Skin Lesions

Shapes and Configurations

1.      Annular-(circular)- tinea corporis (ringworm)

2.      Confluent-lesions run together like urticaria (hives)

3.      Discrete- single lesion alone (skin tag, acne)

4.      Gyrate- twisted, coiled, snakelike

5.      Grouped- clusters of lesions (contact dermatitis- poison ivy)

6.      Linear-scratch, streak, line, or stripe

7.      Target- iris of eye, rings of color (erythema multiforme)

8.      Zosteriform- linear fashion along nerve route (herpes zoster)

9.      Polycyclic-annular lesions grow together (psoriasis)

Primary Skin Lesions

1.      Macule- color change, flat, < 1 cm (freckle)

2.      Patch- macule that is >1cm

3.      Papule- palpable, <1cm, solid, elevated (elevated nevus, wart)

4.      Plaque- joining of papules, >1 cm (psoriasis)

5.      Nodule- solid, elevated, hard or soft, > 1 cm (nevus)

6.      Tumor- >1cm, firm or soft, benign/malignant (lipoma)

7.      Wheal- superficial, raised, irreg. shape, edema (mosquito bite)

8.      Urticaria- wheals together to form extensive rxn, pruritic (hives)

9.      Vesicle- elevated cavity w/ clear fluid, <= 1 cm (blister)

10. Bulla- > 1 cm diameter; superficial, ruptures easily (burn)

11. Cyst-encapsulated fluid-filled cavity (cyst)

12. Pustule- pus in the cavity, elevated (impetigo, acne)

MaculeàPatch

PapuleàPlaque

NoduleàTumor

WhealàUrticaria

VesicleàBulla

Cyst/Pustule

Secondary Skin Lesions (change in primary lesion over time)

A.     Debris on Skin Surface

1.      Crust- thick dry exudate of various colors(scab)

2.      Scale- flakes of skin of various colors (psoriasis, eczema, dry skin)

B.     Break in Continuity of Surface

1.      Fissure- linear crack extending into dermis, dry or moist, (chelosis)

2.      Erosion- scooped out, shallow depression, no scar because not deep

3.      Ulcer-deeper depression into dermis, leaves scar (pressure injury)

4.      Excoriation-self-inflicted abrasion/scratching; superficial; can be crusted (bites)

5.      Scar-permanent fibrotic change, collagen replaces normal tissue (acne, surgical)

6.      Atrophic Scar-depressed skin level w/loss of tissue (striae, surgical)

7.      Lichenification-prolonged, intense scratching, thickened skin (“moss”), (lichen)

8.      Keloid-benign excess of scar tissue beyond sites of original injury (piercing, acne)

Pressure Injuries- occur over bony prominences when circulation is impaired

     Stage 1- Non-Blanchable Erythema-intact, unbroken but red skin, doesn’t blanch

     Stage 2- Partial-Thickness Skin Loss-superficial, shallow, loss of epidermis

     Stage 3- Full-Thickness Skin Loss- extends into subcutaneous tissue, looks like crater

     Stage 4-Full-Thickness Skin/Tissue Loss- all skin layers, exposing bone/muscle/tendon

     Deep Tissue Pressure Injury-Localized, non-blanchable color change- (DEEP)

     PI Caused by Medical Device-injury to skin in shape of medical device (oxygen tubing)

Vascular Skin Lesions

Hemangiomas- caused by benign proliferation of blood vessels in the dermis

1.      Port-wine stain- large, flat macular patch covering face or scalp

2.      Strawberry mark (infantile hemangioma)- 2-3cm, raised bright red area, no blanch

3.      Deep hemangioma- reddish/blue, irregular shape

Telangiectases

1.      Telangiectasia-caused by permanently enlarged/dilated blood vessels that are visible on the skin surface

2.      Spider Telangiectasia- fiery red, star-shaped marking with a solid circular center

3.      Venous lake- blue/purple spot on lip, ear, face

Purpuric Skin Lesions

1.      Petechiae- 1-3mm punctate hemorrhages, round, dark red/purple/brown color

2.      Purpura- extensive patch of petechiae and ecchymoses; >3 mm, flat, red to purple

3.      Ecchymosis- purplish patch from extravasation of blood into the skin, >3 mm

4.      Contusion- (bruise)- injury (trauma) results in hemorrhage into tissues; skin intact

NOTE: A bruise is different from petechiae, ecchymosis, and purpura because these 3 are not caused by blunt force trauma.

