H.A chapter 14 pt 2

Erosion

Loss of superficial epidermis that does not extend to the dermis.

• It is a depressed, moist area. Examples include rupture vesicle, scratch mark, and aphthous ulcer (aphthous stomatitis, commonly called a canker sore, pictured below).

Erosion image

Ulcer

Skin loss extending past epidermis, with necrotic tissue loss.

Bleeding and scarring are possible.

Examples include stasis ulcer of venous insufficiency (stasis dermatitis with venous stasis ulcer, pictured below) and pressure injury.

Ulcer image

SCAR (CICATRIX)

healing of wound or lesion that represents replacement by connective tissue of the injured tissue.

• Young scars are red or purple, whereas mature scars

  • white or glistening. Examples include healed wound and healed surgical incision.

Scar Cictrix image

Fissure

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

Examples include chapped lips or hands and athlete’s foot.

Interdigital tinea pedis with fissures and maceration is pictured below.

Fissure image

Vascular Skin Lesions

Vascular skin lesions are associated with bleeding, aging, circulatory conditions, diabetes, pregnancy, and hepatic disease, among other problems.

Petechia

• tiny pinpoint bleeding spots.

• Definition: Tiny pinpoint spots (≤2 mm) caused by small capillary bleeding.

• Appearance: Red, purple, or brown dots; flat and don’t blanch (don’t turn white when pressed).

• Causes: Platelet problems (low platelet count, clotting disorders), trauma (like tight tourniquet, coughing, vomiting).

Petechia image

Ecchymosis

• larger bruise-like bleeding under skin.

• Definition: Larger area of bleeding under the skin, >1 cm.

• Appearance: What we usually call a “bruise.” Color changes over time (red → purple/blue → yellow/green → brown).

• Causes: Trauma (most common), bleeding/clotting disorders, medications (like anticoagulants).

Ecchymosis image

Hematoma

• Definition: A collection (pool) of blood under the skin, tissue, or organ due to vessel rupture.

• Appearance: Swollen, raised, painful lump; can be firm or fluctuant depending on size.

• Causes: More significant trauma, surgery, or vessel injury.

Hematoma image

Cherry Angioma

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

It may blanch with pressure. It is a normal age-related skin alteration and usually not clinically significant.

Cherry Angioma image

Spider Angioma

Red arteriole lesions with a central body and thin branches

• Found on face, neck, arms, and upper chest

• Rare below the waist

• Associated with liver disease, pregnancy, and vitamin B deficiency

Spider Angioma image

Telangiectasis

Blush or red lesion with varying shape (spider-like or linear)

• Does not blanch with pressure

Cause/Pathophysiology: Due to superficial dilation of venules vessels and capillaries.

• Common Locations: Legs, anterior chest.

• Associated Conditions: States of increased venous pressure (e.g., varicosities, venous hypertension).

Telangiectasis image

Malignant melanoma

can be deadly if not discovered and treated early, which is one reason why professional health assessment and skin self-assessment can be life-saving procedures.

ABCDE

A for asymmetrical;

B for borders that are irregular (uneven or notched);

C for color variations;

D for diameter greater than 1/4 in. or 6 mm; and E for evolution (changes over time)

Basal Cell Carcinoma

Squamous cell Carcinoma 

Most dangerous

Melanoma image

Configurations of skin lesions

Describing lesions by shape, distribution, or configuration is one way to communicate specific characteristics that can help identify causes and treatments.

Linear configuration example dermatographism

Annular configuration example tiena corporis

Clustered configuration, lesions grouped together. An example is herpes simplex

Discrete configuration individual distinct lesions. An example is multiple nevi

Nummular configuration, coin-shaped lesions. An example is nummular eczema

Confluent configuration

Smaller lesions run together to form larger lesions. Example is tiena versicolor

Longitudinal ridging parallel ridges running lengthwise. May be seen in the elderly and some people with no know etiology

Half-and-half nails. Nails that are white on the upper proximal half and pink on the distal half

May be seen the chronic renal disease

CKD

Pitting seen with psoriasis

Koilonychia, 

Spoon-shaped nails that may be seen with trauma to cuticles or nail folds or in iron deficiency anemia, or endocrine or cardiac disease

iron-deficiency anemia

Yellow nail syndrome

Nails grow slow and are curved

May be seen in AIDs and respiratory syndromes

Paronychia, local infection