H&P of Derm Patient

Question 1

Primary Lesion

Answer 1

physical changes in the skin caused directly by the disease process-types of primary lesions are rarely associated with a single disease entity

Question 2

Secondary lesions:

Answer 2

may arise from primary lesions or from external causes

Line between primary and secondary is often hard to define

Question 3

Primary Lesions (name them)

Answer 3

Macule 				
Patch
Papule
Nodule
Tumor
Plaque
Papilloma
Urticara (wheal, hive)
Vesicle
Bulla
Pustule
Abscess
Purpura
Telangiectasia
Comedo (clogged hair follicle)
Cyst

Question 4

Secondary Skin Lesions (name them)

Answer 4

Lichenification
Crust
Erosion
Ulcer
Excoriation
Atrophy
Scar
(SACULEE)

Question 5

Macule

Answer 5

flat, colored lesion

Question 6

Patch

Answer 6

PATCH: large, > 0.5 cm flat lesion with a color different from the surrounding skin (i.e., large macule)
Examples: port-wine stain, tattoo, infections, drug eruptions

Question 7

Papule

Answer 7

solid lesion,

Question 8

Nodule

Answer 8

solid, firm lesion 0.5 to 1.0 cm in diameter raised above the surface of the skin (i.e., large papule)
Example: lipoma, fibroma, keratinous cyst, erythema nodosum, neoplasm

Question 9

Tumor

Answer 9

solid, firm lesion > 1 cm above the surface of the skin

Question 10

Plaque

Answer 10

flat-topped raised lesion > 1 cm with distinct edges (psoriasis) or gradually blend with surrounding skin (eczema)-coalescence of papules

Question 11

Vesicle

Answer 11

fluid-filled lesion,

Question 12

Bulla

Answer 12

fluid-filled raised, translucent lesion > 0.5 cm

Example: friction blister, bullous pemphigoid, bullosis diabeticorum

Question 13

Bulla and vesicles can occur in different layers…

Answer 13

1. subepidermal-bullous pemphigoid
2. subcorneal-impetigo
3. subgranular cell layer-friction blister
4. spongiotic-contact derm and acute T. pedis (intercellular edema in epidermis)
   Epidermal layers: “Colleges/ Like Good/ Strong Beer/”

Question 14

Pustule

Answer 14

a vesicle filled with leukocytes or pus

Question 15

Abscess

Answer 15

pus-filled lesion > 0.5 cm (large vesicle)-usually indicates infection
Example: paronychia

Question 16

Cyst

Answer 16

raised, encapsulated lesion
Originates from invagination of epidermis into dermis
Process continues until lesion detaches from epidermis and becomes completely lined by epidermis
Example: inclusion cyst

Question 17

Wheal

Answer 17

raised, erythematous papule or plaque, usually representing short-lived dermal edema
Example: allergic reaction to drugs, insect bites, sensitivity to cold, heat, pressure, sunlight
Angioneurotic edema: larger localized area of edema

Question 18

TELANGIECTASIA

Answer 18

dilated, superficial blood vessel

Example: scleroderma, long-term topical steroid therapy, necrobiosis lipoidica diabeticorum

Question 19

Purpura

Answer 19

general term referring to extravasated blood and can also be considered a macule

Question 20

CRUST

Answer 20

dried exudate of body fluids that may be either yellow (serous) or red (hemorrhagic)
Example: acute tinea pedis

Question 21

EROSION

Answer 21

loss of epidermis without an associated loss of dermis

Example: pemphigus, herpes viruses

Question 22

ULCER

Answer 22

loss of epidermis and at least a portion of the underlying dermis
Example: diabetic neurotrophic ulcer

Question 23

EXCORIATION

Answer 23

linear, angular erosions that may be covered by crust and are caused by scratching
Example: venous stasis dermatitis

Question 24

ATROPHY

Answer 24

acquired loss of substance which may appear as a depression with intact epidermis or as a site of shiny, delicate, wrinkled lesions
Example: topical steroid usage, atrophie blanche

Question 25

SCAR

Answer 25

change secondary to trauma or inflammation-may be erythematous, hypopigmented, or hypertrophic Example: keloid