Skin Lesions

>>firstidentifylesion:
1. Macule
a. Circumscribed,FLATlesionthatdiffersfromsurroundingskinbecauseof
itsCOLOR
b. Capillarydilatation(erythema);extravasatedRBC(purpura),
telangiectasia(PERMANENTdilatationscapillaries),petechiae(small
pinpointpurpura),sugillations(swollenblackandbluemarks)
c. applicationofpressurewithtwoglassslidesoranunbreakableclearlens(
diascopy)onaredlesionisasimpleandreliablemethodfor
differentiatingrednessduetovasculardilatation(erythema)fromredness
duetoextravasatederythrocytesorerythrocyteproducts(purpura).Ifthe
rednessremainsunderthepressureoftheslide,thelesionispurpuric.
d.
2. Papule
a. Smallsolidelevatedlesionlessthan1cm
b. Obliquelightingwithaflashlightinadarkenedroomisoftennecessaryto
detectslightelevation
c. SHAPEAcuminated(pointed)miliariarubra,surmountedwithscale
(secondarysyphilis),domeshaped(molluscumcontagiosum)
d. COLORRedpapules(psoriasis),coppercolor(secondarysyphilis),with
violaceoushue,netlikewhitemarkings(lichenplanus),yellowpapules
(xanthomosis)
3. Plaque
a. Mesalikeelevationthatoccupiesalargersurfaceareaincomparisonwith
itsheight
4. Nodule
a. Epidermal(verrucavulgaris,keratocoacanthoma,basalcellcarcinoma),
epidermaldermal(compoundnevi,malignantmelanoma,invasive
squamouscell),dermal(dermatofibromas),dermalsubdermal,
subcutaneous
5. Wheal
a. roundedorflattoppedpapuleorplaquethatischaracteristically
evanescent,disappearingwithinhours
b. resultfromedemaintheupperportionofthedermis
c. Thewhealproducedinresponsetothestrokingofareddishbrownor
brownishmacule(Darier'ssign)ispathognomonicofurticariapigmentosa
(mastocytosis)
d.
6. Vesicleandbullae
a. Elevated,fluidfilledlessthan0.5cmvesicle,morethanbullae
b. Arisefromcleavagefromvariouslevelsoftheskin

7. Erosions
a. Lossofallportionofviableepidermis
8. Pustules
a. circumscribed,raisedlesionthatcontainsapurulentexudate
9. Cyst
10. Atrophy
a. diminutioninthesizeofacell,tissue,organ,orpartofthebody.
Epidermalatrophyreferstothinningoftheepidermisandisassociated
withadecreaseinthenumberofepidermalcells
11. Ulcers
a.destructionoftheepidermisandatleasttheupper(papillary)dermis
12. scar
13. sclerosis
a. circumscribedordiffuseHARDENINGoftheskin
14. calcinosis
a. hardnodulesorplaques(dermisorsubcutaneoustissue)withorwithout
alterationinskinsurface
15. desquamation
a. abnormalsheddingofstratumcorneum(usuallyepidermiscompletely
replacedafter27days)
>>thendetermineSHAPE,ARRANGEMENTINRELATIONTOEACHOTHER
ANDEXTENT
1. Linear
a. May suggest exogenous cause
b. Koebner phenomenon trauma is followed by new lesion in
otherwise healthy skin (lesion would be identical to those
seen in traumatized skin)
2. Annular
a. Most acute erythemas associated with inflammation
b. Iris/ bulls eye lesion characteristic of erythema
multiforme syndrome
3. Grouped
a. Little diagnostic value unless there is a pattern
4. Reticular
a. Netlike/lacy
b. Livedo reticularis
Distribution of skin lesion can be localized, regionalized, generalized
1. bilateral, symmetric distribution endogenous cause, may
suggest hematogenous dissemination (usually indicative of
hypersensitivity)

2. localized may be with diseases caused by exposure to sunlight

Instrumental and Laboratory Procedures

1. Magnification
a. Hand lens magnifier (7x)
b. Especially helpful in the diagnosis of lupus erythematosus
(follicular plugging and atrophy), wickham striae (lichen
planus), basal cell carcinoma (telangiectasia, translucence)
c. Epiluminescence microscopy differentiates benign and
malignant
2. Woods lamp (long wave, ultraviolet black light)
a. High pressure mercury lamp with a specially compounded
filter made of nickel oxide and silica (woods filter)
b. Opaque to all light except for 320-400 nm band
c. Dermatophytosis in hair shaft
3. Diascopy
a. Firmly pressing a transparent hard flat object over the
surface of the skin lesion
b. Used to determine if red color of a macule or papule is due
to capillary dilatation or purpura (extravasion of blood)
Clinical Signs
1. Dimple sign
a. Useful maneuver in differentiating dermatofibromas from
malignant melanoma
b. Application of lateral pressure with thumb and index finger
results in the formation of a dimple (in dermatofibroma);
elevated if with melanomas
2. Nikolskys sign
a. Refers to the sheetlike removal of the epidermis by gentle
traction that can be observed in several diseases such as
pemphigus vulgaris and toxic epidermal necrolysis
3. Dariers sign
a. Development of an urticarial wheal (urticarial pigmentosa)
4. Auspitz sign
a. Pinpoint dots of blood at tops of ruptured capillaries when
scale is forcibly removed (psoriasis)
Microscope
1. gram
a.
b.

examination
stain/culture
if suspecting bacterial or yeast infection
ulcers and nodules require scalpel biopsy wedge of tissue
consisting of all three layers of the skin, biopsy minced in
sterile mortar and cultured

c. microscope examination of mycelia should be made of

roof of vesicles or advancing border of the scale (10% KOH
tissue, 20%- nails)
2. tzanck test
a. may reveal giant multinucleated cells (Herpes)
Biopsy
- selection of site is important and is usually based on the stage of
eruption
-