Lesion of skin

different types of skin lesions

1. LESIONS OF SKIN DR SUBODH KUMAR SHAH

2. Types Of Lesions

3. Primary Lesions defination : Lesion occurring on non pathological skin(normal skin) which have not been altered by trauma, manipulation (scratching, scrubbing ) . Macule Papule Patch Plaque Nodule Wheal Vesicle Bulla Pustule Cyst

4. Secondary Lesions : defination :Modification of primary skin lesions that result from traumatic injury , evolution from primary lesion or other external factors. Crust Scale Erosion Ulcer Fissure Sinus Scar Atrophy Excoriation Lichenification Infarct

5. Special Lesions Burrow Comedo Milium Striae Target lesion Horn Sclerosis Poikiloderma

6. These lesions may be: Raised Depressed Flat Surface Change Fluid Filled Vascular

7. Papule Solid , well circumscribed, elevated lesion, less than 0.5cm in size, significant portion raised above skin. Formed by 1)Hyperplasia of epidermis , dermis or both E.g : verruca vulgaris 2)Metabolic deposits or cellular infiltrates E.g : xanthelasma

8. Types of Papules A-NODULAR B-SESSILE C-PEDUNCULATED D-FILIFORM E-VERRUCOUS(ROUGH ) F-MAMMILATED FLAT TOPPED PAPULE

9. Filiform Acuminate(pointed) Mammillated ( mammilated naevi ) Pedunculated (skin tag)

10. Umbilicated Dome shaped papule ( molluscum contagiosum )

11. Plaque • Solid plateau-like elevation that occupies relatively large surface area in comparison with its height above the normal skin surface. Has a diameter larger than 0.5cm

12. Types Scaly Plaque : Psoriasis , P.Rosea Lichenified plaque : Lichen Simplex Chronicus Erythematous plaque : Tuberculoid leprosy

13. Nodule Palpable solid round or ellipsoidal lesion larger than 0.5cm diameter Depth of involvement rather than diameter differentiates a nodule from large papule and plaque. PAPULE NODULE SEEN BETTER FELT BETTER

14. Types of Nodules Depending on the anatomic components , primarily involved, nodules are of 5 main types: 1) Epidermal 2) Epidermal- Dermal 3) Dermal 4) Dermal- Subdermal 5) Subcutaneous

15. Nodular basal cell carcinoma(epidermal) Keratoacanthoma

16. Nodular acne X anthoma

17. Cyst An encapsulated cavity or sac lined with true epithelium that contains liquid or semisolid material in a well-defined cavity . May be hard, doughy or fluctuant.

18. Dermoid cyst

19. Wheals a rounded or flat-topped papule or plaque that is characteristically evanescent , disappearing in few hours. Also known as ‘hives’ or ‘ urticaria ’ Usually round ,oval ,annular or serpiginous , pink to red , surrounded by a flare of macular erythema Caused by transient vascular reaction in the upper dermis mainly due to vasodilatation and increased permeability of capillaries

20. Wheal

21. Scar Arises from proliferation of fibrous tissue that replaces previously normal collagen after a wound or ulceration breaches the reticular dermis. Initially it may be pink to red colour , later it may become hypo/ hyper pigmented. Adnexal structures such as hair follicle are absent. They may be: 1)Hypertrophic 2)Keloid 3)Atrophic

22. Hypertrophic Scar Characterized by erythematous, pruritic, raised fibrous lesions. Do not expand beyond the boundaries of the initial injury. May undergo partial spontaneous resolution.

23. Keloid Keloids are the result of an overgrowth of dense fibrous tissue that usually develops after healing of a skin injury. The tissue extends beyond the borders of the original wound, does not usually regress spontaneously(web –like extension). Tends to recur after excision. Clawlike outline of a keloid

24. Atrophic Scar These are thin wrinkled plaques. Cribriform scar is perforated with multiple small pits. E.g. pyoderma gangrenosum

25. COMEDO Comedo is a hair follicle infundibulum that is dilated and plugged by keratin and lipids. Open comedo (Black Heads) : - In this the pilosebaceous unit is open to the surface of the skin with a visible keratinaceous plug. -Black colour of the comedo is due to the oxidized sebaceous content. Closed comedo (White Heads) : In this the follicular opening is unapparent which accumulates whitish keratin due to closed infundibulum.

