Health Assessment Skin and Nails

Macule 

small/flat and non-palpable skin color change; less than 1cm and circumscribed boarder  

Patch

small/flat and non-palpable skin color change; greater than 1cm and irregular boarder  

Papule

Elevated and palpable; circumscribed border and less than 0.5cm

Examples of papule

elevated nevi, warts, lichen planus

Plagues

Elevated and palpable; greater than 0.5cm

Examples of plagues 

Psoriasis and actinic keratosis 

Nodule

elevated and palpable mass that extends deeper into the dermis than papule; 0.5 to 2cm and circumscribed

Examples of Nodules

Keloid, lipoma, poorly absorbed injection, dermatofibroma

Tumor 

elevated and palpable mass that extends deeper into the dermis than papule; greater than 1 to 2cm and do not always have sharp boarders 

Examples of tumors 

Larger lipoma and carcinoma 

Vesicle 

 circumscribed elevated, palpable mass containing serous fluid; less than 0.5cm 

Examples of vesicle

Herpes simplex/zoster, Varicella (chicken pox), poison ivy and second-degree burn

Bulla

 circumscribed elevated, palpable mass containing serous fluid; greater than 0.5cm

Examples of bulla

Pemphigus, contact dermatitis, large burn blisters, poison ivy, and bullous impetigo

Wheal 

elevated mass with transiet borders, often irregular, size and color vary. caused by movement of serous fluid into the dermis 

Examples of wheal

Urticaria (hives) and insect bites

Pustule

pus-filled vesicle or bulla

Examples of pustule

acne, impetigo, furuncles, and carbuncles

Cyst

Encapsulated fluid-filled or semisolid mass and located in the subcutaneous tissue/dermis

Examples of cyst 

sebaceous cyst and epidermoid cyst 

Erosion

 Loss of superficial epidermis that does not extend to the dermis; depressed, moist area.

Examples of erosion

rupture vesicle, scratch mark, and aphthous ulcer (aphthous stomatitis, commonly called a canker sore)

Ulcer

 Skin loss extending past epidermis, with necrotic tissue loss; bleeding and scarring possible.

Examples of ulcers 

stasis ulcer of venous insufficiency (stasis dermatitis with venous stasis ulcer) and pressure injury.

Scar

 Skin mark left after healing of wound or lesion that represents replacement by connective tissue of the injured tissue.

 Young scars are red or purple

 Mature scars are white or glistening.

Examples of scars 

healed wound and healed surgical incision

Fissure

 Linear crack in the skin that may extend to the dermis and may be painful

Examples of fissure

chapped lips or hands and athlete’s foot. Interdigital tinea pedis with fissures and maceration

Petechia

 Round red or purple macule that is 1 to 2 mm in size.

 Secondary to blood extravasation and associated with bleeding tendencies or emboli to skin.

Ecchymosis

 Round or irregular macular lesion Larger than petechial lesion

 Color varies and changes: black, yellow, and green hues.

 Secondary to blood extravasation

 Associated with trauma and bleeding tendencies.

Hematoma

Localized collection of blood creating an elevated ecchymosis (associated with trauma)

Cherry Angioma

 Papular and round, red or purple lesion found on the trunk or extremities.

 May blanch with pressure.

 Normal age-related skin alteration and usually not clinically significant.

Spider Angioma

 Red arteriole lesion with a central body with radiating branches

 Usually noted on the face, neck, arms, and trunk

 Rare below the waist

 Compression of the center of the arteriole completely blanches the lesion.

What is spider angioma associated with?

Liver disease, pregnancy, and vitamin B deficiency

Telangiectasis (venous star)

 Bluish or red lesion with varying shape (spider-like or linear) found on the legs and anterior chest.

 Does not blanch when pressure is applied.

 Secondary to superficial dilation of venous vessels and capillaries and associated with increased venous pressure states (varicosities).

Linear configuration

straight line as in a scratch or streak

example of linear

dermatographism

Annular configuration

circular lesions

example of annular

tinea corporis

Clustered configuration

lesions grouped together 

example of clustered

herpes simplex

Discrete configuration 

individual and distinct lesions

example of discrete 

multiple nevi 

Nummular configuration

coin-shaped lesions

example of nummular 

nummular eczema 

Confluent configuration

smaller lesions run together to form larger lesion

example of confluent

tinea versicolor

Longitudinal ridging  

common with aging, dehydration, iron-deficiency, rheumatoid arthritis, hypothyroidism

Half and half nails 

sign of chronic kidney disease (CKD)- advanced renal disease

Pitting

common with psoriasis, alopecia areata, eczema, reactive arthritis

Koilonychia

also known as spoon nails; common with iron deficiency, trauma, Raynaud's disease

Yellow nail syndrome

common with lymphatic dysfunction, autoimmune disease, respiratory infections (fungal infections, psoriasis, or smoking patients)

Paronychia

infection of skin around the nail