TYPE OF LESION Flat: o o o o Discrete flat lesions Not palpably raised above the skin surface Colour change

e only Surface normal but may have non-palpable fine scaling

Raised: o o

Macule Patch -

<0.5 cm diameter e.g. lentigo, purpura >0.5 cm e.g. vitiligo

Discrete lesions visibly raised above the surface Solid lesions Papule Nodule Plaque <0.5 cm e.g. lichen planus >0.5 cm e.g. BCC raised lesions with a flat top e.g. psoriasis

Fluid filled:

o o o
Normal:

Vesicles - <0.5 cm, clear/serous fluid e.g. chicken pox Bulla >0.5 cm e.g. pemphigoid

Pustule - contain pus, usually <0.5 cm e.g. folliculitis SURFACE FEATURES

larger lesions = abscess

pathology must be in dermis e.g. haemangioma

Abnormal: o Abnormal stratum corneum: Scale e.g. psoriasis Hyperkeratosis - keratin cannot be easily picked off e.g. actinic keratosis Maceration e.g. athletes foot between toes o Broken epidermal surface:

Fissure - small deep but narrow ulcer e.g. anal fissure Changes in thickness to epidermis or dermis

Exudate - occurs on broken skin and comes from body fluids (serum, pus or blood) Crust - dried exudates and overlies an erosion or ulcer, can be picked off e.g. impetigo Erosion - superficial, involves epidermis only e.g. pemphigus Ulcer - extends into dermis e.g. venous leg ulcer

Warty - e.g. seborrheic keratosis Lichenification - secondary to persistent scratching e.g. lichen simplex Epidermal atrophy - characterised by fine tissue paper wrinkling e.g. lichen sclerosus Dermal atrophy - results in thinning of the skin (often with depression) COLOUR

Pink, red or purple - caused by blood

o o o o

Erythema - blood within blood vessels Purpura - blood leaked outside blood vessel

Brown - due to pigment Melanin - varying shades of brown, may be black, blue-grey colour caused by melanin pigment deep in dermis Haemosiderin - follows purpura

Yellow - lipids or bilirubin e.g. jaundice, xanthelasma White - due to lack of pigment DEFINITION Border:

o o o
Centre: o

Well defined - e.g. eczema Poorly defined - e.g. psoriasis Accentuated border - e.g. tinea Uniformly involved Reduced involvement of centre e.g. fungal skin infection Variable

o
o

SHAPE

Surface shape Profile shape -

round, oval, irregular spherical, dome, pedunculated or flat-topped DISTRIBUTION face, trunk, limbs o Flexures/extensors/sparing Arrangement: o Discrete o Coalesce o Grouped o Annular o Linear o Serpiginous

Site -

Number - single, multiple, rash Extent localised, regionalised, widespread, disseminated Distribution o Symmetrical most endogenous rashes e.g. psoriasis o Asymmetrical suggests a possible exogenous cause e.g. tinea o Sun-exposed sites shaded areas spared FEEL Surface palpation: o Smooth o Uneven e.g. scaly o Rough keratin or crust Deep palpation: pinch lesion between finger and thumb o Soft feels same as lips o Normal like sqeezing your cheek o Firm lesion is slightly compressible o Hard cannot compress o Induration palpable thickening