Skin Lesions

skin lesion

common and usually manifest due to localized damage to the skin, or due to an underlying condition

primary and secondary

two types of skin lesions

primary skin lesion

arise from previously healthy skin and are linked to a particular cause

secondary skin lesion

- originate from the progression of a primary skin lesion
- can be due to its treatment or due to traumatic manipulation, including rubbing or scratching

- blisters
- macule
- nodule
- papule
- pustule
- rash
- wheals
- patch

types of primary skin lesions

- crust
- ulcer
- scale
- scar
- skin atrophy

types of secondary skin lesions

blister

fluid-filled bubble under the skin, where the clear, watery liquid inside called serum leaks in from neighboring tissues as a result of injury in the skin

vesicles

small blisters, while those larger than an inch are bullae

- irritation
- allergies
- infections
- skin diseases
- medications

possible causes of blisters

macule

a small patch on the skin that is not elevated but is different in color than the surrounding skin

hypomelanotic (ash leaf) macules

- aka hypopigmented macules
- patches of skin that are lighter than the surrounding area
- vary in shape but are commonly lance shaped or elliptical
- harmless white spots that are often seen in patients with Tuberculosis Sclerosis Complex

cafe-aut-lait macules

- aka circumscribed café-au-lait hypermelanosis, von Recklinghausen spot, or abbreviated as 'CALM'."
- "common birthmark, presenting as a hyperpigmented skin patch with a sharp border and diameter of \>0.5 cm.
- may be isolated or linked to systemic diseases like neurofibromatosis (NF), Legius syndrome, McCune Albright syndrome, and Noonan syndrome with multiple lentigines syndrome

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T/F
Café-au-lait macules are associated with genetic syndromes such as Watson syndrome, Bloom syndrome, and Silver-Russell syndrome.

nodule

- an "elevated, solid, palpable lesion \> 1 cm usually located primarily in the dermis and/or subcutis"
- greatest portion of the lesion may be exophytic or beneath the skin surface
- most common causes are infections, thyroid hormones, iodine deficiency, and lymphadenopathy

- Sebaceous cyst
- Lipoma
- Basal cell carcinoma
- Warts
- Xanthoma
- Acrochordons

common causes of nodules

papule

an elevated, solid lesion that is ≤ 1 cm in diameter and can be palpated

acne papule

- Solid, inflamed bumps that are typically conical without a white or yellow pus-filled tip
- Usually smaller than 1 cm and may be either the same color as the skin or red, brown or purple
- Most common during adolescence but can also affect adults

- oil (sebaceous) glands produce too much oil
- increased presence of bacteria on your skin.
- increased presence of a group of sex hormones called androgens.
- some medications, such as corticosteroids and anabolic steroids, can cause acne papules.

common causes of acne papules

fibrous papules

- common and are often a solitary lesion around the nose area
- shaped like a dome, firm, non-tender, 1-6mm in diameter, and typically develop during late adolescence and early adulthood
- can occur without an underlying condition
- harmless but widespread and in great number, often extending beyond the nasal area

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*fibrous papules

T/F
Acne papules are not connected to genetic conditions such as tuberous sclerosis, Birt-Hogg-Dubé syndrome, and multiple neuroendocrine neoplasia type 1 (MEN1).

pustule

- "circumscribed lesion that contains pus"
- frequently seen in adolescents and are usually manifestations of underlying disorders, including acne and folliculitis
- can appear anywhere in the body but are typically located on the face, chest, and back

- bacterial infection
- viral infection
- fungal infection
- parasitic skin infection
- non-infectious causes

common causes of pustules

rashes

- the skin becomes red, inflamed, and bumpy
- some are dry and itchy, while others are painful

- Environmental Allergens
- Bacterial infections, such as strep throat
- Skin conditions like eczema
- Irritants
- Viruses

causes of skin rashes

- contact dermatitis
- eczema
- hives
- psoriasis
- viral

types of skin rashes

wheals

- also known as Hives, are often characterized by a raised, itchy rash
- can be both acute and chronic

acute hives

last 6 weeks or less and can be caused by an allergen or irritant, such as eating or touching a nettle

chronic urticaria

type of hives
- a long-term condition
- might be a symptom of an autoimmune disorder or a chronic medical condition
- experience hives everyday for months or even years

- Allergens
- Physical trigger, such as extreme temperatures
- Underlying health condition
- Sometimes they happen for no apparent reason

hives can develop in repsonse to:

T

T/F
If a person has hives, they are at risk of developing anaphylaxis, a potentially fatal condition.

patch/plaque

- macule or papule larger than 1⁄2 inch (

crust

- dried fluid or exudates on the skin
- filled with sebum, pus, and bloodfilled with sebum, pus, and blood and the color of it gives us a hint about its cause

sebum

yellow crusts

pus

yellow-green crusts

blood

red or brown crusts

Oval/Round shape

crust from bulla or pustule

Linear shape

crust from excoriations

ulcer/skin ulcer

- open wound, with a thick and raised outer border caused by poor blood circulation
- most commonly encountered on the skin and subcutaneous tissue of the lower extremities

scale

- loss of the outer layer of the epidermis
- dry, horny, platelike excrescence which is usually the result of imperfect cornification
- usually a symptom of underlying or associated conditions such as allergic eczema, athlete's foot, contact dermatitis, and psoriasis.