26. Open comedo

27. Horn: Hyperkeratotic conical mass of cornified cells , arising over an abnormally differentiating epidermis

28. Calcinosis Deposits of calcium in the dermis or subcutaneous tissue may be appreciated as hard , whitish nodules or plaques , with or without visible alteration of skin’s surface. Calcinosis : in dermatomyositis  

29. Erosion An erosion, is a moist, circumscribed, usually depressed lesion that results from loss of all or a portion of the viable epidermis. May result in pin point bleeding in a sieve like fashion. Results from trauma, rupture of vesicles and bullae become or epidermal necrosis. They do not scar on healing unless secondarily infected.

30. Erosion formed after rupture of bulla

31. Ulcer defect that remains after an area of epidermis and at least part of the dermis have been destroyed or removed . Because the dermis is involved, ulcers heal with scarring. Borders may be rolled,undermined , punched out,jagged or angular. Base may be clean, ragged or necrotic .

32. Discharge may be purulent , granular or malodorous. Surrounding skin may be red, purple , pigmented, reticulated, indurated, sclerotic, infarcted

33. Poikiloderma It refers to the combination of - atrophy - telangiectasia - pigmentary changes(hypo- &hyper-)

34. S inus It is a tract connecting deep suppurative cavities to each other or to the surface of skin. a cavity or track with a blind ending .

35. Striae These are linear depression of the skin that usually measure several cms in length Result from changes in reticular dermis that occur with rapid stretching of the skin .

36. Burrow It is a wavy thread like tunnel( Serpinginous tunnel ) through the outer portion of epidermis made by parasite( Scabetic mite). About 5mm in length

37. Sclerosis Diffuse or circumscribed induration or hardening of the skin that results from dermal fibrosis. Skin may feel board- like,immobile and difficult to pick up .

38. Macule Definition : Flat, circumscribed skin discoloration that lacks surface elevation or depression, less than 1 cm in diameter

39. TYPES 1) Hypopigmented : due to decrease in number of melanocytes or the amount of pigment they produce E.g. : tuberous sclerosis , nevus achromicus , etc nevus achromicus

40. 2) Depigmented : due to complete loss of melanocytes E.g.: vitiligo , halonaevus 3) Hyperpigmented : due to excess production of melanin in skin E.g.: freckles or chloasma

41. Erythema Blanchable pink to red colour of skin or mucous membrane. Caused by increased blood flow through the skin due to capillary dilatation. Easily blanched by pressure E.g : macular viral and drug rash

42. Erythroderma Generalized deep redness of the skin involving more than 90% of the body surface within days to weeks. E.g. drug reaction

43. Crust Crusts result when serum, blood, or purulent exudate dries on the skin surface Colour of crust when formed from - serous dried secretion- yellow - purulent secretion - tubid green or yellow-green - haemorrhagic secretion - reddish-black

44. Scale Scale is flat plate or flake arising from the outermost layer of the stratum corneum . Can range in size from fine dust like particles to extensive parchment like sheets.

45. Types of Scales Crack-like/ Craquele Desquamation giving the appearance of dried,cracked skin. E.g.Eczema Craquele ( Asteatotic eczema/ Winter eczema)

46. 2) Exfoliative : Scales split of from the epidermis in finer scales or on sheets. E.g.Drug Reaction( Exfoliative dermatitis)

47. 3) Follicular: Scales appear as keartotic plug ,spines or filaments. E.g.Keratotic Pilaris

48. 4) Gritty: Densely adherent scales with a sand paper texture. E.g.Actinic Keratosis

