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primary lesions
macule
patch
papule
plaque
nodule
tumor
wheal
vesicle
bullae
pustule
macule
<1 cm
no elevation
no fluid
color change from surrounding skin
patch
1+ cm
no elevation
no fluid
color change from surrounding skin
large macule
papule
circumscribed
solid elevation
no visible fluid
<1 cm
plaque
broad papule
1+ cm
flat top elevation
no fluid
nodule
large papule
1+ cm but typically less than 2cm
elevation possible but can also be centered in dermis or SQ fat
no fluid
tumor
large nodule
2+ cm
elevation possible but can also be centered in dermis or SQ fat
no fluid
wheal (hives)
evanescent
edematous
plateau like elevation
blanching
no fluid
any size
vesicle
circumscribed
fluid filled
epidermal elevation
< 1 cm
no blanching
bullae
large vesicle
1+ cm
elevation
no blanching
fluid filled
pustule
small elevation containing purulent material
no blanching
fluid filled
small
secondary lesions
scale
crust
erosion
ulcer
fissure
scar
scale
dry/greasy laminated mass of keratin
pathologic exfoliation
appear silver if air trapped
crust
dried serum, pus, or blood
serum: yellow
purulent exudate: green, yellow-green
blood: brown, dark red, or black
erosion
loss of all, or portions, of epidermis alone
may or may not crust
heals w/o scar
ulcer
local excavation of surface of an organ or tissue
complete loss of epidermis and some portion of dermis
heals with some degree of scarring
fissure
crack or cleft thru epidermis or into dermis
scar
new connective tissue that has replaced lost substance in dermis or deeper parts due to injury or disease
can be depressed or thickened, lighter or darker
keloid
exuberant proliferation of scar tissue beyond the limits of the original injury
distribution
dermatomal pattern
grouping
characteristic of certain diseases
configurations
linear: lesions in lines
annular: forms a complete circle
targetoid: forms a target
arcuate: forms a portion of a circle
polycyclic: several intersecting portions of circles
serpiginous: not straight, but also does not form circle
guttate: round lesions like small drops
nummular: larger coin-like lesions
color
hypopigmented: appears lighter than surrounding skin due to loss of only part of pigment
hyperpigmented: appears darker than surrounding skin
depigmented: true loss of pigment of skin
erythematous: red lesions, sometimes blanching
violaceous: deep purple, red lesions
purpuric: nonblanching erythematous vascular lesions
consistency
hard: Ca2+ deposit
firm: fibrous tumor or keloid
soft: lipoma (fatty and squishy)
fixed/nonmovable: LN is suggestive of cancer
freely movable: movable w/ palpation such as normal LN
fluctuant: fluid filled such as large cyst filled w/ pus, feels if pushed too hard will pop like balloon
blanches: turns lighter in color when pressed gently before resuming its natural
nonblanching: does not turn color when gently pressed, suggests purpuric lesions
verrucous: rough surface, like a wart
hyperesthesia/anesthesia
painful
burning
tender to palpation
decreased sensation
telangiectasia
dilated cutaneous blood vessel
purpura
brownish or purplish macules due to multifocal extravasation of blood into skin or mucus membranes
types of purpura
petechiae
ecchymosis
hematoma
petechiae
superficial, pinhead (<3mm), round, hemorrhagic, nonblanching macule
ecchymosis
flat, irregularly, shaped nonblanching, blue-purplish patch due to deeper and more extensive interstitial hemorrhage
hematoma
fluctuant nodule that is due to pool-like collection of blood in tissue
atrophy
thinning or depression of skin due to reduction of underlying tissue
striae
depressed lines or bands of thin, reddened skin which later become white, smooth, shiny, and depressed due to stretching of the dermis
cyst
papule or nodule filled with debris that has a lining or sac
comedone
primary lesion of acne
open: flat or slightly elevated papule w/ dilated central opening filled w/ blackened keratin
blackhead
closed: 1mm yellowish papules
whitehead
abscess
confined collection of pus w/in dermis and deeper skin tissue
painful, tender, fluctuant, erythematous nodules
furuncle
acute, round, tender, circumscribed, perifollicular abscess that generally ends in central suppuration
carbuncle
deep multicompartment abscess along fascia that erupts at multiple adjacent sinuses, often appearing as 2+ confluent furuncles
burrow
linear lesion in stratum corneum secondary to scabies mite
lichenification
thickening of skin due to repeated irritation, often from scratching
excoriation
punctate or linear abrasion produced by mechanical means, often from scratching