Describing lesions

Question 1

How to describe lesions

Answer 1

General observation

1) site
2) number of lesions
3) pattern of distribution and configuration

Describe individual lesions

1) size
2) shape
3) colour
4) primary morphology
5) secondary morphology
6) margin

Question 2

Palpate lesions and feel for:

Answer 2

1) surface 2) consistency 3) mobility 4) tenderness 5) temperature

Question 3

comedone

Answer 3

plug in sebaceous follicle containing altered sebum bacteria and cellular debris: can present as either open (blackheads) or closed (whiteheads)

Question 4

Describe the configuration

Answer 4

target: concentric rings

Question 5

Describe the configuration

Answer 5

annular: like a circle or ring

Question 6

Describe the configuration

Answer 6

discoid: coin shaped/ round lesion

Question 7

Describe the lesion and likely diagnosis

Answer 7

Lesion on the ? which appears wide spread consisting of some larger confluent patches - ecchymoses and some discrete macules - petechiae

pupura in colour

Henoch- Scholein pupura - small vessel vasulitis

Question 8

what does this picture show

Answer 8

diffuse rash

areas of discrete and confluent patches

annular

hypopigmentation - areas of paler skin

Question 9

Describe this lesion

Answer 9

Large erythmatous patch on the right cheek and nose

Question 10

Describe this lesion

Answer 10

Collection of discrete papules

Question 11

Describe this lesion and what do you think it is

Answer 11

Large scaly erythmatous patch spreading across both buttockand down onto the posterior thigh

psoriasis

Question 12

what is this

Answer 12

nodule: solid rasied lesion >0.5cm

Question 13

what are these

Answer 13

vesicle: raised, clear fluid filled lesion <0.5cm

Question 14

what is this

Answer 14

bulla: raised clear fluid filled lesion >0.5cm

Question 15

what are these

Answer 15

pustules: pus containing lesion <0.5cm

Question 16

what secondary morphology does this show

Answer 16

Excoriation: loss of epidermis following trauma

Question 17

What secondary morphology does this show?

Answer 17

Lichenification: well defined roughening of skin with accentuation of skin markings due to chronic itching/rubbing in eczema

Question 18

What secondary morphology does this show?

Answer 18

Crust: rough surface consisting of dried serum, blood, bacteria and cellular debris that has exuded through an eroded epidermis

Question 19

What secondary morphology does this show?

Answer 19

Ulcer: loss of epidermis and dermis

leg ulcers

Question 20

What secondary morphology does this show?

Answer 20

Fissure: epidermal crack often due to excess dryness

Question 21

What is this and what is the cause/ your managment / complications

Answer 21

Eczema Hepecticum - extensive crusted papulers, blisters and erosions,wide spread eruption

complication of atopic eczema

cause: Herpes simplex virus

may be systemically unwell with fever and malaise

Managment: antivirals e.g. aciclovir

AB for bacterial secondary infection

Complications: herpes hepatitis, encephalitis, disseminated intravasuclar coagulation (DIC) and rarely death

DERMATOLOGICAL EMERGENCY

Question 22

What is this

managment

complications

Answer 22

Erythroderma

skin appears inflamed, oedematous and scaly

wide spread erythema

systemically unwell with lymphadenoapthy and malaise

treat underlying cause (Eczema, psorisasis, lymphoma, drugs, idiopathic)

emollients and wet wraps to maintain mositure

topical steroids may relieve inflammation

complications: secondary infection, fluid loss, electrolyte imbalance, hypothermia, high output caridac failure and capillary leak syndrome

Question 23

what is this

Answer 23

Basal cell carcinoma - nodular type

small skin coloured papule or nodule with surface telangiectasia and a pearly rolled edge: lesion may have nectrotic or ulcerated centre

Question 24

What is this

Answer 24

Squamous cell carcinoma

ill defined nodule which may ulcerate

can be keratotic e.g. scaly and crusty

Question 25

What is this

Answer 25

bilateral erythmatous dry scaly patches on antecubital fossas - felxural surfaces can see signs of excoriations which suggests chronic scratching/ rubbing

Question 26

What is this

Answer 26

Psoriasis wide spread, well demarcated discrete erythmatous scaly plaques may be itchy, burning or painful common on extensor surfaces and scalp

Question 27

What is this

Answer 27

basal cell carcinoma pearly traslucnet nodule telangiesctasia

Question 28

What is this

Answer 28

Melaoma ABCDE Asymmetrical irregular Border Colour: dark but only one Diameter: measure with tape mesure evolving; ask patient

Question 29

What is this

Answer 29

Guttate psoriasis small pink plaques of psoriasis on trunk after streptococcal sore throat

Question 30

What is this

Answer 30

papules and pustules acne vulgaris

Question 31

Spot diagnosis

Answer 31

Seborrhoeic warts nonncancerous/bengin requires no treatment reasy or crusty spots appear to be stuck on skin tend to appear at 40+ can be frozen off if bothersome colour varies but often dark brown/black

Question 33

What is this

Answer 33

Varicous eczema affects lower legs common in those with varicose veins poor circulation and venous insufficency can cause