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.

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Papules surmounted with scales

are called Papulo-squamous

lesions.

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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

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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

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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!