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DR. MALCOLM PINTO ASSISTANT PROFESSOR YENEPOYA MEDICAL COLLEGE YENEPOYA UNIVERSITY Layers of the skin Types of skin lesions Functions of the skin Basics in history taking Morphology Configuration Distribution Primary lesions Secondary lesions Special lesions Primary lesion Definition Macule Flat, circumscribed, change in colour/texture of skin w/o surface elevation /depression (Non palpable)<1 cm Well-demarcated, circumscribed, change in colour of the skin >1 cm Patch Macules Patches Primary lesion Papule Plaque Definition Circumscribed, solid, raised lesion <0.5 cm Circumscribed, solid, plateau-like lesion >0.5 cm Plaque Papule Primary lesion Definition Nodule Solid raised lesion, > 0.5 cm diam + deeper component Cyst Encapsulated lesion with epithelial inner lining containing liquid or semisolid material Nodule Primary lesion Definition Nodule Solid raised lesion, > 0.5 cm diam + deeper component Cyst Encapsulated lesion with epithelial inner lining containing liquid or semisolid material Primary lesion Vesicle Bulla Definition Circumscribed, Fluid filled, raised lesion <0.5 cm Circumscribed, Fluid filled, raised lesion >0.5 cm Primary lesion Vesicle Bulla Definition Circumscribed, Fluid filled, raised lesion <0.5 cm Circumscribed, Fluid filled, raised lesion >0.5 cm Primary lesion Definition Pustule Well-circumscribed, elevated lesion containing visible purulent exudate Abscess Localized accumulation of pus in the dermis/ subcutaneous tissues Primary lesion Definition Pustule Well-circumscribed, elevated lesion containing visible purulent exudate Abscess Localized accumulation of pus in the dermis/ subcutaneous tissues Primary lesion Wheal Telangiectasia Definition Evanescent , edematous , plateau-like elevations of various sizes Persistent dilatation of dermal capillaries, visible as fine, bright-red streaks or in a net-like pattern Primary lesion Wheal Telangiectasia Definition Evanescent , edematous , plateau-like elevations of various sizes Persistent visible dilatation of dermal capillaries, visible as fine, bright-red streaks or in a net-like pattern Primary lesion Purpura Definition Reddish discoloration of skin or mucous membrane, non- blanchable due to extravasation of red blood cells Petechiae : < 0.3 cm Purpura : 0.3–1 cm (3–10 mm) Ecchymoses: > 1 cm Secondary skin lesions Scale Crust Eschar Erosion Ulcer Fissure Excoriation Lichenification Secondary lesion Definition Scale Laminated masses of keratin resulting in perceptible flakes on the skin surface Hardened deposits resulting from drying of serum, blood or purulent exudate on the surface of the skin (F) Crust Secondary lesion Definition Scale Laminated masses of keratin resulting in perceptible flakes on the skin surface Crust Hardened deposits resulting from drying of serum, blood or purulent exudate on the surface of the skin (F) Secondary lesion Fissure Erosion Ulcer Definition Linear, sharply defined , deep cleft through the epidermis or into the dermis Loss of all or portions of the epidermis Full thickness loss of continuity of epidermis plus some portion of the dermis associated with molecular death Secondary lesion Fissure Erosion Ulcer Definition Linear, sharply defined , deep cleft through the epidermis or into the dermis Partial, Focal loss of superficial epidermis Full thickness loss of continuity of epidermis plus some portion of the dermis associated with molecular death Secondary Definition lesion Excoriation Punctate or linear abrasion produced by mechanical means, usually involving only the epidermis Eschar Black, hard crust resulting from tissue necrosis of the epidermis and/or dermis Secondary lesion Lichenification Definition Thickening of the epidermis, hyperpigmentation and accentuation of skin markings in response to prolonged rubbing Secondary lesion Lichenification Definition Thickening of the epidermis, hyperpigmentation and accentuation of skin markings in response to prolonged rubbing Secondary lesion Pokiloderma Definition Pigmentation (Hypo/ Hyper), atrophy, telangiectasia Secondary lesion Sclerosis Induration Definition Diffuse / circumscribed induration of the skin (dermal fibrosis) Firm and thick skin due to dermal involvement Secondary lesion Sclerosis Induration Definition Diffuse / circumscribed induration of the skin (dermal fibrosis) Firm and thick skin due to dermal involvement Secondary lesion Atrophy Definition Loss of tissue characterized by the loss of normal skin markings Special lesion Definition Burrow Wavy, Slightly raised, brownish, tortuous, thread like tunnel in the epidermis that houses scabies mite: Sarcoptes scabiei var hominis Special Lesion Definition Comedone Papule plugging sebaceous follicle , containing sebum and cellular debris Papule with a dilated central opening filled with blackened keratin (open comedo or blackhead) Open Special Lesion Definition Milia A tiny white cyst lined by epithelium containing lamellated keratin Special Lesion Definition Target Lesion These are less than 3 cm diameter 3 zones; Central zone of dusky erythema/purpura Middle paler zone of oedema Outer ring of erythema with a well-defined edge Special Lesion Definition Alopecia Loss of hair from a normally hairy area • Generalised : all over the body • Widespread : involving large areas or extensive • Localized : Restricted to one/ some area or the body • Flexural : Body folds like groin, neck, behind ears, popliteal and antecubital fossa TERMS USED TO DESCRIBE DISTRIBUTION ( The pattern of spread of lesions) • • Extensor : knees, elbows, shins • Pressure areas : Sacrum, buttocks, ankles, heels • Symmetrical : similar distribution on both sides of the midline • Asymmetrical : dissimilar distribution on both sides of the midline • Photosensitive : over areas exposed to the sun • Acral : pertaining to peripheral parts TERMS USED TO DESCRIBE CONFIGURATION ( Pattern or shape of grouped lesions) • Discrete : individual lesions separated from each other • Confluent : Lesions merging together • Linear : In a line • Annular : Like a circle or a ring • Target : Group of rings inside each other ( concentric) • Discoid/ Nummular : Like a coin