Skin lesions

The Primary Lesions Macule Papule Nodule Tumor Plaque

Vesicle Bullae Pustule Wheal Burrow Telangiectasia

MACULE A macule is a change in the color of the skin MACULE A macule is a change in the color of the skin. It is flat, if you were to close your eyes and run your fingers over the surface of a purely macular lesion, you could not detect it. A macule greater than 1 cm. may be referred to as a patch.

Examples of macules include freckles and flat moles.

PAPULE A papule is a solid raised lesion that has distinct borders and is less than 1 cm in diameter. Papules may have a variety of shapes in profile (domed, flat-topped, umbilicated) and may be associated with secondary features such as crusts or scales

Papules are associated with such conditions as warts, syphilis, psoriasis, seborrheic and actinic keratoses, lichen planus, and skin cancer

The plaque on the left lumbosacral area of this 7-year-old boy is a shagreen plaque associated with tuberous sclerosis.

NODULE A nodule is a raised solid lesion more than 1 cm NODULE A nodule is a raised solid lesion more than 1 cm. and may be in the epidermis, dermis, or subcutaneous tissue

keratinous cysts, lipomas, fibromas

This nodule is a basal cell carcinoma on the scalp of a 23-year-old man

TUMOR A tumor is a solid mass of the skin or subcutaneous tissue; it is larger than a nodule. (Please bear in mind this definition does not at all mean that the lesion is a neoplasm.)

VESICLE Vesicles are raised lesions less than 1 cm VESICLE Vesicles are raised lesions less than 1 cm. in diameter that are filled with clear fluid.

This 3-year-old boy has oval vesicles in his palm from hand, foot, and mouth disease

These lesions may be the result of sunburns, insect bites, chemical irritation, or certain viral infections, such as herpes.

BULLAE Bullae are circumscribed fluid-filled lesions that are greater than 1 cm. in diameter

PUSTULE Pustules are circumscribed elevated lesions that contain pus PUSTULE Pustules are circumscribed elevated lesions that contain pus. They are most commonly infected (as in folliculitis) but may be sterile (as in pustular psoriasis

A pustule is usually the result of an infection, such as acne, imptigeo, or boils

Wheal. A skin elevation caused by swelling that can be itchy and usually disappears soon after erupting. Wheals are generally associated with an allergic reaction, such as to a drug or an insect bite

WHEAL A wheal is an area of edema in the upper epidermis

Telangiectasia. Small, dilated blood vessels that appear close to the surface of the skin. Telangiectasia is often a symptom of such diseases as rosacea or scleroderma

TELANGIECTASIA Telangiectasia are the permanent dilatation of superficial blood vessels in the skin and may occur as isolated phenomena or as part of a generalized disorder, such as ataxia telangiectasia.

BURROW Burrows are linear lesions produced by infestation of the skin and formation of tunnels (e.g., with infestation by the scabitic mite or by cutaneous

The Secondary Lesions Scale Crust Atrophy Lichenification Erosion

Excoriation Fissure Ulceration Scar Keloids Petechiae, Purpura, and Ecchymoses

Scale. A dry, horny build-up of dead skin cells that often flakes off the surface of the skin. Diseases that promote scale include fungal infections, psoriasis, and seborrheic dermatitis

Crust. A dried collection of blood, serum, or pus Crust. A dried collection of blood, serum, or pus. Also called a scab, a crust is often part of the normal healing process of many infectious lesions. Erosion. Lesion that involves loss of the epidermis.

EXCORIATION Excoriations are traumatized or abraded skin caused by scratching or rubbing

FISSURE A fissure is linear cleavage of skin which extends into the dermis.

Atrophy. An area of skin that has become very thin and wrinkled Atrophy. An area of skin that has become very thin and wrinkled. Normally seen in older individuals and people who are using very strong topical corticosteroid medication

Scar. Discolored, fibrous tissue that permanently replaces normal skin after destruction of the dermis. A very thick and raised scar is called a keloid Scar. Discolored, fibrous tissue that permanently replaces normal skin after destruction of the dermis. A very thick and raised scar is called a keloid

KELOIDS Keloids are an exaggerated connective tissue response of injured skin that extend beyond the edges of the original wound.

Lichenification. Rough, thick epidermis with exaggerated skin lines Lichenification. Rough, thick epidermis with exaggerated skin lines. This is often a characteristic of scratch dermatitis and atopic dermatitis

Ulcer. Lesion that involves loss of the upper portion of the skin (epidermis) and part of the lower portion (dermis). Ulcers can result from acute conditions such as bacterial infection or trauma

PETECHIAE, PURPURA, AND ECCHYMOSES Three terms that refer to bleeding that occurs in the skin are petechiae, purpura, and ecchymoses. Generally, the term "petechiae" refers to smaller lesions. "Purpura" and "ecchymoses" are terms that refer to larger lesions. In certain situations purpura may be palpable.

In all situations, petechiae, ecchymoses, and purpura do not blanch when pressed. If there is any question, press on the lesions carefully with a glass slide. Don't break the slide or cut the patient

The palpable purpura on the foot of this nearly 3-year-old boy are associated with the disease Henoch-Schönlein Purpura.

The purpura and ecchymosis on the skin of this 12-year-old boy were the presenting symptoms of his acute myelogenous leukemia.

This eschar covers an area of necrosis on the foot of a 15-month-old boy with meningococcemia