49. 5) Ichthyosiform : Scales are regular polygonal plates arranged in parallel rows or diamond patterns(fish-like). E.g. Ichthyosis vulgaris

50. 6) Keratotic / Hyperkeratotic : Scales appear as heaped-up column of scales. E.g. Cutaneous Horn

51. 7) Lamellar: Scales are thin large plates or shields attached in the middle and looser around the edges. E.g.Lamellar Ichthyosis

52. 8) Pityriasiform : Scale is small and branny. E.g. Pityriasis Rosea

53. 10) Seborrheic: Scales are thick, waxy or greasy, yellow to brown, flakes. E.g. Seborrheic Dermatitis

54. Keratoderma Keratoderma is excessive accumulation of scales(hyperkeratosis) that results in a yellowish thickening of the skin usually on palms and soles . May be inherited (abnormal keratin formation) or acquired(mechanical stimulation)

55. Excoriation Punctate or linear excavation of epidermis produced by mechanical means(scratching). Caused by scratching with fingernails in a variety of disease E.g : Atopic dermatitis , Scabies

56. Fissure Linear cleft in the skin through the epidermis and part of dermis. May be single or multiple ranging from microscopic to a few millimeters having well defined margins . They occur most commonly when skin is dry and thickened due to inflammation . Commonest sites a) tips and flexural creases of thumb , finger and palms b) edges of heel c)clefts between fingers and toes d) angle of mouth, lips, nares, auricles and anus

57. Lichenification Focal area of thickened skin produced by chronic scratching or rubbing which may resemble tree bark. Clinically triad of Accentuation of skin markings Thickening of epidermis Hyperpigmentation Eg : Lichen Simplex Chronicus (usually seen superimposed on pruritic conditions)

58. E schar Circumscribed, adherent, hard, black crust on the surface of the skin. Presence of an eschar implies tissue necrosis, infarction, deep burns, gangrene or other ulcerating process.

59. Vesicle and Bulla Elevated ,superficial well circumscribed lesion containing clear fluid , less than 0.5 cm in diameter is known as Vesicle A vesicle larger than 0.5 cm is known as Bulla. They can arise by separation of skin at different levels i.e a) intraepidermal e.g. Pemphigus foliaceus b) supra basal e.g Pemphigus vulgaris c) dermoepidermal e.g. Bullous Pemphigoid

60. vesicles Bulla

61. Pustule Well-circumscribed, elevated lesion containing visible purulent exudate. Composed of leukocytes with or withuot cellular debris and may contain bacteria or may be sterile.

62. Furuncle Deep necrotizing folliculitis with suppuration. Presents as an inflamed follicle-centered nodule greater than 1cm. Several furuncles coalesce to form “carbuncle”.

63. Abscess An abscess is a localized collection of pus below the skin(dermis or subcutaneous tissue). It is erythematous, warm, tender, fluctuant nodule. Pus in an abscess is usually not visible and do not have well-defined lining as cyst.

64. Purpura / Ecchymoses : Purpura is discoloration of the skin or mucous membranes due to extravasation of red blood cells. Petechiae are small purpuric lesions usually 1–2 mm (occasionally up to 4 mm) across, often occurring in crops. Ecchymoses or bruises are larger extravasations of blood

65. Telangiectasia Persitent , dilatation of small capillaries in the superficial dermis disappear with pressure Visible as fine,bright , non pulsatile red lines or network like patterns on skin E.g : Scleroderma Rosacea

66. Infarct An area of cutaneous necrosis resulting from a bland or inflammatory occlusion of blood vessels in skin. Presents as a tender, irregularly shaped dusky reddish gray macule or firm plaque that may b depressed. E.g. cholesterol emboli

67. Target lesions Pathognomic to erythema multiforme Three zones: 1) central area of dusky erythema or purpura 2)middle pale edematous zone 3)outer ring of zone of erythema These are less than 3 cm in diameter

68. Milia Milia are small superficial cyst with an epidermal lining Occur on face especially in periorbital region.

69. Thank you