** only titles in BOLD PINK were mentioned by the doctor

The 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

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Vesicles are small raised lesions (blisters) less than 0.5 cm. in diameter that are
filled with clear fluid.

e.g herpes simplex, dermaitis

6. BULLAE

Bullae are large circumscribed fluid-filled lesions (blisters) that are greater than 1
cm. in diameter.

7. PUSTULE

Pustules are small circumscribed elevated lesions that contain pus. They are
most commonly infected (as in folliculitis) but may be sterile (as in pustular
psoriasis). They may develop spontaneously or from a papule.

e.g acne pustule

8. WHEAL

TRANSIENT solid swelling resembling an orange skin

e.g urticaria

9. ERYTHEMA

An area of redness or duskiness

e.g cellulitis, drug reaction

10. TUMOR

A tumor is a solid mass of the skin or subcutaneous tissue; it is larger than a

nodule. (Please bear in mind this definition does not at all mean that the lesion is
a neoplasm.)

11. BURROW

Burrows are linear lesions produced by infestation of the skin and formation of
tunnels (e.g., with infestation by the scabitic mite or by cutaneous larva migrans).
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12. TELANGIECTASIA

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.

The Secondary Lesions

Secondary lesions may evolve from primary lesions, or may be caused by

external forces such as scratching, trauma, infection, or the healing process. The
distinction between a primary and secondary lesion is not always clear.

1.EXUDATE

Fluid content of a broken papule, vesicle, bulla or pustule.

e.g Impetigo, eczema, dermatitis

2. SCAB

A mass of an incomplete dried exudate

e.g eczema or dermatitis,Impetigo

3. CRUST:

Friable mass of a completely dried exudate. If we remove the crust we will find
the erosion underneath

e.g scabies, Impetigo

Crusting is the result of the drying of plasma or exudate on the skin. Please
remember that crusting is different from scaling. The two terms refer to different
phenomena and are not interchangeable. One can usually be distinguished from
the other by appearance alone.

EXUDATE  SCAB  CRUST EROSION “result from removing the crust”

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4. ULCER

Deeper loss of skin and mucosa, extending below the dermo-epidermal junction.
(necrosis of the epidermis and dermis and sometimes of the underlying
subcutaneous tissue)

This heals with scarring

e.g ecthyma

** N.B an erosion will heal without scaring

5. SCALE

Heaped up stratum corneum cells fromed in many common skin diseases

e.g scabies

6. SCAR

The end result of a healed ulcer

The permanent fibrotic changes that occur on the skin following damage to the
dermis.

Maybe flat or hypertrophic

Scars may have secondary pigment characteristics

7. KELOIDS

Keloids are an exaggerated connective tissue response of injured skin that

extend beyond the edges of the original wound.

(firm solid over growth of fibrous tissue)

8. CYST:

subcutaneous lump containing fluid or semisolid material

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9. EXCORIATION (Scratch)

Irregular mark on the skin resulting from epidermal loss caused by scratching

10. FISSURE (Crack)

LINEAR or irregular breach in the skin muscosa. Usually ACCENTUATE TO

NORMAL SKIN LINES.

e,g candidal intertrigo, angular stomatitis in vitamin B deficiency

11. ATROPHY

Loss of substance of the skin showing palpable thinness

12. HYPOPIGMENTATION

13. HYPERPIGMENTATION

15. LICHENIFICATION

"Lichenification" refers to a thickening of the epidermis seen with exaggeration of

normal skin lines. It is usually due to chronic rubbing or scratching of an area.

16. EROSION

Erosions are slightly depressed areas of skin in which part or all of the epidermis
has been lost.

21. ESCHAR

An eschar is a hard, usually darkened, plaque covering an ulcer implying

extensive tissue necrosis, infarcts or gangrene.

23. PETECHIAE, PURPURA, AND ECCHYMOSES

Three terms that refer to bleeding that occurs in the skin are petechiae, purpura,
and ecchymoses. Generally, the term "petechiae" refers to smaller lesions.

