Describing lesions Flashcards
How to describe lesions
General observation
1) site
2) number of lesions
3) pattern of distribution and configuration
Describe individual lesions
1) size
2) shape
3) colour
4) primary morphology
5) secondary morphology
6) margin
Palpate lesions and feel for:
1) surface 2) consistency 3) mobility 4) tenderness 5) temperature
comedone
plug in sebaceous follicle containing altered sebum bacteria and cellular debris: can present as either open (blackheads) or closed (whiteheads)
Describe the configuration
target: concentric rings
Describe the configuration
annular: like a circle or ring
Describe the configuration
discoid: coin shaped/ round lesion
Describe the lesion and likely diagnosis
Lesion on the ? which appears wide spread consisting of some larger confluent patches - ecchymoses and some discrete macules - petechiae
pupura in colour
Henoch- Scholein pupura - small vessel vasulitis
what does this picture show
diffuse rash
areas of discrete and confluent patches
annular
hypopigmentation - areas of paler skin
Describe this lesion
Large erythmatous patch on the right cheek and nose
Describe this lesion
Collection of discrete papules
Describe this lesion and what do you think it is
Large scaly erythmatous patch spreading across both buttockand down onto the posterior thigh
psoriasis
what is this
nodule: solid rasied lesion >0.5cm
what are these
vesicle: raised, clear fluid filled lesion <0.5cm
what is this
bulla: raised clear fluid filled lesion >0.5cm
what are these
pustules: pus containing lesion <0.5cm
what secondary morphology does this show
Excoriation: loss of epidermis following trauma
What secondary morphology does this show?
Lichenification: well defined roughening of skin with accentuation of skin markings due to chronic itching/rubbing in eczema
What secondary morphology does this show?
Crust: rough surface consisting of dried serum, blood, bacteria and cellular debris that has exuded through an eroded epidermis
What secondary morphology does this show?
Ulcer: loss of epidermis and dermis
leg ulcers
What secondary morphology does this show?
Fissure: epidermal crack often due to excess dryness
What is this and what is the cause/ your managment / complications
Eczema Hepecticum - extensive crusted papulers, blisters and erosions,wide spread eruption
complication of atopic eczema
cause: Herpes simplex virus
may be systemically unwell with fever and malaise
Managment: antivirals e.g. aciclovir
AB for bacterial secondary infection
Complications: herpes hepatitis, encephalitis, disseminated intravasuclar coagulation (DIC) and rarely death
DERMATOLOGICAL EMERGENCY
What is this
managment
complications
Erythroderma
skin appears inflamed, oedematous and scaly
wide spread erythema
systemically unwell with lymphadenoapthy and malaise
treat underlying cause (Eczema, psorisasis, lymphoma, drugs, idiopathic)
emollients and wet wraps to maintain mositure
topical steroids may relieve inflammation
complications: secondary infection, fluid loss, electrolyte imbalance, hypothermia, high output caridac failure and capillary leak syndrome
what is this
Basal cell carcinoma - nodular type
small skin coloured papule or nodule with surface telangiectasia and a pearly rolled edge: lesion may have nectrotic or ulcerated centre
What is this
Squamous cell carcinoma
ill defined nodule which may ulcerate
can be keratotic e.g. scaly and crusty
What is this
bilateral erythmatous dry scaly patches on antecubital fossas - felxural surfaces
can see signs of excoriations which suggests chronic scratching/ rubbing
What is this
Psoriasis
wide spread, well demarcated discrete erythmatous scaly plaques
may be itchy, burning or painful
common on extensor surfaces and scalp
What is this
basal cell carcinoma
pearly traslucnet nodule
telangiesctasia
What is this
Melaoma
ABCDE
Asymmetrical
irregular Border
Colour: dark but only one
Diameter: measure with tape mesure
evolving; ask patient
What is this
Guttate psoriasis
small pink plaques of psoriasis on trunk
after streptococcal sore throat
What is this
papules and pustules
acne vulgaris
Spot diagnosis
Seborrhoeic warts
nonncancerous/bengin
requires no treatment reasy or crusty spots appear to be stuck on skin
tend to appear at 40+
can be frozen off if bothersome
colour varies but often dark brown/black
What is this
Varicous eczema
affects lower legs
common in those with varicose veins
poor circulation and venous insufficency can cause
