NRS 203 Integumentary 3. Lecture 39

Skin Lesions and Disorders

Key Types of Skin Lesions

  • Macule

    • Definition: Same as freckles, flat area of color change
    • Characteristics:
      • Less than 1 cm in size
      • Examples include freckles, black moles, and petechiae (which can appear as two or three tiny lesions).

  • Papule

    • Definition: A small, elevated lesion
    • Characteristics:
      • Less than 1 cm in size
      • Examples: Warts, elevated moles.

  • Patch

    • Definition: Flat, non-palpable, irregularly shaped lesion
    • Examples: Port wine stain, Mongolian spots (commonly found in babies).

  • Plaque

    • Definition: Elevated, firm lesion with a rough surface
    • Examples: Psoriasis, keratosis (as shown in photographs during the lecture).

  • Wheal

    • Definition: Elevated lesion caused by an allergic reaction
    • Characteristics:
      • Irregular shape with possible surrounding erythema and edema
      • Variable in size, often associated with insect bites or allergic reactions.

  • Nodule

    • Definition: A firm, elevated lesion that is deeper than a papule
    • Characteristics:
      • Generally, 1-2 cm in diameter
      • Example: Lipoma.

  • Tumor

    • Definition: Larger, solid lesion located deeper in the dermis
    • Characteristics:
      • Larger than a nodule
      • Examples: Benign tumors, neoplasms like lymphomas or hemangiomas.

  • Vesicle

    • Definition: Elevated, superficial lesions filled with serous fluid
    • Examples: Seen in chickenpox, shingles, and blisters.

  • Pustule

    • Definition: Elevated lesion filled with pus
    • Examples: Commonly seen with acne or impetigo.

  • Cyst

    • Definition: Elevated, encapsulated lesion that extends into the dermis or subcutaneous layer
    • Example: Sebaceous cyst.

  • Telangiectasia

    • Definition: Fine, irregular lines on the skin
    • Causes: Capillary dilation due to sun exposure, aging, trauma, or conditions such as alcoholism or liver disease. Also found in smokers.
    • Commonly known as spider veins.

  • Scale

    • Definition: Dry skin; associated with various conditions
    • Causes: Drug reactions or dermatitis.

  • Lichenification

    • Definition: Rough, thickened epidermis
    • Characteristics: Typically found on flexor surfaces (ankles, elbows) due to chronic dermatitis.

  • Keloids

    • Definition: Scars that extend beyond the original wound boundaries
    • Characteristics: Form after surgery or injury.

  • Scar

    • Definition: Fibrous tissue that replaces normal skin after injury
    • Characteristics: Can be thin or thick.

  • Excoriation

    • Definition: A scratch or abrasion on the skin.

  • Fissure

    • Definition: Cracks in the skin, such as those caused by athlete's foot
    • Characteristics: Can occur at corners of the mouth.

  • Erosion

    • Definition: Defect in the epidermis after a vesicle ruptures
    • Characteristics: Depressed area following the loss of part of the epidermis.

  • Ulcer

    • Definition: Injury with loss of epidermis and dermis
    • Characteristics: Varies in size, can indicate pressure injury.

  • Crust

    • Definition: Dried serum, blood, or exudate
    • Commonly seen in conditions like impetigo.

  • Atrophy

    • Definition: Thinning of the skin
    • Characteristics: Translucent and paper-like appearance, often associated with aging.

Pressure Injuries

  • Stage 1

    • Definition: Intact skin with non-blanchable redness.

  • Stage 2

    • Definition: Partial thickness loss of dermis
    • Characteristics: Shallow open injury with specific appearance.

  • Stage 3

    • Definition: Full thickness tissue loss extending to subcutaneous fat
    • Characteristics: Bone, tendon, and muscle are not exposed, potential for undermining or tunneling.

  • Stage 4

    • Definition: Full thickness tissue loss with exposed structures
    • Characteristics: High risk for osteomyelitis, often features undermining and tunneling.

  • Unstageable

    • Definition: Full thickness loss with a wound base covered by slough (yellow/tannish) or eschar (brown/black)
    • Characteristics: True depth cannot be determined until the wound base is visible.

  • Suspected Deep Tissue Injury

    • Definition: Intact skin with underlying soft tissue damage
    • Characteristics: Appears purple or maroon, often feels mushy or boggy.

Treatment and Management

  • Medications: Various treatments available for pressure injuries include hydrofiber and aqua-cell debriding agents.
  • Dressings: Transparent dressings like Upsalite and Tegaderm may be applied depending on the type of injury.