Basic Skin

Lesions
Primary skin
lesions
 Macule

Depending upon the colour

of macule they can be
classified as -hypopigmented/
depigmented macule,
hyperpigmented macule,
erythema, purpura
 Macule:

A macule is a circumscribed
alteration in the colour of the skin¹. A
macule is flat and not palpable.

❖1:ROOK’S TEXTBOOK OF DERMATOLOGY,7th edn

Hypopigmented/ depigmented macule

Idipopathic guttate
Vitiligo hypomelanosis
V
i
t
i
l Lepros
Pityriasis
i y
versicolor
g
 Hyperpigmented Macule

Lentigo Freckle
s

Cafe’-au-lait Melasma
 Erythema

Drug eruption Viral exanthem

 Purpura
Extravasation of red cells from
cuteneous vessels into skin or mucus
membrane results in reddish purple
lesions known as purpura¹. Petechiae
are small pinpoint macule approximately
1-2 mm in diameter. Ecchymosise larger
(>2mm in diameter) purpuric macule.²
❖ 1:Fitzpatric’s DERMATOLOGY IN GENERAL MEDICINE, 7th edn

❖ 2:ROOK’S TEXTBOOK OF DERMATOLOGY,17th edn

 Petechiae and
Ecchymoses

Petechia Ecchymose
e s
 Patch
• An obsolete term now
• Previously used to denote a
macule>0.5 cm in diameter.¹

❖ 1:Fitzpatric’s DERMATOLOGY IN GENERAL MEDICINE,

7th edn
 Papule
A circumscribed palpable
elevation, less than 0.5 cm in
diameter.¹
The term tumour implies a large
nodular lesion.

❖ 1:ROOK’S TEXTBOOK OF DERMATOLOGY,7th edn

 Papule

Psoriatic papule Molluscum contagiosum

Lichen Malignant melanoma

 Papule

Xanthoma

Skin tag
Miliaria
 Papule

Plane wart Pyoderma

granulosum

Verruca vulgaris Condyloma

 Nodule
A solid mass in the skin > 0.5 cm
in diameter, which can be observed as an
elevation or can be palpated.¹
The term tumour implies a large
nodular lesion.²

❖ 1:ROOK’S TEXTBOOK OF DERMATOLOGY,17th ed

❖ 2:IADVL TEXTBOOK AND ATLAS OF DERMATOLOGY
 Nodule

Erythema
Nodosum Prurigo
nodularis
Nodule

Leprosy
nodule
 Plaque
A Plaque is a solid plateau- like elevation that occupies a
relatively large surface area in comparison with its height above the
normal the normal skin level and has a diameter >0.5 cm.¹
Plaque can appear denovo or by the extension or
coalescence of either papule or nodule
The term small plaque is used to describe a plaque<0.5 cm
and those are >0.5 cm in diameter are called large plaques. ²

❖ 1:Fitzpatric’s DERMATOLOGY IN GENERAL MEDICINE, 7th edn

❖ 1 1:ROOK’S TEXTBOOK OF DERMATOLOGY,17th ed
 Plaque

Leprosy(TT)

Granuloma annulare
Tinea
 Plaque

Numular
eczema

Discoid lupus
erythematosus
Psoriatic plaque
 Plaque

Subacute cutenious lupus

erythematosus
 Blisters

Blisters are fluid filled , circumscribed, elevated

lesions, which arise due to a split in skin.¹
• (A circumscribed elevated superficial skin lesion containing
clear fluid) ²
• (Visible acumulations of fluid within or beneath the
epidermis)³
• If <0.5 cm in diameter, they are called vesicles and
• if >0.5 cm in diameter, they are called bulla.³
• 1:Illustrated Synopsis of Dermatology by NEENA KHANNA 2 nd edn
• 2:IADVL TEXTBOOK AND ATLAS OF DERMATOLOGY
• 3:ROOK’S TEXTBOOK OF DERMATOLOGY,17th ed
 Blister
• Depending upon the level of split they can be
divided as

