Topic I/1) Primary and secondary lesions with examples Flashcards
Primary lesions (with examples):
- Macule
- Papule
- Plaque
- Nodule
- Vesicle
- Pustule
- Wheal
Macule
a circumscribed skin area with altered color, but without any elevation or depression (thus: not a palpable lesion).
patch
macule of over 1,0 cm in diameter is often referred to as a patch
macular exanthem
A rash consisting of macules
macules types
Vitiligo – white macules
- „Café au lait spots” – brown macules
- Mongolian spots – blue macules
- Port wine stains – red macules (permanent vascular abnormalitites)
purpura
If a red macule remains red even under pressure from a glass slide,sign of extravasation of red blood cells – could be a grave sign, e.g. of sepsis)
erythema
redness disappears from pressure, it is just a sign of vascular dilation, e.g. from inflammation
Papule
a superficial, solid lesion, generally considered to be < 0.5 cm in diameter. Most of it is elevated above rather than deep within the plane of the surrounding skin and it is palpable The elevation is caused by deposited material (metabolic or locally produced) or by hyperplasia of cellular elements
different shape of papules
dome-shaped
cone-shaped
flat-topped may consist of multiple, small, closely packed projected elevations known as a vegetation.
Solitary papules
dermal nevus
basal cell carcinoma
nodular melanoma
Multiple papules
1.condyloma acuminata 2. lichen planus 3.syringomas, 4.psoriasis 5.secondary syphilis 6.neurofibromatosis
Plaque
a plateau-like elevation above the skin-surface that occupies a relatively large surface area; > 1.0 cm in diameter,It is frequently formed by a confluence of papules (e.g. as in psoriasis), and is usually well-defined.
Solitary plaques
lichen simplex chronicus, Bowen’s disease, a superficial spreading melanoma etc.
Multiple plaques
psoriasis, mycosis fungoides Lichenification occurs in: atopic dermatitis, eczematous dermatitis, psoriasis and in mycosis fungoides (rare cutaneous T-cell lymphoma)
Nodule
(„small knot”) a discrete, solid, palpable, round or oval (elipsoidal) lesion of the skin measuring up to 1.0 cm in diameter (or long axis). Applies to processes involving any or all levels of the skin (epidermis, dermis, subcutis), and is a general term for any mass, benign or malignan
difference between nodule and papule
The size and depth of involvement
nodules content
Nodules result from inflammatory infiltrates, neoplasms or metabolic deposits in the dermis or subcutis, Nodules may be hard or soft, well- (superficial) or ill- (deep) defined, they may be smooth, dome-shaped, warty or with a crater-like central depression
tumor
A nodule measuring more than 1.0 cm
Solitary nodules
a dermal nevus, a basal cell carcinoma or a nodular melanoma etc.
Multiple nodules
lipomas, metastatic melanomas, metastatic cancer
Vesicle
a circumscribed fluid-filled lesion (blister) less than 1.0 cm in diameter that is usually elevated above the surrounding skin
vesicle types
solitary grouped umbilicated dyshidrotic spongiotic, multi-locular uni-locular
bulla
A fluid filled skin lesion above 1.0 cm in diameter
vesicles-bulla contents
serum (yellowish) or blood (red to black) and may be intraepidermal or may lie in the dermal-epidermal interface
vesicles and bulla causes
herpes simplex, herpes zoster, varicella, bullous pemphigoid, heat trauma (2nd degree burns)
Pustule
s an elevated vesicle filled with pus/purulent exudate which may be white, yellowish, greenish-yellow or hemorrhagic
Causes of pustular lesions
folliculitis barbae impetigo pustular psoriasis smallpox vesicles caused by herpes simplex and herpes zoster viral infections may become pustular.
Wheal
a rounded or flat-topped pale-red papule or plaque that characteristically disappears within 24-48 hours It is due to edema in the superficial dermis (papillary body) and they may be round, gyrate or irregular with pseudopods – changing rapidly in size due to shifting papillary edema
A rash consisting of wheals
urticarial exanthem or urticaria (the hives) and it may be caused by an allergic reaction or an acute infection.
Secondary lesions
Crusts scales erosions ulcers scars fissures lichenification cysts atrophy
crusts
develop when serum, blood or purulent exudate (pus) dries on the skin surface
ecthyma
If a thick crust is accompanied with necrosis of the deeper tissues (e.g. the dermis)
Conditions involving crusts include
impetigo, echtyma
scales
are formed when the outermost epidermal (desquamating) cell layer is proliferating faster than normal. Epidermal cells (keratinocytes) are normally replaced every 27 days, and they are shed imperceptibly. In certain conditions, such as in psoriasis, these cells are produced faster than normal and the epidermis is seen as scales (flakes of stratum corneum).
papulosquamous exanthem.
A rash consisting of papules and scales
Erosions
are defects (superficial denudation) of the epidermis only, not involving the dermis. Erosions are sharply defined, red and oozes serum They always heal without a scar (in contrast to ulcers). Erosions may be superficial (subcorneal) or deep (with a base in the papillary body) Erosions are caused by physical abrasions (excoriations), or develop after the rupture of blisters and bullas
erosion causes
fungal infections (e.g. candidiasis), Eczematous Dermatitis, Herpes Simplex Virus infections, Intertrigo
Ulcers
are skin defects that extend into the dermis or deeper into the subcutis. Ulcers always occur within pathologically altered tissues and they are therefore always secondary phenomena. Ulcers always heal with scar formation
ulcer causes
Ulcers may form in case of syphilis (chancroid), arterial and venous insufficiency, oral and genital ulcers, skin cancers, pyoderma gangrenosum
Scars
are fibrous tissue replacements (connective tissue). Scars may be hypertrophic (keloid formations)and hard or atrophic and soft with loss of tissue.
Fissures
are splittings of the skin surface.
Lichenification
a thickening of the skin surface and an increase of skin markings, usually seen with chronic coalescence of papular lesions, especially atopic eczema.
Cysts
are cavities filled with a fluid, solid or semisolid substance. They may be superficial or deep. usually soft and will regain their shape after compression. Cysts are lined with epithelium and often have a fibrous capsule. They may be red, blue, yellow or clear. Cysts may be congenital or aquired.
Atrophy
refers to the thinning of the layers of the skin, usually the epidermis, but may also affect the dermis and subcutis. Atrophic skin is easily wrinkled and shiny and is commonly seen in elderly pepople.
