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I. MACULAR SKIN CHANGES (MACULAE)

A. CHANGES IN BLOOD CIRCULATION

1. Macula hyperaemica- active hyperaemia; passive hyperaemia (cyanosis)

 roseola – lues II
 erythema – mechanical, chemical or ionizing factors; erythema emotivum; inflammation
 erythrodermia – psoriasis, atopic dermatitis, mycosis fungoides

2. Macula anaemica
 congenital lack of blood vessels – naevus anaemicus
 vasospasm – pseudoleucoderma angiospasticum

3. Macula teleangiectatica
 congenital – naevus araneus, naevus vinosus, s-ma Louis-Bar, s-ma Rendu-Osler
 acquired – rosacea, sclerodermia progressiva, alcoholism, hepatic disorders, side effect of
topical corticosteroids.
Hyperaemic and teleangiectatic macules disappear under vitropression!

4. Macula haemorrhagica
 petechia
 ecchymosis
 vibices
 sufusio/sugilatio
 haematoma
 purpura - p. senilis, p. Schoenlein-Henoch, p. thrombocytopaenica
Haemorrhagic macules do not disappear under vitropression!

B. CHANGES IN THE SKIN PIGMENTATION

1. Macula hyperchromica /melanin, carotenoids, haemosiderine, heavy metals/

 congenital - ephelides, lentigo, naevus pigmentosus, café au lait (neurofibromatosis)
 acquired - suntan/bronzage, chloasma uterinum/ linea fusca, tattoo
 secondary - postlesional hyperigmentation /lichen ruber planus, pemphigus/

2. Macula achromica
 congenital - albinismus totalis, albinismus partialis /piebaldism/, naevus depigmentosus
 acquired - vitiligo, naevus Sutton
 secondary - leucoderma psoriaticum, leucoderma syphiliticum

3. Macula dyschromica
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II. PALPABLE SKIN CHANGES

1. Papula
- epidermal – acanthosis, parakeratosis
- dermo-epidermal
- dermal
 papula miliaris – lichen ruber planus
 papula lenticularis – lues II, condylomata lata
 papula nummularis – psoriasis

2. Plaque
 psoriasis placata
 eczema nummulare

3. Nodulus
 lupus vulgaris (TBC cutis) – lupoma
 lepra – leproma

4. Nodus/tumour
 erythema nodosum
 lues III – gumma
 TBC cutis, mycosis fungoides, tumors

5. Urtica (wheal) - variable in form, size and localization; transitory, itchy

 nettle-rash
 dermatitis ab insectibus (insect bites)
 hives/urticaria
 red dermographism

6. Lichenificatio - chronic epidermal thickening, rough skin surface, xerosis cutis

 atopic dermatitis /eczema endogens/
 cutis rhomboidalis nuchae, cutis agricoler, cutis nautarum, cutis vagabundorum
 secondary, following chronic skin inflammation

7. Hyperkeratosis
 hyperkeratosis follicularis - keratosis pillaris, pityriasis rubra pillaris
 hyperkeratosis circumscripta - clavus
 hyperkeratosis diffusa - genodermatoses, mal de Meleda

8. Vegetatio - pathological digitiform development of the epidermis and dermal papillae

 verruca vulgaris
 condylomata acuminata
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III. EXUDATIVE SKIN CHANGES

1. Vesicula d<0.5cm
- subcorneal
- intraepidermal
- subepidermal
 eczema acutum
 herpes – h. simplex, h. zoster
 autoimmune bullous dermatoses (dermatitis herpetiformis)

2. Bulla – d>0.5cm
 subcorneal – pemphigus foliaceus
 intraepidermal – pemphigus vulgaris
 subepidermal – pemphigoid, epidermolysis bullosa acquisita, combustion (burning),
congelation (frostbite), mechanical trauma

3. Phlyctaena – loose flat blister full of exudate

4. Pustula – blister with purulent contents

 hair follicles - folliculitis
 smooth skin
 septic
 aseptic – aseptic pustuloses
 primary infection
 secondary infection- impetiginisation

5. Ecthyma – pustule on necrotic basis

6. Abscessus – purulent collection within the tissue of the body

7. Cysta – sack, covered with epithelium

IV. SKIN CHANGES DUE TO INTERRUPTION OF THE SKIN

SURFACE

1. Erosio
- superficial damage of the epidermis or epithelium
- heals without scar formation
 eczema acutum
 pemphigus
 bullous pemphigoid

2. Excoriatio – linear injury of the epidermis/epithelium in itchy dermatoses

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- superficial – heals without scarring

- deep – heals with scarring
 neurodermitis
 scabies – ductulus femelae
 acné excorié des jeunes filles
 pathomymia (autoagression)

3. Fissura/ rhagada - linear deffect, periorificial, very painful

 fissura ani
 еczema

4. Fistula – abnormal hole/canal related to tissue decay

 TBC cutis
 actinomycosis

5. Ulcus - necrosis during inflammation, vascular or neoplastic disorders

- deep defect of the derma
- heals with scar formation
 ulcus venosum cruris – SPT
 ulcus durum (lues I) = erosio
 ulcus rodens – Ca basocellulare
 TBC, lepra, lues III (gumma), deep mycoses

6. Aphtha
 aphtha vulgaris
 M. Behçet (bipolar aphthosis)

V. DISCARD SKIN CHANGES

1. Squama (scale) – in hyper- and parakeratosis

- desquamatio insensibilis
- desquamatio pityroides
- desquamatio lamellosa
 psoriasis – silver-white scales
 dermatitis seborrhoica – yellowish greasy scales
 ichthyosis – grey-black scales
 pityriasis rosea, lues II – collerette de Biette

2. Crusta – dried exudate/secretion

- light yellow colour – serous exudate
- yellow-green colour – purulent secretion
- brown-black colour – haemorrhage
 secondary over exudative skin changes (blisters)
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 scabies crustosa/norvegica

3. Rupia – thick, dark, raised, multilayer, adherent crusts on the skin, somewhat resembling
oyster shells

4. Eschara – dry black skin necrosis

 in disorders of the blood circulation
 in chemical burns with caustic agents

5. Comedon - corneocytes, sebum, melanin

 acne
 Favre-Racouchot (elastoidosis nodularis cutis cystica et comedonica)

6. Indumentum – (coating)

VI. SKIN CHANGES DUE TO VARIATION OF THE

NUMBER/VOLUME OF THE SKIN ELEMENTS

1. Atrophia
- thinning of the skin – “pergament”, “cigarette paper”
- smoothing of the skin surface
- decrease of the number of skin appendages
 localised
- of the epidermis – lichen scleroatrophicus
- of the elastic fibers – anetoderma
- of the hypoderma - lipoatrophia
 diffuse
- physiological – atrophia senilis
- pathological – sclerodemia progressive (systemic scleroderma)
 Poikilodermia – atrophy, pigment disorders, telangiectasia – xeroderma pigmentosum,
connective tissue diseases (dermatomyositis)

2. Hypertrophia
 elephantiasis – chr. inflammation, relapsing erysipelas
 proteus s-me

3. Cicatrix (scar)
 atrophic – posttraumatic, lupus erythematosus chronicus discoides (LECD)
 hypertrophic/keloid
 interstitial – during resorption of inflammation without affecting the skin surface