2/13 Dermatologic Dx and Trmt Flashcards by Jullet Han

Primary Lesions

Macule
Patch
Papule
Plaque
Nodule
Tumor
Wheal
Vesicle
Bulla
Pustule

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Secondary Lesions

Scale
Crust
Erosion
Ulcer
Fissure
Scar
Atrophy

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Special Lesions

Excoriation
Comedone (Open, Closed)
Milia
Burrow
Lichenification
Telangiectasia
Petechiae
Purpura

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What is this?

(defining characteristics + examples)

Macule

circumscribed, flat discoloration of skin up to 0.5 cm;
Inflammatory: produced by vasodilation of superficial vessels
Intrinsic pigment deposition; ex: freckles
Extrinsic pigment deposition; ex: tattoos

Ex: café au lait spots in neurofibromatosis 1 , Peutz-Jegher’s syndrome, melanoma

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Patch

circumscribed, flat discoloration of skin larger than 0.5 cm

ex: melisma, tinea versicolor

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Papule

circumscribed, elevated, superficial, solid lesion, up to 0.5 cm; usually broader than it is thick

ex: cutaneous sarcoidsosis, eruptive xanthomas, lichen spinulosis, mulluscum contagiosum, neurofibromas

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Nodule

circumscribed, palpable, solid, round, or ellipsoidal lesion, larger than 0.5 cm (dermal or subcutaneous; most are greater than 1cm and up to 4-5cm)

Ex: soft nodules of neurofibromatosis, nodules of mycobacterium marinum, prurigo nodules with overlying scale

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Plaque

circumscribed, elevated, superficial, solid lesion larger 0.5 cm

ex: necrosis lipoidica diabeticorum, granuloma annulare, urticarial

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What is a tumor?

(defining characteristics + examples)

proliferation of cells or tissues, either benign or malignant. Any of the other primary and secondary terms may be appropriate in the initial description of a tumor; e.g., nodule or plaque. A large nodule is often referred to as a tumor. There are no size specificities for tumor.

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Wheal

a special type of papule or plaque which is the response of the skin to histamine release and is characterized by the classic three features (triple response of Lewis) of edema, erythema, and a flare. The edema fluid is bound, which contrasts this lesion with the vesicle and bulla. A wheal is transitory or evanescent, seldom remaining in one location for more than 3 or 4 hours.

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Vesicle

circumscribed collection of free clear, fluid, less than 0.5cm; fluid can be clear, serous, hemorrhagic, or pus-filled

ex: miliaria crystallina, dyshidrotic dermatitis, leukocytoclastic vasculitis, herpes zoster (chicken pox)

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Bulla

circumscribed collection of free clear, fluid greater than 0.5cm; fluid can be clear, serous, hemorrhagic, or pus-filled

ex: herpes gestationis, toxic epidermal necrolysis, contact dermatitis, IgA dermatosis

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Pustule

circumscribed collections of pus (contains leukocytes and free fluid) which are variable in size, but less than 0.5cm

ex: pustular psoriasis , steroid/medication-induced acne, folliculitis

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Scale

Excess stratum corneum (most superficial layer of skin) that accumulates in flakes or plates, i.e., keratin. Usually white or grey color. Example: Psoriasis

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Crust

collections of dried serum, blood, or purulent exudate, and cellular debris dries on the skin surface– “scab”. Usually yellow-brown when formed from purulent exudate, red-black when formed by blood
Ex: atopic dermatitis, impetigo

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Atrophy

depression in the skin resulting from thinning of the epidermis, dermis, or subcutaneous fat.

Ex: morphea, anteoderma, lichen sclerosus,

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Erosion

localized losses of epidermis. Usually, some superficial dermal tissue loss as well, but superficial or thin in comparison to ulcers and heals without scarring.

Ex: disseminated herpes infection in immunocompromised patient, pemphigus, vesicant exposure

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Ulcer

loss of epidermis plus variable degrees of the dermis. Variable in depth, size, and shape. Heal with scarring.

Ex: pyoderma gangrenosum, disseminated herpes infection in immunocompromised patient, stasis dermatitis

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Fissure

linear losses of epidermis and dermis which have sharply defined, abrupt walls; a slit

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Scar

abnormal formations of connective tissue replacing tissue lost or altered by some pathologic process. Always implies dermal damage. Cicatrix is a synonym. Types:

Atrophic: thinned
Hypertrophic (keloid)
Striae: a stretch mark

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Excoriation

erosions caused by scratching. Often linear distribution or fingernail size.