• Subcorneal eg, pemphigus foliaceus, bullous

impetigo
• Intra-epidermal eg, pemphigus vulgaris, Herpes
simplex, Herpes zoster,Varicella, Acute eczema
• Sub-epidermal eg, bullous pemphigoid,
Dermatitis herpetiformis
 The characteristic of bulla
depend on the level of split:
Characteristi Subcorneal Intra Sub epidermal
cs epidermal
Ease of Rupture very Rupture less Persist for
rupture easily easily relatively longer
duration
Flaccidity Very flaccid Relatively Tense
less flaccid
 Intraepidermal blister

Pemphigus
vulgaris

Acute eczema
Varicella
 Sub -epidermal blister

Bullous
pemphigoid Dermatitis
herpetiformis
 Pustule
Pustule is a visible accumulation of free pus
It may occur within a pilosebacious follicle or
a sweat duct or less often on glabrous skin
Most commonly due to staphylococcal
infection; it can be due to candidal
infections or due to number of other
dermatoses characterized by sterile
pustule.
❖ 1:ROOK’S TEXTBOOK OF DERMATOLOGY,7th edn
 Pustule

folliculitis Acne

Impetigo Chicken pox

 Pustule

Herpes simplex

Cadidiasis
Pustular psoriasis
 Cyst

A cyst is an encapsulated
cavity or sac lined with true
epithelium that contain fluid or
semisolid material.¹
❖ 1:Fitzpatric’s DERMATOLOGY IN GENERAL MEDICINE, 7th edn
 Cyst

Epidermal cyst

Acne cyst
Pilar cyst
 Abcess
An abscess is a localized
accumulation of purulent material
so deep in the dermis or
subcutaneous tissue that the pus
is usually not visible on the
surface on the skin.¹
It can be diagnosed clinically from
the signs of inflammation in the
overlying skin, and from its
fluctuation.
Unlike cyst it cavity is not lined
with true epithelium.
Its usually begins as folliculitis
resulting from streptococcal or
staphylococcal infection

❖ 1:Fitzpatric’s DERMATOLOGY IN GENERAL

MEDICINE, 7th edn
 Wheal
• A wheal is a evanescent, erythematous
edematous plaque or papule which are
formed predominantly due to dermal
edema. This is the characteristic lesion of
urticaria.
– Other terminology associated with the same
pathological process are:
o Angio-edema
o Dermographism.
 Wheal

Wheal

Angioedema
Dermographism
Secondary skin
lesions
 Atrophy
Atrophy of skin is a term which is
usually applied to the clinical changes
produced by a decrease in the dermal
connective tissue. Epidermal atrophy may
or may not be associated.
 Atrophy

atrophy is clinically
characterized by –
o Thinnig
o Loss of elasticity
o Fine wrinkling
o Lossof skin marking
o prominance of
underlying veins

Senile atrophy
 Atrophy
Atrophy which includes subcutenious
tissue or even deeper structure is called
panatrophy.
o Epider mal,dermal atrophy
• Tuberculoid leprosy
• Steroid induced
o Dermal atrophy
• Anetoderma
o Panatrophy
• Panniculitis
• Morphea
 Atrophy

Morphea Steroid induced

 Sclerosis
– Sclerosis is diffuse or circumscribed induration of
subcutaneous tissue, as well as dermis.
– Usually associated with epidermal atrophy
– sclerosis is result from laying down of excess
amount of collagen in the dermis and
subcutaneous tissue.
o Lupus vulgaris
o Discoid lupus erythematosus
o Scleroderma
o Chronic follicular pyoderma
 Scale
Abnormal shedding or accumulation
of stratum corneum in visible flakes is
called scaling. ¹
Either due to excessive production
(e.g, psoriasis, pityriasis rubra pilaris,
hyperkeratotic eczema) or due abnormal
retension(e.g, icthyosis)

❖ 1:IADVL TEXTBOOK AND ATLAS OF DERMATOLOGY

 Scale may be shed as-fine to stratified-
Scale may be shed as-fine to stratified-

Psoriasis (silvery) PITYRIASIS

VERSICOLOR(BRANNY)

PITYRIASIS
ROSEA(COLLARETTE)
 Or they may shed in
sheets(desquamation)

STAPHYLOCOCCAL SCALDED SKIN

SYNDROME SCARLET FEVER
 Crust
Crust are accumulation of
inflammatory cells, blood cells, plasma,
fibrin mixed with epithelial debris on the
epithelial surface. When blood form the
major component of crust, then it is known
as scab.
 Crust form as a result of some inflammatory
condition,with oozing or due to rupture of vesicle,
bulla, or pustules

