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Q U I C K R E F E R E N C E G U I D E 7

NURSING STANDARD VOLUME 13 NUMBER 46 1999

Identifying and classifying common skin lesions are important skills innursing assessment. This guide should allow you to describe themusing appropriate nursing/medical terminology.

A monthly series of quick reference guides to tear out

and keep. Whether you are a student nurse, need to

update your skills or are teaching others the guides will

be a useful aid to your practice

Dermatological conditions

1. NURSING ASSESSMENT

Much of the language in dermatology is Latin inorigin creating problems with comprehension and

communication, and for nursing assessment. Also,

nurses must rely on visual and tactile assessment to

guide diagnosis, management and nursing care.

Both factors mean that a detailed dermatological

history must be taken systematically. Six main

headings should be used:

I General health to identify exacerbating

conditions or problems (eg. asthma or hayfever,

which are strongly associated with atopic

eczema)

I History of present skin condition including time

of onset, site of onset and details of spread,

distribution and appearance (eg. size, shape,

colour, dry or wet) of rash or lesions associatedsymptoms (eg. pruritus)

I Past history of skin disorders/medical conditions

I Family history of skin conditions

I Social and occupational history (information

about hobbies, work and travel can aid diagnosis

and influence management, and identify

aggravating or improving factors)

I Current drug therapy (both for skin disorder andother conditions).

2. PRIMARY AND SECONDARYLESIONS

Primary lesion applies to the original lesion

presenting, which can change over time into a

secondary lesion (eg. a blister developing into an

erosion and becoming encrusted in herpes

infections).

Primary and secondary lesions can be described in

terms of five features:

I SizeI Shape (eg. nummular [coin-shaped], annular

[ring-like], oval, discoid [disc-like])

I Contours

I Colour

I Characteristics.

Macule (0.5cm)

Papule Plaque

Vesicle Bulla

FissureErosion

Ulcer

Epidermis

Dermis

Primary lesions and related terminology

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Dermatological conditionsExamples of primary lesions and their features

include:

I Macule completely flat change in skin

colour/texture are distinguishing featuresI Papule solid, raised lesion, < 0.5cm in diameter

(eg. comedones, or blackheads, of acne)

erythematous, flesh coloured, pigmented or

showing loss of pigmentation

I Plaque superficial, solid raised lesion, > 2cm in

diameter (eg. large red, raised, scaly lesions in

plaque psoriasis)

I Pustule pus-filled, yellow- or white-topped

lesion

raised and erythematous

I Vesicles fluid-filled blisters, < 0.5cm in diameter

I Bullae fluid-filled blisters, > 0.5cmin diameter

I Nodule small mass or tumour, < 0.5cm in

diameter

can be benign or malignant, therefore,should be described as a nodule until diagnosis of

malignant tumour made

major signs of malignant melanoma are

change of shape, size and colour, and other

signs are itch, erythema, crusting and bleeding

most benign pigmented lesions are of

uniform size, shape and colour

I Weal oedematous reaction in dermis (eg.

urticaria, hives or nettle rash reaction)

often erythematous (weal and flare reaction)

urticarial weals can be intensely itchy

I Angioedema diffuse, widespread reaction with

oedema extending to subcutaneous tissue

associated with urticarial-type reactions

I Haemorrhagic lesions described according toshape and size of lesion

petechiae are tiny, usually flat, pinhead-size

lesions (macules)

purpura describes slightly larger haemorrhagic

lesions (macules or papules)

ecchymosis is more widespread bleeding

haematomas result from gross bleeding into

skin, with pain and swelling

telangiectasis are tiny, spider-like

capillaries visible on the skin.

Primary and secondary lesions can be present

simultaneously as in herpes zoster. Some of the

more common secondary lesions and their features,

include:I Erosion total or partial loss of epidermis

does not leave scarring on healing

I Ulcer complete loss of epidermis and partial

loss of dermis

scarring can occur on healing

I Excoriation caused by scratching

can result in erosions or ulcers

I Fissures slits in skin which can extend into

dermis

I Scale flake of skin on the primary lesion

scaling is a diagnostic factor in psoriasis

I Atrophy follows loss or thinning of epidermis,

dermis or subcutaneous tissues

skin appears white, papery and translucent with

loss of surface markingsI Striae linear lesions

can appear atrophic, deep purple or pink

result of changes in connective tissue

often from misuse of topical steroid therapy

I Pigmentation hypo- or hyperpigmentation can

occur after healing of primary lesion.

Q U I C K R E F E R E N C E G U I D E 7

NURSING STANDARD VOLUME 13 NUMBER 46 1999

Comedones of acne

PustulesDiscoid eczema

Vesicles on foot Acne nodule/cyst

Macule

Herpes zoster Sarcoma

Ashton R, Leppard B (1993) Differential Diagnosis in Dermatology.

Second edition. Oxford, Radcliffe Medical Press.

DeWitt S (1990) Nursing assessment of the skin and dermatologic

lesions. Nursing Clinics of North America. 25, 1, 235-245.

Hunter JAA et al (1989) Clinical Dermatology. Oxford, Blackwell

Scientific.

Further reading