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Comedone

plugs of sebaceous and keratinous material lodged in the openings of the pilosebaceous follicles. The primary lesions of acne vulgaris. Commonly known as blackheads and whiteheads.

Open comedo: a “blackhead”- an open follicle stuffed with sebaceous and keratinous material.

Closed comedo: a “white head” follicular dilatation not as marked; skin appears to cover the follicular orifice.

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Milia

small, superficial keratin cysts

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What is a burrow?

(defining characteristics + examples)

Study These Flashcards

linear or curvilinear papule that house parasites such as the scabies mite

What is this? (defining characteristics + examples)

Lichenification areas of thickened epidermis. The major sign of the thickening is increased prominence of the skin lines, although scaling and low grade inflammation are usually seen as well

What is this? (defining characteristics + examples)

Telangiectasia dilations of superficial cutaneous vessels. Often linear or branch-like; will blanch ex: rosacea, essential Telangiectasia

What is this? (defining characteristics + examples)

Erythema Localized redness of the skin or mucosa; will blanch (color change is due to increase blood flow, not leakage of blood into the skin as in purpura) Ex: erysipelas, dermatomyositis, early lyme disease

What is this? (defining characteristics + examples)

Erythroderma Generalized redness that may be associated with desqsumation (normal process in which the cornified/outermost layer of the epidermis is sloughed in fine scales or sheets); will blanch (color change is due to increase blood flow, not leakage of blood into the skin as in purpura) Ex: scalded skin syndrome, pityriasis, rubra pilaris, erythrodermic psoriasis

What is this? (defining characteristics + examples)

Ecchymosis Extravasation of blood into the skin or mucous membranes; areas of flat color change my progress from blue-black to brown-yellow- or green; does NOT blanch (blood has leaked outside of the vessels into the surrounding skin Ex: bruise, steroid purpura, purpura fulminans

What is this? (defining characteristics + examples)

Petechiae circumscribed deposits of blood or blood pigments that result from tiny hemorrhages; less than 0.5cm but usually smaller, 1-2mm macules; usually brown in color; does NOT blanch (blood has leaked outside of the vessels into the surrounding skin ex: Rocky mountain spotted fever, subacute bacterial endocarditis

What is this? (defining characteristics + examples)

Purpura circumscribed deposits of blood or blood pigments greater than 0.5cm; usually palpable; violaceous in color; does NOT blanch (blood has leaked outside of the vessels into the surrounding skin ex: acute meningococcemia, Henoch-Schoenlein purpura, vasculitis

How are skin/exams lesions characterized?

Patient description (age, sex, color, general state of health) **Distribution** (generalized, localized, bilateral, symmetrical vs asymmetrical, patchy) **Arrangement** (discrete, confluent, grouped, well/ill-defined) **Configuration or shape** **Primary vs Secondary Characteristics/Quality**(size, shape, color, primary lesions, secondary lesions) **Involvement of the mucous,** **hair, nails**?

what term describes these lesions? | (disk-like, targetoid, or annular)

targetoid (annular = cleared in center, like a ring or donut)

what term describes these lesions? (Itchy, polycyclic, arcuate, or whorled)

polycyclic

what is the primary lesion? | (papule, plaque, macule, patch)

Plaque. Due to scale, could have some flaking off if you scraped. Larger than 1/2 cm, palpable.

What is the secondary lesion? | (erythema, scale, crust, kissing)

Scale. Remember **scale** is a skin product, **crust** is a blood product. Crust may be blood (scab) or serous (like a popped blister)

what color is this lesion? (pink, bright red, red and white, violaceous)

bright red.

what is the morphology of this lesion? | (serpiginous, annular, whorled, linear)

serpiginous

what is the primary lesion? | (macule, papule, vesicle, blister)

Vesicle (blister is not a derm word, papule is not fluid-filled, macule is flat)

morphology of these vesicles? (arcuate, grouped, clumped, serpiginous)

Grouped. (clumped is not a derm word) This is a good example where the description can help the diagnosis. a 3cm plaque of grouped vesicles localized to the forearm is very suggestive of shingles.

definition of a plaque?

anything palpable on the skin greater than 1/2 cm. May be a collection of grouped vesicles as below (shingles). He called this a "3 cm **plaque** consisting of **grouped vesicles**"