Topic I/1) Primary and secondary lesions with examples

Question 1

Primary lesions (with examples):

Answer 1

1. Macule
2. Papule
3. Plaque
4. Nodule
5. Vesicle
6. Pustule
7. Wheal

Question 2

Macule

Answer 2

a circumscribed skin area with altered color, but without any elevation or depression (thus: not a palpable lesion).

Question 3

patch

Answer 3

macule of over 1,0 cm in diameter is often referred to as a patch

Question 4

macular exanthem

Answer 4

A rash consisting of macules

Question 5

macules types

Answer 5

Vitiligo – white macules

• „Café au lait spots” – brown macules
• Mongolian spots – blue macules
• Port wine stains – red macules (permanent vascular abnormalitites)

Question 6

purpura

Answer 6

If a red macule remains red even under pressure from a glass slide,sign of extravasation of red blood cells – could be a grave sign, e.g. of sepsis)

Question 7

erythema

Answer 7

redness disappears from pressure, it is just a sign of vascular dilation, e.g. from inflammation

Question 8

Papule

Answer 8

a superficial, solid lesion, generally considered to be < 0.5 cm in diameter. Most of it is elevated above rather than deep within the plane of the surrounding skin and it is palpable The elevation is caused by deposited material (metabolic or locally produced) or by hyperplasia of cellular elements

Question 9

different shape of papules

Answer 9

dome-shaped

cone-shaped

flat-topped may consist of multiple, small, closely packed projected elevations known as a vegetation.

Question 10

Solitary papules

Answer 10

dermal nevus

basal cell carcinoma

nodular melanoma

Question 11

Multiple papules

Answer 11

1.condyloma acuminata 2. lichen planus 3.syringomas, 4.psoriasis 5.secondary syphilis 6.neurofibromatosis

Question 12

Plaque

Answer 12

a plateau-like elevation above the skin-surface that occupies a relatively large surface area; > 1.0 cm in diameter,It is frequently formed by a confluence of papules (e.g. as in psoriasis), and is usually well-defined.

Question 13

Solitary plaques

Answer 13

lichen simplex chronicus, Bowen’s disease, a superficial spreading melanoma etc.

Question 14

Multiple plaques

Answer 14

psoriasis, mycosis fungoides Lichenification occurs in: atopic dermatitis, eczematous dermatitis, psoriasis and in mycosis fungoides (rare cutaneous T-cell lymphoma)

Question 15

Nodule

Answer 15

(„small knot”) a discrete, solid, palpable, round or oval (elipsoidal) lesion of the skin measuring up to 1.0 cm in diameter (or long axis). Applies to processes involving any or all levels of the skin (epidermis, dermis, subcutis), and is a general term for any mass, benign or malignan

Question 16

difference between nodule and papule

Answer 16

The size and depth of involvement

Question 17

nodules content

Answer 17

Nodules result from inflammatory infiltrates, neoplasms or metabolic deposits in the dermis or subcutis, Nodules may be hard or soft, well- (superficial) or ill- (deep) defined, they may be smooth, dome-shaped, warty or with a crater-like central depression

Question 18

tumor

Answer 18

A nodule measuring more than 1.0 cm

Question 19

Solitary nodules

Answer 19

a dermal nevus, a basal cell carcinoma or a nodular melanoma etc.

Question 20

Multiple nodules

Answer 20

lipomas, metastatic melanomas, metastatic cancer

Question 21

Vesicle

Answer 21

a circumscribed fluid-filled lesion (blister) less than 1.0 cm in diameter that is usually elevated above the surrounding skin

Question 22

vesicle types

Answer 22

solitary grouped umbilicated dyshidrotic spongiotic, multi-locular uni-locular

Question 23

bulla

Answer 23

A fluid filled skin lesion above 1.0 cm in diameter

Question 24

vesicles-bulla contents

Answer 24

serum (yellowish) or blood (red to black) and may be intraepidermal or may lie in the dermal-epidermal interface

Question 25

vesicles and bulla causes

Answer 25

herpes simplex, herpes zoster, varicella, bullous pemphigoid, heat trauma (2nd degree burns)

Question 26

Pustule

Answer 26

s an elevated vesicle filled with pus/purulent exudate which may be white, yellowish, greenish-yellow or hemorrhagic

Question 27

Causes of pustular lesions

Answer 27

folliculitis barbae impetigo pustular psoriasis smallpox vesicles caused by herpes simplex and herpes zoster viral infections may become pustular.

Question 28

Wheal

Answer 28

a rounded or flat-topped pale-red papule or plaque that characteristically disappears within 24-48 hours It is due to edema in the superficial dermis (papillary body) and they may be round, gyrate or irregular with pseudopods – changing rapidly in size due to shifting papillary edema

Question 29

A rash consisting of wheals

Answer 29

urticarial exanthem or urticaria (the hives) and it may be caused by an allergic reaction or an acute infection.

Question 30

Secondary lesions

Answer 30

Crusts scales erosions ulcers scars fissures lichenification cysts atrophy

Question 31

crusts

Answer 31

develop when serum, blood or purulent exudate (pus) dries on the skin surface

Question 32

ecthyma

Answer 32

If a thick crust is accompanied with necrosis of the deeper tissues (e.g. the dermis)

Question 33

Conditions involving crusts include

Answer 33

impetigo, echtyma

Question 34

scales

Answer 34

are formed when the outermost epidermal (desquamating) cell layer is proliferating faster than normal. Epidermal cells (keratinocytes) are normally replaced every 27 days, and they are shed imperceptibly. In certain conditions, such as in psoriasis, these cells are produced faster than normal and the epidermis is seen as scales (flakes of stratum corneum).

Question 35

papulosquamous exanthem.

Answer 35

A rash consisting of papules and scales

Question 36

Erosions

Answer 36

are defects (superficial denudation) of the epidermis only, not involving the dermis. Erosions are sharply defined, red and oozes serum They always heal without a scar (in contrast to ulcers). Erosions may be superficial (subcorneal) or deep (with a base in the papillary body) Erosions are caused by physical abrasions (excoriations), or develop after the rupture of blisters and bullas

Question 37

erosion causes

Answer 37

fungal infections (e.g. candidiasis), Eczematous Dermatitis, Herpes Simplex Virus infections, Intertrigo

Question 38

Ulcers

Answer 38

are skin defects that extend into the dermis or deeper into the subcutis. Ulcers always occur within pathologically altered tissues and they are therefore always secondary phenomena. Ulcers always heal with scar formation

Question 39

ulcer causes

Answer 39

Ulcers may form in case of syphilis (chancroid), arterial and venous insufficiency, oral and genital ulcers, skin cancers, pyoderma gangrenosum

Question 40

Scars

Answer 40

are fibrous tissue replacements (connective tissue). Scars may be hypertrophic (keloid formations)and hard or atrophic and soft with loss of tissue.

Question 41

Fissures

Answer 41

are splittings of the skin surface.

Question 42

Lichenification

Answer 42

a thickening of the skin surface and an increase of skin markings, usually seen with chronic coalescence of papular lesions, especially atopic eczema.

Question 43

Cysts

Answer 43

are cavities filled with a fluid, solid or semisolid substance. They may be superficial or deep. usually soft and will regain their shape after compression. Cysts are lined with epithelium and often have a fibrous capsule. They may be red, blue, yellow or clear. Cysts may be congenital or aquired.

Question 44

Atrophy

Answer 44

refers to the thinning of the layers of the skin, usually the epidermis, but may also affect the dermis and subcutis. Atrophic skin is easily wrinkled and shiny and is commonly seen in elderly pepople.