Skin Lesion Recognition

& Rx in Primary Care

NURS 870
Spring 2016
 Outline

I. Derm Terminology Review

II. Allergic Conditions
III. Inflammatory Conditions
IV. Bacterial Skin Infections
V. Fungal Skin Infections
VI. Viral Skin Infections
Dermatology 101
• Largest organ of body
• Immune Functions
• Hormone production
(vitamin D)
• 3 layers:
• Epidermis
• Dermis
• Subcutaneous tissue
• Protection from:
• Bacteria
• Environment
• Temperature
• Ultraviolet light
 Derm terms: Primary Lesions
Tutorial A: The Primary Lesions

1. Macule - A macule is a change in the color of the skin. 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 1 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.
3. Nodule - A nodule is a raised solid lesion more than 1 cm. and may be in the epidermis, dermis, or subcutaneous tissue.
4. 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.)
5. Plaque - A plaque is a solid, raised, flat-topped lesion greater than 1 cm. in diameter. It is analogous to the geological
formation, the plateau.
6. Vesicle - Vesicles are raised lesions less than 1 cm. in diameter that are filled with clear fluid.
7. Bullae - Bullae are circumscribed fluid-filled lesions that are greater than 1 cm. in diameter.
8. Pustule - Pustules are circumscribed elevated lesions that contain pus. They are most commonly infected (as in
folliculitis) but may be sterile (as in pustular psoriasis).
9. Wheal - A wheal is an area of edema in the upper epidermis.
10.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).
11.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.

http://www.pediatrics.wisc.edu/education/derm/tutorials.html
 Derm terms: Secondary Lesions
Tutorial B: The Secondary Lesions

12.Scale - Scale consists of flakes or plates that represent compacted desquamated layers of stratum corneum.
Desquamation occurs when there are peeling sheets of scale following acute injury to the skin.
13.Crust - 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.
14.Atrophy - Atrophy is thinning or absence of the epidermis or subcutaneous fat.
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.
17.Excoriation - Excoriations are traumatized or abraded skin caused by scratching or rubbing.
18.Fissure - A fissure is linear cleavage of skin which extends into the dermis.
19.Ulceration - Ulcerations occur when there is necrosis of the epidermis and dermis and sometimes of the underlying
subcutaneous tissue.
20.Scar - Scars are the permanent fibrotic changes that occur on the skin following damage to the dermis. Scars may
have secondary pigment characteristics.
21.Eschar - An eschar is a hard plaque covering an ulcer implying extensive tissue necrosis, infarcts, deep burns, or
gangrene
22.Keloids - Keloids are an exaggerated connective tissue response of injured skin that extend beyond the edges of the
original wound.
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. "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.

http://www.pediatrics.wisc.edu/education/derm/tutorials.html
 Derm terms:
Patterns & Distribution
Tutorial C: Patterns and Distribution

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 that may assume the same pattern.
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. Any many more!

http://www.pediatrics.wisc.edu/education/derm/tutorials.html
 Dermatology Quiz

For a real challenge, try this:

http://
www.pediatrics.wisc.edu/education/derm/tutc/quizc.
html
 DermNet

Dermatology Atlas online!

http://www.dermnet.com/dermatology-pictures-skin-
disease-pictures
/
 Chapter 1
Derm Terminology

• Color
• Elevation (flat, raised)
• Pattern or shape
• Size in centimeters
• Location & distribution on body
• Exudate
 Derm Terms: Color

1. Macule – color change

2. Patch – macule > 1 cm

PollEv1: What is the Dx?

 Derm Terms: Color

3. Hyper pigmented –

darker than
surrounding skin
 Derm Terms: Color

4. Hypo pigmented –

lighter than
surrounding skin

PollEv2: What is the Dx?

 Derm Terms: Elevation

1. Papule:

< ½ cm, solid, elevated

(small mole, wart, pimple)
 Derm Terms: Elevation

2. Plaque:

plateau-like
coalesced papules
surface area > 1 cm

PollEv3: What is the Dx?

 Derm Terms: Specific Lesions

1. Wheal:

superficial, raised,
erythematous

“hives” when wheals coalesce

to form extensive reaction

PollEv4: What is the Dx?

