Basic skin lesions

1. PRESENTED BY:- DR. AAKANKSHA SINGH.

2. When describing a skin lesion,it is important to
note the following features:-
1)size
2)type
3)shape and symmetry
4)colour and pigmentation
5)surface area
6)Distribution over the body surface

3. Types of lesion
Basic skin lesions are broadly categorized as :
1. Primary
2. Secondary
3. special

4. Primary lesions :- Basic reaction patterns of skin
with a definite morphology.
Secondary lesion :- Develop during the evolutionary
process of skin disease or are created by scratching or
infection.
special skin lesion :- Specific for certain disease.

5. Primary Skin Lesions
Macule
Patch
Papule
plaque
nodule
Vesicle
Bulla
Pustule
Abscess
Wheal
Cyst

6. Macule
A flat circumscribed lesion
showing change in color
without change in its
consistency. Macules are non-
palpable.
They are 0.5cm-1cm in size.
Discoloration may be brown,
blue ,red and hypopigmented
or hyperpigmented

7. Brown coloured macules
Beckers neveus Freckle
Fixed drug eruption Cafe-au-lait spot

8. Blue coloured macules
Mongolian spot Blue naevus
ink(tattoo)

9. Drug eruptions Secondary syphilis
Red coloured macules

10. Hypopigmented
Tinea versicolor

11. PATCH
A large macule is called
patch (>1cm in size).
May have scaling.
Eg :- Vitiligo, melasma,
pityriasis alba

12. Papule
A small, solid lesion,
<0.5 cm in diameter,
raised above the surface
of surrounding skin &
hence palpable.
Papules may be of
various colors.

13. Flesh colored,yellow or white
colored papules
Molluscum
contagiosum
Skin tags

14. Brown colored papules
Melanoma Dermatofibroma

15. Red colored papule
Acne
folliculits
Insect bite

16. Blue colored papules
Blue nevus Lichen planus
violaceous papules)

17. Plaque
It is an indurated area of
skin larger than 0.5 cm
in diameter which may
be raised or depressed
from skin surface.

18. Examples of plaque
Psoriasis Lichen planus
Tinea corporis

19. Other examples of plaque
Pityriasis rosea
Seborrheic dermatitis
Tinea pedis
Eczema

20. Nodule
A large ( 0.5 – 5.0 cm ), firm lesion raised above the
surface of surrounding skin.
It is the depth of involvement that differentiates a
nodule from a large papule.
Could be warm, soft,fluctuant,movable,fixed or
painful.
Surface-smooth,keratotic,ulcerated or fungating.

21. Examples of nodule
Basal cell carcinoma Hemangioma
Prurigo nodularis neurofibromatosis

22. Other examples of nodule
Xanthoma
Keratoacanthoma
Melanoma

23. Vesicle
A small, fluid filled
lesion, <0.5 cm in
diameter, raised above
the plane of surrounding
skin. Fluid is often
visible and the lesions
are translucent

24. Examples of vesicle
Chicken pox Herpes zoster

25. Other examples of vesicle
Impetigo
Insect bite
Herpes simplex
Dermatitis herpetiformis

26. bulla
A fluid filled, raised,
often a translucent
lesion >0.5cm in
diameter

27. Examples of bulla
Bullous pemphigoid Fixed drug reaction

28. Pustule
A vesicle filled with pus
It is formed due to
collection of
inflammatory exudate
rich in leucocytes.
It may contain bacteria
or may be sterile.

29. Acne Pustular psoriasis
Folliculitis Scabies

30. Abscess
A localized collection of
pus deep in dermis or
subcutaneous tissue
Due to deep seated
location pus may not be
visible on skin surface
but would show sign of
inflammation.

31. Wheal
It is a transient swelling
of skin disappearing
within 24 hrs.
It is formed due to
sudden extravasation of
fluid in the dermis.
Eg: urticaria

32. Examples of wheal
Urticaria dermographism

33. Cyst
It is a spherical or oval
sac or an encapsulated
cavity containing fluid
or semi solid material.
It is lined with true
epithelium.
Eg:- mucous retention
cyst

34. Secondary Skin Lesions
Scale
Crust
Erosion
Fissure
Sinus
Scar
Atrophy
Lichenification

35. Scale
Excess dead epidermal
cells that are produced
by abnormal
keratinization and
shedding
Eg: Psoriasis, Icthyosis

36. Types of scales
Fine to stratified
•Erythema craquele(dense
scale)
•Psoriasis(silvery scale)

37. Ichthyosis vulgaris

38. Tinea versicolor(fine)

39. Scaling in sheets(desquamation)
Scarlet fever(hands and feet)

40. Staphylococcal scalded skin syndrome
Kawasaki syndrome

41. Other types of scales
Crack like - eczema
craquele.
Exfoliative- drug rxn.
Follicular- keratosis
pilaris.
Gritty- actinic keratosis.
Ichthyosiform-
ichthyosis vulgaris.
Keratotic/
hyperkeratotic-
cutaneous horn.

