Dermatology

Objectives
Review primary and secondary skin lesions.
Provide a framework for describing skin lesions
Practise

Primary vs. Secondary Lesion
A primary lesion involves the first visible lesion or the initial changes in skin.
Macules, Patches, Papules, Plaques, Nodules, Cysts, Pustules etc

A secondary lesion is due to changes caused by the skin disorder itself. Either
from manipulation or infection.
Excoriation, Lichenification, Edema, Scale, Crust, Fissure, Erosion, etc
Macules and Patches (Not Bumpy)
Macule: A circumscribed area of
color change in the skin with no
elevation or depression. <1cm
Patch: A Macule >1cm
Papules and Plaques
Papule: An elevated, solid lesion
<0.5 cm in diameter. It is palpable.
Plaques: Elevation above the skin
surface covering a larger surface
area than its height above skin. A
papule > 0.5cm
Vesicles and Bullae
Circumscribed, elevated, superficial
cavity with fluid <0.5 cm
Dome shaped, umbilicated, or
flaccid.
Circumscribed, elevated, superficial
cavity with fluid >0.5 cm
Pustules
Also a circumscribed, superficial
cavity of the skin. Different from a
vesicle in that it contains purulent
fluid.
Nodules
A large, palpable, solid lesion which
can involve the epidermis, dermis,
or subcutaneous tissue.
Differs from a papule due to its
size and depth
Wheals
A special type of papule or plaque
due to edema in papillary body of the
dermis. The shape can vary due to
shifts in edema.
Wheals usually disappear in 24-48
hours.
Cysts
Liquid containing cavity.
Appears like a spherical papule or
nodule, palpation shows a resilient
structure.
Erosion
An epidermal issue, no scar!
Well defined, red, oozes
Erythema

Ulcers

To Summarize
Macules are flat, they're very shy rashes, but then they get big, now they're
called patches.
Papules are raised, and can travel in packs. Once they get big, we then call
them plaques.
Vesicles/Bullae have fluid thats seen. Pustules are similar, but not very clean.
Secondary Descriptors
Excoriation

Lichenification
Thick Skin
Accentuated Lines
Atrophy
Thinning of skin leading to loss of
texture, increased visibility through
it.
Describing Skin Lesions
Type and shape of individual lesions.
Arrangement (scattered, linear)
Distribution (where on the body is it flexor surfaces, dermatomal)
Color
Consistency/Feel

Practise!
Macule,Papule, Vesicle, Plaque?
Source: (2)
Describe The Rash
Conclusion
Practise makes perfect.
Knowing the terminology is essential.
Key descriptors: Type of lesion, arrangement, distribution, color.
Sources
Goldstein, B; Goldstein, A. Approach to Dermatologic Diagnosis. Aug 2012.
http://www.uptodate.com/contents/approach-to-dermatologic-
diagnosis?source=search_result&search=Rashes&selectedTitle=2~150
Goldstein, B; Goldstein, A. Approach to The Patient with Macular Skin Lesions. Nov 2013.
http://www.uptodate.com/contents/approach-to-the-patient-with-macular-skin-
lesions?source=search_result&search=macule&selectedTitle=1~150
Le, T; Bhushan,V. Musculoskeletal, Skin, and Connective Tissue. First Aid For The USMLE Step 1. 2013.
McGraw Hill
Pielop, J. Benign Skin and Scalp Lessions in the Newborn and Young Infant. Jul 2013
http://www.uptodate.com/contents/benign-skin-and-scalp-lesions-in-the-newborn-and-young-
infant?source=search_result&search=mongolian+spot&selectedTitle=1~10
Uptodate. Patient Information: Shingles (The Basics)
Wolff, K; Allen, R. Fitzpatricks Color Atlas and Synopsis of Clinical Dermatology, 6
th
Ed. 2009. McGraw-Hill.
ppxxvii-xxxiii
Young, A; Tewari, A. Sunburn. May 2013. http://www.uptodate.com/contents/sunburn?source=see_link