 Derm Terms: Specific Lesions

2. Tumor:

firm lesion
larger than a few cm

PollEv5: What is the Dx?

 Derm Terms: Specific Lesions
3. Vessicle:

elevated cavity w fluid

Less than 1 cm

PollEv6: What is the Dx?

 Derm Terms: Specific Lesions

4. Pustule:

elevated cavity w/ pus

PollEv7: What is the Dx?

 Derm Terms: Specific Lesions

5. Boil or furuncle:

Large pus-filled cavity

PollEv8: What is the organism?

 Derm Terms: Descriptives

1. Crust:

PollEv9: What is the Dx?

PollEv10: What is the organism?
 Derm Terms: Descriptives

2. Scale:

PollEv11: What is the Dx?

PollEv12: What is the
organism?
 Derm Terms: Descriptives

3. Excoriation:

Skin lesions which have

been scratched or picked

PollEv13: What is the Dx?

PollEv14: What is the Rx?

 Derm Terms: Descriptives

4. Scar:

Hypertrophic growth
following a skin injury

PollEv15: What is the Dx?

 Chapter 2
Allergic Skin Lesions
• Contact Dermatitis

PollEv16: What is the allergy?

 Allergic Skin Lesions
• Urticaria (hives)
PollEv17: What do we call this?

PollEv18: What is the Rx?

 Chapter 3
Inflammatory Skin Lesions
(non-infectious)

1. Eczema
2. Psoriasis
3. Acne
Eczema (dermatitis) - Hand

PollEv19: What is causing

the problem here?
Eczema (dermatitis) - Face
PollEv20: Rx for child?
PollEv21: Rx for adult?
PollEv22: What is the Dx?

PollEv23: What is the Rx?

Acne
 Chapter 4
Bacterial Skin Infections

1. Impetigo
2. Folliculitis
3. Furuncles (boils)
4. Cellulitis
24. What’s this?
PollEv25: What is this?

Folliculitis
PollEv26: What is the this?
PollEv27: What is the Dx?

Boil with Cellulitis

PollEv28: What is the Dx?
 Bacterial Skin Infections
Rx Options:

1. Topical or oral antibiotics

2. Boils sometimes only need only incision &
drainage
3. Often athletes may continue participation if wound
is kept covered and athlete practices good hand-
washing.
4. Encourage athletes to wash linens and not share
towels
 Chapter 5
Fungal Skin Infections

1. Tinea
Capitus - scalp
Corporis – body
Cruris – groin
Pedis – feet

2. Candidiasis
PollEv29: What is the Dx?
PollEv29: What is the Dx?

PollEv30: What is the Dx?

31. What’s this?
 Fungal Skin Infections
Rx options:

2. Topical or oral antifungals required

3. Often athletes may continue participation.
Wrestlers have NCAA rules for return.
4. Encourage athletes to wash linens and not share
towels
 Chapter 6
Viral Skin Infections

1. HSV – 1
Cold Sores
HSV – 2
2. Shinges ( Varicella Zoster)
3. Molluscum
4. Warts
Planus - flat
Verruca - bumpy
Plantar - grow inward
PollEv32: What is the Dx?
33. What is this?
34. What is this?
PollEv35: What is the Dx?
 Viral Skin Infections
Rx Options:

1. Herpes & Shingles – need oral medication

2. Molluscum – may resolve spontaneously or may be
curetted or frozen with liquid nitrogen
3. Warts – may be frozen with liquid nitrogen. Over-
the-counter preparations may be successful for
small, isolated warts
 PollEv 36.
Consult!

What the…
PollEv37: What is the Dx?

This was in my differential:

 When in doubt, refer!

Punch Biopsy
 Want to learn more derm?
American Academy of Dermatology:
http://www.aad.org/skin-conditions

Hardin MD: Medical Information and Pictures:

http://hardinmd.lib.uiowa.edu

Medline Plus:
http://www.nlm.nih.gov/medlineplus/medlineplus.html

Primary Care Dermatology: Skin Lesion Nomenclature

http://www.pediatrics.wisc.edu/education/derm/text.html
Did you like my skin show?