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"Purpura" and "ecchymoses" are terms that refer to larger lesions. In certain
situations purpura may be palpable. In all situations, petechiae, ecchymoses, and
purpura do not blanch when pressed. If there is any question, press on the
lesions carefully with a glass slide. Don't break the slide or cut the patient.

Patterns and Distribution

Not only is the appearance of lesions important, but the pattern and distribution
on the skin is as well.

24. ANNULAR

Annular lesions are seen in a ring shape. Tinea corporis, erythema migrans (the
lesion associated with lyme disease), and granuloma annulare are three common
examples.

25. DISCRETE

Discrete lesions tend to remain separate. This is a helpful descriptive term but
has little specific diagnostic significance.

26. CLUSTERED

Clustered lesions are those that are grouped together. They are commonly seen
in herpes simplex or with insect bites, for example.

27. CONFLUENT

Confluent lesions tend to run together.

28. DERMATOMAL, ZOSTERIFORM

Dermatomal, zosteriform lesions follow a dermatome. The lesions of varicella

zoster (also known as shingles) are the classic example, but there are other
lesions which may assume the same pattern.

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29. ECZEMATOID

Eczematoid lesions are inflamed with a tendency toward clustering, oozing, or

crusting.

30. FOLLICULAR

It is sometimes helpful to determine if lesions specifically involve the hair follicle.

31. GUTTATE

Guttate lesions look as though someone took a dropper and dropped this lesion
on the skin. Guttate lesions are characteristic of one form of psoriasis, though
that is not the only example.

32. IRIS OR TARGET LESIONS

Iris lesions are also known as target lesions and are a series of concentric rings.
These have a dark or blistered center. These lesions are frequently seen with
erythema multiforme but not exclusively so.

33. KOEBNER PHENOMENON

The Koebner phenomenon, also called the isomorphic response, refers to the
appearance of lesions along a site of injury. This phenomenon is seen in a variety
of conditions; for example, lichen planus, warts, molluscum contagiosum,
psoriasis, lichen nitidus, and the systemic form of juvenile rheumatoid arthritis.

34. LINEAR LESIONS

Linear lesions occur in a line or band-like configuration. This descriptive term

may apply to a wide variety of disorders. (One should be certain that the lesions
are not following a dermatome.)

35. MULTIFORM

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Patients with multiform lesions have lesions of a variety of shapes.

36. RETICULAR

Reticular or net-like lesions can be seen in a variety of circumstances; e.g., very

commonly in newborns (or even grown children and adults) as cutis marmorata,
or with livedo reticularis. The former fades as the skin is warmed the latter
becomes more florid.

37. SERPIGINOUS

Serpiginous lesions wander as though following the track of a snake.

38. UNIVERSALIS

Universalis refers to a widespread disorder that affects the entire skin.

39. SCARLATINIFORM

Scarlatiniform rashes have the pattern of scarlet fever. The patient with a
scarlatiniform rash has innumerable small red papules that are widely and
diffusely distributed. Note that the term scarlatiniform does not mean that the
patient has scarlet fever, although by definition all patients with scarlet fever have
a scarlatiniform rash. Patients with a variety of other conditions such as
Kawasaki disease, viral infections, or drug reactions may have rashes with the
same pattern.

40. STRAWBERRY TONGUE

Patients with scarlet fever, Kawasaki disease or other conditions may develop a
distinctive appearance of their tongues. Because of its resemblance to the well-
known berry, the appearance is called "strawberry tongue."

41. MORBILLIFORM

The term "morbilliform" means that the patient has a rash that looks like measles.
Patients with measles will have the rash but patients with Kawasaki disease,
drug reactions, or other conditions may also have a morbilliform rash. The rash

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consists of macular lesions that are red and are usually 2-10 mm in diameter but
may be confluent in places.

42. 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,
smaller red macules located adjacent to the body of the main lesions.

43. PATTERNS OF INTENTIONAL OR UNINTENTIONAL INJURY

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, slap marks,
strap marks, burns, etc.) or in cases of unintentional injury. Abrasions are
traumatically caused erosions.