)

does not necessarily signify the

existence of an infection

Folliculitis
(infected)
Psoriasis

Vesicle

small, elevated lesion filled with

serous fluid

Bates: up to 1.0 cm
Harrisons and Doc Guzman: less
than 0.5 cm

Herpes simplex

TRANSCRIBERS: Daguno

Wheal

Pustular psoriasis
(sterile)

raised erythematous, edematous

papule or plaque, usually
representing short-lived
vasodilation and vasopermeability
somehow irregular, relatively
transient superficial area of edema
(in the upper epidermis)

Urticaria

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BASIC SKIN LESIONS

o

Burrow

minute, slightly raised, linear

lesions produced by infestation of
the skin and formation of tunnels

Scale

excessive accumulation of
desquamated layers of stratum
corneum (appearing as flakes or
plates)
desquamation occurs when there
are peeling sheets of scale
following acute injury to the skin

Dry skin

Ichthyosis vulgaris

Scabies

Telangiectasia

dilated, superficial blood vessel

may occur as isolated phenomenon

or as part of a generalized disorder,
such as ataxia telangiectasia

Spider angioma

Crust

dried residue of plasma or exudate

on the skin (serum, pus, or blood)
may be either yellow (i.e. serous
crust) or red (i.e. hemorrhagic crust)
Note: Crusting is different from
scaling. By appearance alone, one
can usually be distinguished from
the other.

Spider vein

Secondary Skin Lesions (modified by scratching or

infection)
o Lichenification

visible and palpable thickening of

the epidermis and roughening of
the skin seen with exaggeration of
normal skin lines / furrows
(accentuated skin-fold markings)

often due to chronic rubbing or

scratching of an area

Neurodermatitis

TRANSCRIBERS: Daguno

Impetigo

Erosion

nonscarring loss of the superficial

epidermis (appearing as slightly
depressed areas of skin) without an
associated loss of dermis

with moist surface that does not

bleed

Apthous stomatitis

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BASIC SKIN LESIONS

Ulceration

deeper loss / necrosis of the

epidermis and dermis (sometimes,
even the underlying subcutaneous
tissue)

Scar

increased connective tissue that

arises from injury or disease
sites may be erythematous,
hypopigmented, or hyperpigmented
(depending on age or character)
sites on hair-bearing areas may be
characterized by destruction of hair
follicles

Syphilitic chancre

Excoriation

linear, angular erosions caused by

scratching or rubbing

traumatized or abraded skin

Hypertrophic scar from steroid injection

Fissure

linear crack / cleavage in the skin

that extends into the dermis

often resulting from excessive

dryness

Cat scratches

Atrophy

thinning or absence of the

epidermis or subcutaneous fat

may appear as depression with

intact epidermis (i.e. loss of dermal
or subcutaneous tissue) or as sites
of shiny, delicate, wrinkled lesions
(i.e. epidermal atrophy)

Athletes foot

Eschar

hard plaque covering an ulcer

implies extensive tissue necrosis,

infarcts, deep burns, or gangrene

Atrophoderma
Meningococcemia

TRANSCRIBERS: Daguno

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BASIC SKIN LESIONS

Keloid

DISTRIBUTION
exaggerated connective tissue
response of injured skin
(hypertrophic scarring)
extends beyond the edges of the
initiating injury / original wound

Photodistributed
o pattern follows the sun-exposed skin
o typical areas of involvement: forehead, upper
ears, nose, cheeks, upper lip, neck,
forearms, and dorsum of the hands

Keloid (ear lobe)

Polymorphous light eruption

Petechiae, Purpura, and Ecchymoses

terms referring to bleeding that

occurs in the skin

petechiae: smaller lesions

purpura & ecchymoses: larger
lesions

Note: Purpura may be palpable in

certain situations (e.g. necrotizing
vasculitis). Petechiae, purpura,
and ecchymoses do not blanch
when pressed. If uncertain, press
on the lesions carefully with a glass
side. Be careful not to break the
slide or cut the patient.

Intertriginous
o involves skin creases and folds
o areas of involvement: axillae, crural fold,
gluteal crease, and possibly the
inframammary fold

Hailey-Hailey Disease

Petechiae

Purpura

(Thrombocytopenia)

(Henoch-Schnlein Purpura)

Lymphangitic
o appears along the path of the lymph
channels of the leg or arm

Cellulitis

Ecchymoses
(Acute myelogenous leukemia)

TRANSCRIBERS: Daguno

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BASIC SKIN LESIONS

Dermatomal
o involves area of skin supplied with sensory
innervation by a particular nerve root
o does not cross the midline of the body

Herpes zoster (Shingles)

areas of involvement: distal aspects of the

head (ears, nose) and the extremities
(hands, fingers, feet, toes)

