Professional Documents
Culture Documents
Patch
A patch refers to a large area of color change, with smooth surface.
Papule
Papules are small palpable lesions. The usual definition is that they
are less than 0.5 cm diameter, although some authors allow up to
1.5 cm. They are usually visibly raised above the skin surface, and
may be solitary or multiple.
Papules may be sessile, pedunculated, filiform, or verrucous.
Primary skin lesions
Plaque
A plaque is a palpable flat lesion greater than 0.5 cm diameter. Most
plaques are elevated, but a plaque can also be a thickened area
without being visibly raised above the skin surface.
Nodule
A nodule is an enlargement of a papule in three dimensions (height,
width, length).
Vesicle
Vesicles are small blisters less than 0.5cm diameter. They are fluid-
filled papules, and may be single or multiple.
Pustule
A pustule is a purulent vesicle. It is filled with neutrophils, and may
be white, or yellow. Not all pustules are infected.
Primary skin lesions
Bulla
A bulla is a large fluid-filled blister. It may be a single compartment
or multiloculated.
Wheal
A wheal is an edematous papule or plaque caused by swelling in the
dermis. Whealing often indicates urticaria.
Purpura
Purpura is bleeding into the skin. This may be as petechiae (small
red or brown spots), or as ecchymoses (bruises).
Telangiectasia
Telangiectasia is the name given to prominent cutaneous blood
vessels.
Secondary skin lesions
Scaling
Scaling is an increase in the dead cells on the surface of the skin
(stratum corneum). The scale can be psoriatic-type (large white or
silver flakes), pityriasis-type (branny powdery scale), or lichenoid
(tightly adherent to skin surface).
Lichenification
Lichenification is caused by chronic rubbing which results in
palpably thickened skin with increased skin markings and lichenoid
scale. It occurs in chronic eczema eg. atopic dermatitis or lichen
simplex.
Exfoliation
Exfoliation is the stratum corneum peeling off, usually occurring after
acute inflammation.
Secondary skin lesions
Crusting
Crust occurs when plasma exudes through an eroded epidermis. It
is rough on the surface and is yellow or brown in color. Bloody crust
appears red, purple or black.
Excoriation
An excoriation is a scratch mark. It may be a linear erosion or a
picked scratch. Excoriations may occur in the absence of a primary
dermatosis.
Erosion
An erosion is caused by loss of the surface of a skin lesion, it is a
shallow moist or crusted lesion.
Secondary skin lesions
Fissure
A fissure is a thin crack within epidermis or epithelium, and is due to
excessive dryness.
Ulcer
An ulcer is full thickness loss of epidermis or epithelium. It may be
covered with a dark-colured crust called an eschar.
Erythroderma
Erythroderma is a term used to indicate red skin over the entire
body.
A 10-year-old girl with atopic dermatitis
reports itching that has recently become
relentless, resulting in sleep loss. Her mother
has been reluctant to treat the girl with
topical corticosteroids, because she was told
that they damage the skin, but she is
exhausted and wants relief for her child.
Class 1--superpotent
Betamethasone dipropionate = Diprolene gel/ointment, 0.05%; Diflorasone diacetate = Psorcon ointment, 0.05%
Clobetasol propionate = Temovate cream/ointment, 0.05%; Halobetasol propionate = Ultravate cream/ointment, 0.05%
Class 2--potent
Mometasone furoate = Elocon ointment, 0.1%; Amcinonide = Cyclocort ointment, 0.1%;
Betamethasone dipropionate = Diprosone ointment, 0.05%; Desoximetasone = Topicort cream/ointment, 0.25%; gel
0.05%; Fluocinonide = Lidex cream/ointment, 0.05%; Halcinonide = Halog cream, 0.1%
Class 3--upper mid-strength
Betamethasone dipropionate = Diprosone cream, 0.05% Betamethasone valerate = Valisone ointment, 0.1%
Diflorasone diacetate = Florone, Maxiflor creams, 0.05% Triamcinolone acetonide = Aristocort cream, 0.5%
Fluticasone propionate = Cutivate ointment, 0.05%
Class 4--mid-strength
Mometasone furoate = Elocon cream, 0.1%; Desoximetasone = Topicort LP cream, 0.05%;
Fluocinolone acetonide = Synalar-HP cream, 0.2%; Synalar ointment, 0.025%;
Flurandrenolide = Cordran ointment, 0.05%; Triamcinolone acetonide = Aristocort, Kenalog ointments, 0.1%
Class 6--mild
Alclometasone dipropionate = Aclovate cream/ointment, 0.05%; Triamcinolone acetonide = Aristocort cream, 0.1%;
Desonide = DesOwen cream, 0.05%,Tridesilon cream, 0.05%
Fluocinolone acetonide = Synalar cream/solution, 0.01%; Betamethasone valerate= Valisone lotion, 0.1%
Class 7--least potent
Hydrocortisone (0.5, 1.0, 2.5%) = Cortaid, Cortizone 10 (OTC), 2.5% (Hytone) is Rx only
A 3-month-old girl developed an
asymptomatic scaly red eruption in the
diaper area and the face. The lesions in the
diaper area were well circumscribed and red-
orange in color.
multiple widespread
round to oval 1-3
cm almost confluent
plaques
An 18-year-old boy was evaluated for facial
acne. He had multiple open and closed
comedones and a few red papules and
pustules on his malar and temporal areas.
Erythematous,
hyperpigmented
scaly plaques
centered on the
inguinal creases and
extending down the
medial thighs
A 20-year-old man had an extensive itchy
rash involving the soles, undersurfaces of
the toes, and web spaces of both feet.
Well-demarcated
hypopigmented
macules with
minimal scale
Pityriasis versicolor
Pityriasis versicolor
Red macules
Brown macules