42. Cont…
Lamellar- lamellar
ichthyosis.
Pityriasiform- pityriasis
rosea.
Psoriasiform -psoriasis
vulgaris.
Seborrheic- seborrheic
dermatitis.
Wickham striae- lichen
planus

43. Crust
Dried exudate of body
fluids (blood / serous
fluid)
Which might be either
yellow / red

44. Examples of crusting
Tinea capitis Impetigo

45. Erosion
A focal loss of epidermis
Erosions do not
penetrate below the
dermoepidermal
junction and therefore
heal without scarring
Eg:- tinea
pedis,candidiasis,eczem
a-tous disease, herpes
simplex
Tinea pedis candidiasis

46. ulcer
A focal loss of epidermis
and/or dermis
Scarring depends on the
depth of the ulcer
Eg-
chancroid,pyoderma
gangrenosum,decubitus

47. chancroid

48. Pyoderma
gangrenosum
decubitus

49. Radiodermatitis

50. Fissure
It is a linear loss of continuity of
skin due to excessive tension.
Eg:- eczema(fingertips),intertrigo

51. Finger fissure d/t
eczema
intertrigo

52. Scar
It is replacement of
normal skin by fibrous
tissue in the process of
healing of damaged skin.
Scars are of two types-
hypertrophic and
atrophic.
Eg:- acne, burns, herpes
zoster, keloid
Acne scar

53. scar of herpes zoster Burn scar

54. Keloid:- area of overgrowth of fibrous tissue that
usually develops after healing of skin injury
&extends beyond the original defect

55. Atrophy
• It is reduction in size
and number of skin
cells.
• It may be limited to
epidermis, dermis, or
subcutaneous tissue.
• Eg:- leprosy,
atrophoderma,
lipoatrophy

56. Lichenification
Repeated rubbing of
skin results in
thickening and
hyperpigmentation of
skin
The skin markings
become prominent.
Eg:- Lichen simplex
chronicus, Atopic
dermatitis.

57. Burrow
Comedone
Milia
Telengiectasia
Poikiloderma
Purpura
infarct

58. Burrow
It is a serpentine tunnel
made by scabies mite in
stratum corneum.
The open end of the
tunnel has a papule.

59. Comedone
It is a tiny plug present
at opening of hair
follicle formed by
keratin and sebum
It is of two types: Open
comedone (black head)
and Closed comedone
(white head)

60. Milium
It is a tiny superficial
cyst with epidermal
lining. Milia are seen on
face at periorbital
region.

61. Telengiectasia
It is visible dilataion of
capillaries of skin which
blanch on pressure.
Eg:- Dermatomyositis,
Systemic sclerosis.

62. Poikiloderma
It is a combination of
reticulate telengiectasia,
pigmentary change and
atrophy.
Eg:-
Dermatomyositis,poikilo
derma of civatte

63. Purpura
Extravasation of red
blood cells from
cutaneous vessles in skin
& mucous membrane.
Diascopy- non
blanchable.

64. Infarct
Area of cutaneous necrosis- tender,irregularly shaped
Dusky red-grey macule or firm plaque

65. SHAPES OF PAPULES AND
NODULES
Dome shaped-
Trichoepithelioma.
Flat topped- verruca
plana.
Umblicated- molluscum
contagiosum.
Acuminate-
condylomata acuminata
Verrucous-verruca
vulgaris.

66. Cont..
Pedunculated- skin tags.

67. CONFIGURATION OF LESIONS
Annular- T. corporis,
granuloma annulare.
Round/ discoid-
nummular eczema,
discoid lupus.
Polycyclic- urticaria,
SCLE.
Arcuate- urticaria.

68. Cont…
Linear- scabies burrow,
lichen nitidus. Kobners
phenomenon.
Reticular- livedo
reticularis.
Serpiginous- cutaneous
larva migrans.
Targetoid lesions- with 3
distinct zones. Erythema
multiforme.

69. Cont…
Whorled- incontinentia
pigmenti.

70. ARRANGEMENT OF LESIONS
Grouped/ herpetiform-
HSV-1
Scattered

71. DISTRIBUTION OF LESIONS
Dermatomal/
zosteriform.
Blaschkoid- following
lines of skin cell
migration during
embryogenesis.
Longitudinal on limbs
Circumferential on trunk

72. Lymphangitic- strep. Or
staph cellulitis.
Sun exposed-
Photodermatitis,
PMLE, SCLE
Sun protected-
parapsoriasis, mycosis
fungoides.
Acral-
chilblains,palmoplantar
pustulosis.

73. Truncal
Extensor-psoriasis
Flexor-atopic dermatitis
Intertriginous-
candidiasis.
Localized- cellulitis
Generalized- exanthema,
drug eruptions.
B/L symmetrical- vitiligo
Universal-alopecia
universalis.

74. THANK YOU