Chilblains (Perniosis)

Palms and/or soles

Acral
o

Scattered
o skin lesions occurring across many body
locations can appear to be distributed
randomly or haphazardly

Secondary syphilis

Neurofibromatosis

Pitted keratolysis

Symmetric
o skin lesions found symmetrically on the
extremities can be indicative of diagnoses of
many etiologies, including infectious,
metabolic, genetic, and inflammatory causes

Stasis dermatitis

TRANSCRIBERS: Daguno

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Widespread
o involves the entire or almost the entire
body

Discrete
o tend to remain separate
o helpful descriptive term but has little specific
diagnostic significance

Vesicles of Varicella
Erythematous drug eruption

Clustered
o grouped together

CONFIGURATION
Configuration

Disease

Flat-topped

Lichen planus

Dome-shaped

Lymphomatoid
papulosis

Figure

Vesicles of Varicella

Slightly elevated

Panniculitis

Acuminate

Acute spongiotic
dermatitis

Papillated

Nipple-like,
intradermal nervus

Digitated

Finger-like, wart

Umbilicated

Molluscum
contangiosum

Confluent
o tend to run together

Macular lesions of Kawasaki disease

Dermatomal / Zosteriform
o lesions that follow a dermatome

PATTERNS OF SKIN LESIONS

Annular
o seen in a ring shape

Zosteriform nevus
Tinea corporis

TRANSCRIBERS: Daguno

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BASIC SKIN LESIONS

Eczematoid
o inflamed lesions with a tendency toward
clustering, oozing, or crusting

Iris or target
o series of concentric rings with dark or
blistered center

Erythema multiforme

Linear
o

occur in a line or band-like configuration

Atopic dermatitis

Follicular
o sometimes helpful to determine if lesions
specifically involve the hair follicle

Poison ivy dermatitis

Multiform
o lesions of variety of shapes

Folliculitis

Guttate
o look as though someone took a dropper and
dropped this lesion on the skin

Erythema multiforme

Reticular
o net-like lesions that can be seen in a variety
of circumstances

Guttate psoriasis

Livedo reticularis

TRANSCRIBERS: Daguno

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BASIC SKIN LESIONS

Serpiginous
o wander as though following the track of a
snake

Strawberry tongue
o with resemblance to the well-known berry

Scarlet fever

Urticaria

Morbilliform
o with rash that looks like measles
o rash consists of macular lesions that are red
and are usually 2-10 mm in diameter but
may be confluent in places

Universalis
o widespread disorder that affects the entire
skin

Measles

Alopecia universalis

Scarlatiniform
o have the pattern of scarlet fever (with
numerable small red papules that are widely
and diffusely distributed)
o Note: The term scarlatiniform DOES NOT
mean that the patient has scarlet fever,
although by definition all patients with scarlet
fever have a scarlatiniform rash.

Drug reaction to Dilantin

Satellite lesions
o describe a portion of the rash of cutaneous
candidiasis in which a beefy red plaque may
be found surrounded by numerous, smaller
red macules located adjacent to the body of
the main lesions

Serum sickness
Candidal diaper dermatitis

TRANSCRIBERS: Daguno

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BASIC SKIN LESIONS

Patterns of intentional or unintentional injury

o Skin lesions in cases of child abuse or other
intentional injury or cases of unintentional
injury

IMPORTANT SIGNS IN DERMATOLOGY

Koebner Phenomenon / Isomorphic Response

o appearance of lesions along a site of injury

Scaly psoriatic lesions

along the line of ventral hernia repair

Auspitz Sign
o appearance of a tiny bleeding point after
removing a scale from psoriasis lesion

Basilar skull fracture

(Battle sign)

COLORS IN DERMATOLOGY
Color

Examples

Red

Vascular lesions
(e.g. port wine stain, psoriasis)

Blue

Blue nevus
Mongolian spot

Yellow

Xanthoma

White

Vitiligo

Black

Melanocytic nevus
Melanoma

Psoriasis lesion and Auspitz sign

Purple /
Violaceous

Lichen planus

TRANSCRIBERS: Daguno

Dariers Sign
o occurrence of erythema and edema (due to
mast cell degranulation with histamine
release) upon stroking a lesion of urticarial
pigmentosa (a form of cutaneous
mastocytosis)

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BASIC SKIN LESIONS

Nikolsky Sign
o appearance of new blisters upon rubbing
normal skin beside a blister

Dermatographism
o appearance of edema and erythema (that
looks like writings on the skin) when the
normal skin is stroked

Button-hole Sign
o If you try to push it, it goes inside the skin.

Neurofibroma

TRANSCRIBERS: Daguno

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