Morphologic skin lesions
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Transcript of Morphologic skin lesions
MORPHOLOGIC
SKIN LESIONS
DR TAHIR KAMAL
FCPS, D.Dsc (UK),
M.A.A.C.S (USA)
MORPHOLOGIC SKIN LESIONS
1. Raised
2. Depressed
3. Flat
4. Surface change
5. Fluid filled
6. Vascular
Morphologic lesions
RAISED LESIONS
PAPULE:
A papule is a solid , elevated lesion
less than 0.5 cm in size in which a signific-
ant portion projects above the plane of surrounding skin.
continue…
Papules surmounted with scales
are called Papulo-squamous
lesions.
continue…
Shapes & surfaces of papule:
Sessile, pedunculated, dome-shaped
Flat topped, rough , smooth , filiform,
mammilated, acuminate, umblicated .
PAPULEPapules in lichen planus
PLAQUE
A solid plateau-like elevation that
occupies a relatively large surface
area in comparison with its height
above the normal skin level and
has a diameter larger than 0.5 cm
NODULE
A circumscribed, solid, round or
ellipsoidal palpable lesion larger
than 0.5 cm in size.
Types of nodule:
Epidermal
Epidermal-dermal
Dermal
Dermal-subdermal
Subcutaneous
Others ( tumor, gumma )
Surface of nodule may be:
Smooth
Keratotic
Ulcerated
fungating
Nodule
Nodular basal cell carcinoma
CYST:
A cyst is an encapsulated cavity
or sac lined with a true epithelium
that contains fluid or semisolid
material ,cell & cell products such
as keratin.
A cyst
Cystic hidradenoma
WHEAL
A wheal is the swelling of skin
that is characteristically
evanescent , disappearing within
hours.
A wheal
SCAR
A scar arises from proliferation of
fibrous tissue that replaces previously normal collagen after a
wound or ulceration breaches the reticular dermis.
Types of scars:
Hypertrophic scar
Keloid scar
SCAR
COMEDO
A comedo is a hair follicle infundibulum
that is plugged with keratin and lipids.
Types:
1-Open comedo
2-Closed comedo
COMEDO
DEPRESSED
LESIONS
EROSION
An erosion is a moist , circumscribed ,
Depressed lesion that results from loss
of a portion or all of the viable epidermal
Or mucosal epithelium.
e.g. TEN
EROSION
ULCER
An ulcer is a defect in which the epidermis
and at least the upper (papillary) dermis
Has been removed.
ULCER
ATROPHY
Atrophy refers to diminution in size of a
Cell, tissue , organ , or part of the body.
- Epidermal atrophy
- Atrophy of panniculus
ATROPHY
POIKILODERMA
It refers to combination of atrophy ,
telangiectasias and various pigmentary
changes over skin.
poikiloderma
SINUS
A sinus is a tract connecting deep
Suppurative cavities to each other
Or to the surface of skin.
Contents :
pus , fluid, keratin etc.
sinus
STRIAE
Striae are linear depression of the skin that
usually measure several cm in length and
result from changes to reticular collagen
that occur with rapid stretching of the skin.
striae
BURROW
A burrow is a wavy , thread like tunnel
through the outer portion of epidermis
excavated by a parasite.
BURROW
SCLEROSIS
It refers to a circumscribed or diffuse
hardening or induration in the skin
that is a result of dermal fibrosis.
SCLEROSIS
FLAT AND
MACULAR
LESIONS
MACULE
A macule is a flat lesion , even with the
surface level of surrounding skin, perceptible
as an area of colour different from the
surrounding skin or mucous membranes
A macule may be:
Hyperpigmented
Hypopigmented
Depigmented
MACULE
PATCH
it is a flat area of the skin or mucous
membrane with a different colour from
its surroundings > 0.5 cm in size.
Patch
ERYTHEMA
Erythema is blanchable change in the
colour of the skin or mocous membranes
that is due to dilatation of arteries and
veins in the papillary and reticularis dermis.
ERYTHRODERMA
it is generalised deep redness of the
skin Involving more than 90% of the
body surface within days to weeks .
Scaling and desquamation generally
follows.
SURFACE
CHANGE
SCALE
It is a flat plate or flake arising from the
outer most layer of the stratum corneum.
Scale
Types of scale :
Crack like
Exfoliative
Follicular
Gritty
Ichthyosiform
Keratotic
continue…
Pityriasiform
Psoriasiform
Seborrheic
lamellar
CRUST
Crusts are the hardened deposits that
result when serum, blood, or purulent
exudate dries on the surface of the skin.
EXCORIATION :
Excoriations are surface exavations of
the epidermis that result from scratching
and are frequent findings in patients
experiencing pruritis .
FISSURE :
A fissure is the linear loss of continuity of
the skin surface or mucosa that results from excessive tension or
decreased elasticity of involved area.
LICHENIFICATION :
Repeated rubbing of skin may induce a
reactive thickening of epidermis with
changes in underlying collagen.
Lichenification
KERATODERMA
It is excessive hyperkeratosis of the stratum
corneum that results in yellowish thickening
of the skin.
ESCHAR:
The presence of eschar implies tissue
necrosis, infarction , deep burns, gangrene
or other ulcerating process.
eschar
FLUID FILLED
LESIONS
VESICLE AND BULLA:
A vesicle is a fluid filled cavity or elevation less than 0.5 cm.
Whereas a bulla measures larger than 0.5 cm.
PUSTULE:
A circumscribed raised cavity in the epidermis or infundibulum
containing pus. The purulent exudate composed of leukocytes
with or without cellular debris , may contain bacteria or sterile.
FURUNCLE:
It is a deep necrotizing folliculitis with
Suppuration.
VACULAR
LESIONS
PURPURA :
Extravasation of red blood from cutaneous vessels into skin or
mucous membrane results in reddish purple lesion.
Petechie:Small , pinpoint pupuric macules.
Ecchymoses:Larger , bruise like pupuric patches.
Plapable purpura:If a lesion is pupuric and palpable.
TELANGIECTASIA :
It is persistent dilatations of small
capillaries in the superficial dermis
that are visible as fine , bright, non_
pulsatile red lines or net like pattern
on skin.
SHAPE
ARRANGEMENT,
AND DISTRIBUTION
OF LESION
SHAPE OF SKIN LESION:
Annular
Round/nummular/discoid
Polycyclic
Arcuate
Linear
Continue…
Serpiginous
Targetoid
Whorled
Reticular
Nummular
ARRANGEMENT
Single
Grouped/ herpetiform
scattered
Arrangement of lesionsa) (b) Grouped pigmented areas in a speckled lentiginous naevus. (c) Grouped vesicles in herpes simplex. (d) Grouped lesions within a mosaic plantar wart
Distribution of multiple
lesions : Dermatomal/zosteriform
Blaschkold
Lymphangitic
Sun exposed
Sun protected
Truncal
Intertiginous
Localized
Generalized
Bilateral/ symmetrical
Universal
Extensor
Pointers &
Pitfalls in
Dermatologic
Diagnosis
Approach each and every evaluation with patience and
thorough diagnosis.
Beware of snap, curbside, or doorway diagnosis.
Examine the entire mucocutaneous surface as well as
hair and nails.
A new or changing mole should be carefully evaluated.
Generalized pruritus of more than one month’s duration
mandates a complete systemic workup.
Drug induced eruptions can mimic most skin conditions.
Beware of the atypical diagnosis. Atypical ‘’this’’ may be
‘’typical’’ that to someone
who has seen it before.
THANK
YOU!