scar

- mark left in our skin after the healing of an injury or wound. It is a part of our body's natural healing process
- form when the dermis is damaged

- keloid scars
- hypertrophic
- contractures
- adhesions

types of scars

keloid scars

- thick, rounded, irregular clusters of scar tissue that form at the site of a wound on the skin but extend beyond the wound's borders
- made up of collagen

hypertrophic scars

- are similar to keloids but they grow within the confines of the original skin defect, they may be more responsive to treatment
- usually thick and raised, may appear red as well
- commonly occurs to the burn patients who have second-degree deep burn or severe burns

contactures

unusual occurrence that occurs when a large area of skin is damaged and lost, leaving a scar

adhesions

scar-like bands of tissue that form between two surfaces within the body and cause them to stick together

skin atrophy

- a decrease in dermal thickness
- usually a manifestation of aging

acne

skin condition that occurs when your hair follicles become plugged with oil and dead skin cells

- Excessive oil production in the pores
- Build-up of dead skin cells in the pore
- Bacterial growth in the pore

causes of acne

- whiteheads
- blackheads
- papules
- pustules/pimples
- nodules
- sever nodular acne/cystic acne

types of acne

whiteheads

hair follicle plugs that remain beneath the skin and cause a white bump

blackheads

- plugged follicles that reach the skin's surface and open up
- appear black on the skin's surface due to air discoloration of the sebum, not because they are dirty

papules

inflamed lesions that appear as small, pink bumps on the skin and are tender to the touch

pustules/pimples

Papules with white or yellow pus-filled lesions at the base that may be red

cold sore

cluster of painful, tiny blisters caused by the herpes simplex virus (HSV)

fever blisters

are also known as herpes simplex labialis

herpes simplex

- skin infection caused by a virus
- lasts a lifetime and causes painful or itchy sores and blisters that appear and disappear

- Herpes simplex 1 (HSV-1; oral herpes)
- Herpes simplex 2 (HSV-2;genital herpes)

types of herpes simplex

actinic keratosis

a rough, scaly patch of skin caused by years of sun exposure

eczema

- lesions that take the form of erythematous papules, often with overlying vesicles, which ooze and become crusted
- coalesce into raised, scaling plaques over time.

- Allergic contact dermatitis
- Atopic dermatitis
- Drug-related eczematous dermatitis
- Photoeczematous dermatitis
- Primary irritant dermatitis

subtypes of eczema

impetigo

- superficial infections associated with puncture wounds that are caused by bacteria such as Pseudomonas aeruginosa
- bacterial infection characterized by an accumulation of neutrophils beneath the stratum corneum that often produces a subcorneal pustule

bullous impetigo

A less frequent bullous variant of pediatric impetigo

psoriasis

a common chronic inflammatory dermatosis

- plaque psoriasis
- guttate psoriasis
- inverse psoriasis
- pustular psoriasis
- erythrodermic psoriasis

classifications of psoriasis

chicken pox

- an infection caused by the varicella-zoster virus
- causes an itchy rash with small, fluid-filled blisters

shingles

an acute infection of the peripheral nervous system caused by herpes zoster, the virus that also causes chickenpox

- prodromal
- eruptive

two stages of shingles

sebacous cyst

- also known as Epidermoid cysts
- is a dome-shaped, protein-filled, slow-growing mass that can move easily under the skin
- white or yellow

MRSA (staph) infection

Infections are common after Staphylococcus aureus is inoculated into an open wound.

- Hospital-associated (HA) MRSA
- CA-MRSA

two types of staph MRSA infection

cellulitis

a frequent and possibly dangerous bacterial skin infection

scabies

not an infection, but an infestation, and also known as sarcoptic mange.

- traditional
- crust (Norweigan)
- nodular

types of scabies

boils

a painful, pus-filled bump that develops beneath the skin, in which when bacteria infect and inflame one or more of hair follicles

carbuncle

collection of boils that unite to form an infected region beneath the skin

bullae

a fluid-filled sac or lesion, develops when fluid becomes trapped beneath a thin layer of skin; type of blister

- blood blisters
- friction blisters
- heat blisters

types and associated causes of blisters

- lymph node nodules
- vocal cord nodules
- lung nodules
- thyroid nodules

types and associated causes of nodules

hives

- also known as urticaria
- itchy, raised welts that are found on the skin and are usually red, pink, or flesh-colored

warts

raised bumps on skin caused by the human papillomavirus (HPV)

- common warts
- plantar warts
- flat warts
- filiform warts
- periungal warts

types of warts

- pressure ulcer
- diabetic ulcer
- venous wound
- arterial wound
- surgical wound

types of wounds

pressure ulcer

a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction

diabetic ulcer

- developed due to the peripheral circulatory disturbance
- usually affect the lower extremities, particularly the feet

venous wound/ulcer

- result of chronic venous hypertension, due to severe varicose veins or congestive heart failure
- most oftenly affect the elderly

arterial wound/ulcer

- due to atherosclerosis of peripheral artery, especially associated with diabetes

surgical wound

caused by purposeful or surgical incision