Common Skin Lesions in Children (FYI)

1.      Diaper Dermatitis- diaper rash; Red, moist, maculopapular patch

2.      Candidiasis- (yeast)red, moist patches-some scales

3.      Impetigo- moist, thin-roofed vesicles with thin, erythematous base

4.      Atopic Dermatitis (Eczema)- chronic inflammatory skin lesion caused by overstimulated immune system; pruritic, localized patches of eczema; erythema or purplish color depending on race of patient; can be weeping, vesicular, papular, crusts

5.      Varicella (Chickenpox)- Shiny vesicles on an erythematous base are commonly described as the “dewdrop on a rose petal

6.      Rubeola (Measles)-  Red-purple maculopapular blotchy rash; doesn’t blanch

7.      Rubella (German Measles)- Pink, papular rash (similar to measles but paler)

Common Skin Lesions

1.      Primary Contact Dermatitis (poison ivy)

2.      Allergic Drug Reaction- varies

3.      Tinea Corporis (Ringworm of the Body)

4.      Tinea Pedis (Ringworm of the Foot- Athlete’s Foot)

5.      Psoriasis- Chronic plaque psoriasis is a raised, scaly, erythematous patch, with silvery scales that are pruritic and painful

6.      Tinea Versicolor- scaling, round, hypomelanotic patches of pink, tan, or white (thus the name) that do not tan in sunlight, caused by a superficial fungal infection

7.      Herpes Zoster (Shingles)- unilateral vesicles following a dermatomal pattern (nerve path)

8.      Erythema Migrans (seen in Lyme Disease)- bullseye

9.      Labial Herpes Simplex (Cold Sores)-  tight vesicles followed by pustules and produces acute gingivostomatitis with many shallow, painful ulcers

Malignant Skin Lesions

1.      Basal Cell Carcinoma- may start as a small, pink or red papule with a pearly translucent top and overlying telangiectasia (broken blood vessel). Then develops rounded, pearly borders with central red ulcer or looks like large open pore with central yellowing. Most common form of skin cancer; slow but inexorable growth

2.      Squamous Cell Carcinoma- arise from actinic keratoses or de novo. Erythematous scaly patch with sharp margins, 1 cm or more. Develops central ulcer and surrounding erythema

3.      Malignant Melanoma-Usually brown; can be tan, black, pink-red, purple, or mixed pigmentation. Often irregular or notched borders. May have scaling, flaking, oozing texture; various types

Abnormal Conditions of Hair

1.      Toxic Alopecia- patchy, asymmetric balding with severe illness or chemotherapy

2.      Tinea Capitis (Ringworm of Scalp)-rounded, patchy hair loss on scalp, leaving broken-off hairs, pustules, and scales on skin; fungal infection

3.      Traction Alopecia- mechanical hair loss; often seen in black women as the result of trauma from tight braiding, weaves, chemicals, cornrows, barrettes

4.      Seborrheic Dermatitis (Cradle Cap)- thick, yellow-to-white, greasy, adherent scales with mild erythema on scalp and forehead

5.      Folliculitis Barbae (“Razor Bumps”)- superficial inflammatory infection of hair follicles; see multiple pustules, “whiteheads,” with hair visible at center and erythematous base

6.      Pediculosis Capitis (Head Lice)- see nits or mature lice along hairline; evidence of pruritis

7.      Hirsutism- excess body hair in females forming a male distribution (upper lip, face, chest, abdomen, arms, legs); caused by excess circulating androgens

8.      Scabies- Mites form a linear or curved elevated burrow on the fingers, web spaces of hands, and wrists. Highly contagious. Severe itching

Abnormal Conditions of Nails

1.      Paronychia- Red, swollen, tender inflammation of the nail folds

2.      Beau Lines- Transverse furrow, groove or depression across the nail that extends down to the nail bed. Occurs with any trauma- grows out with nail

3.      Splinter Hemorrhages- Red-brown linear streaks from damage to nail bed capillaries; occurs with systemic diseases or nail trauma

4.      Onychomycosis (fungus of nails)- slow, persistent fungal infection of nails; causes change in color, texture, and thickness or nail

5.      Clubbing- Inner edge of nail elevates; nail bed angle is greater than 180 degrees. Distal phalanx looks rounder, wider, and shiny

6.      Pitting- Sharply defined pitting and crumbling of nails with distal detachment- often occurs with psoriasis

7.      Habit-Tic Dystrophy- Depression down middle of nail or multiple horizontal ridges; caused by continuous picking of cuticle

Furuncle and Abscess (Boil)- Red, swollen, hard, tender, pus-filled lesion caused by acute, localized bacterial (usually staphylococcal)