DESCRIBING SKIN LESIONS

1. TYPE OF LESION Flat: o o o o o o Discrete flat lesions Not palpably raised above the skin surface Colour change only Surface normal but may have non-palpable fine scaling Macule <0.5 cm diameter e.g. lentigo, purpura Patch >0.5 cm e.g. vitiligo

Raised: o Discrete lesions visibly raised above the surface o Solid lesions o Papule <0.5 cm e.g. lichen planus o Nodule >0.5 cm e.g. BCC o Plaque raised lesions with a flat top e.g. psoriasis Fluid filled: o Vesicles o Bulla o Pustule <0.5 cm, clear/serous fluid e.g. chicken pox >0.5 cm e.g. pemphigoid contain pus, usually <0.5 cm e.g. folliculitis larger lesions = abscess

2. SURFACE FEATURES Normal: pathology must be in dermis e.g. haemangioma Abnormal: o Abnormal stratum corneum: Scale e.g. psoriasis Hyperkeratosis - keratin cannot be easily picked off e.g. actinic keratosis Maceration e.g. athletes foot between toes o Broken epidermal surface: Exudate - occurs on broken skin and comes from body fluids (serum, pus or blood) Crust - dried exudates and overlies an erosion or ulcer, can be picked off e.g. impetigo

Erosion - superficial, involves epidermis only e.g. pemphigus Ulcer - extends into dermis e.g. venous leg ulcer Fissure - small deep but narrow ulcer e.g. anal fissure

o Changes in thickness to epidermis or dermis Warty - e.g. seborrheic keratosis Lichenification - secondary to persistent scratching e.g. lichen simplex Epidermal atrophy - characterised by fine tissue paper wrinkling e.g. lichen sclerosus Dermal atrophy - results in thinning of the skin (often with depression) e.g. steroid atrophy 3. COLOUR Pink, red or purple - caused by blood o Erythema - blood within blood vessels o Purpura - blood leaked outside blood vessel Brown - due to pigment o Melanin - varying shades of brown, may be black, blue-grey colour caused by melanin pigment deep in dermis o Haemosiderin - follows purpura Yellow - lipids or bilirubin e.g. jaundice, xanthelasma White - due to lack of pigment

4. DEFINITION Border: o Well defined - e.g. eczema o Poorly defined - e.g. psoriasis o Accentuated border - e.g. tinea Centre: o Uniformly involved o Reduced involvement of centre e.g. fungal skin infection o Variable

5. SHAPE

Surface shape Profile shape -

round, oval, irregular spherical, dome, pedunculated or flat-topped

6. DISTRIBUTION Site face, trunk, limbs Number single, multiple, rash Extent localised, regionalised, widespread, disseminated Distribution o Symmetrical most endogenous rashes e.g. psoriasis o Asymmetrical suggests a possible exogenous cause e.g. tinea o Sun-exposed sites shaded areas spared o Flexures/extensors/sparing Arrangement: o Discrete o Coalesce o Grouped o Annular o Linear o Serpiginous

7. FEEL Surface palpation: o Smooth o Uneven e.g. scaly o Rough keratin or crust Deep palpation: pinch lesion between finger and thumb o Soft feels same as lips o Normal like sqeezing your cheek o Firm lesion is slightly compressible o Hard cannot compress o Induration palpable thickening