Acute
Tinea capitis
eczema

Pemphigus
Impetigo foliaceus
 Excoriation
• An excoriation is a scratch which removes
the epidermis and hence causes bleeding.
Excoriations are usually linear, superficial.
But it can be sharply circumscribed and
deep.
 Excoriation
• Excoriation are usual
finding in diferrent pruritic
dermatoses and prurigos.
Scabies is an example.
This is predominant
finding in acne,
urticata,and acne
excoree, producing more
damage than the original
dis order(acne)
 Lichenification:
It is a triad of
o Thickening of skin
o hyperpigmentation
o Increase skin marking
It is due to repeated
scratching and is
trypically seen in lichen
simplex chronicus and
atopic dermatitis LICHEN SIMPLEX
CHRONICUS OF
SCROTUM
 Fissure
A fissure is a linear loss of continuity
of the skin's surface or mucosa that results
from excessive tension or decreased
elasticity of the involved tissue.
 Fissure

Candidal intertrigo psoriasis

 Erosion
An erosion is more or less circumscribed
loss of tissue, limited only to epidermis. It
never penetrate beyond dermo-epidermal
junction, so superficial and healed without
scarring .
Eg, pemohigus vulgaris, herpes
simplex,candidiasis
Fissure

Fissures
frequently occur on
the palms and soles
where the thick
stratum corneum is Chronic irritant
least expandable. contact dermatitis of
Transi­tional areas palm and finger
between skin and
mucosa and skin
overlying joints are
susceptible if
elasticity is reduced.

Chelitis
Special skin
lesions
 Telangiectasia
These are chronically dilated
capillaries or small venule that are
visible through the skin or mucus
membrane.¹

❖ 1:ROOK’S TEXTBOOK OF DERMATOLOGY,17th ed

 Telangiectasia

They commonly
represent the effect of
wear and tear on the
skin leading to skin
atrophy-
• Old age
• Light exposed skin
• X ray irradiation
• Steroid induced
Telangiectasia
• They are also
commonly found in
certain connective
tissue disorder-
o Lupus erythematosus
o Dermatomyositis
o Scleroderma

Nail fold telangiectasia in a patient of

dermatomyositis
 Sinus
• Sinus: A sinus is a blind tract
leading from the surface down
to the tissues. The sinus is
lined by granulation tissue
which may be
epithelialized.¹eg,
• Hydradenitis suppurotiva
• Scrofuloderma
• Mycetoma
❖ 1 manual of clinical surgery An sinus involving buttock in a
case of hydradenitis
by S. Das-5th edn.
suppurotiva
 Poikiloderma
A triad of
o Atrophy of skin
o Macular or reticular pigmentation and
o Telangiectasia

❖ 1:ROOK’S TEXTBOOK OF DERMATOLOGY,17th ed

 Poikiloderma
May be
o Congenital
o Acquired
• Cuteneous injury by ionizing
radiation,heat,cold
• Connective tissue disease
Dermatomyositis
Lupus erythematosus
Systemic sclerosis
 Burrow

A burrow is
a wavy, thread like
tunnel through the
outer portion of
epidermis excavated
by a parasite.¹

❖ 1:Fitzpatric’s DERMATOLOGY IN
GENERAL MEDICINE, 7th edn

Scabies burrow
 Milium

A small subepidermal keratin cyst with no visible

opening.¹
o May arire normaly in underdeveloped sebacceous
gland.
o May arised in a proximal part of damaged sweat ducts as a
result of avulsion in
▪ Subepidermal bulla
▪ 2nd degree burn
▪ Epidermolysis bullosa
▪ Porphyria cutenia tarda
▪ Bullous lichen planus

❖ 1:clinical dermatology by THOMAS P. HABIF

 Comedones
A plug of sebaceus and
keratinus material lodged in
the opening in a hair follicle
 Comedones:
Comedones are
inspissated plugs of
keratin and sebum
lodged in dilated
piloseba-ceous
orifices.. Closed comedone
There are 2
types of come­dones:
• Open comedo
• Closed comedo

Open comedone
Thank You