different types of skin lesions

1. LESIONS OF SKIN
DR SUBODH KUMAR SHAH

2. TYPES OF LESIONS
Primary Lesions
Secondary Lesions
Special Lesions

3. PRIMARY LESIONS
DEFINATION: LESION OCCURRING ON NON PATHOLOGICAL
SKIN(NORMAL SKIN) WHICH HAVE NOT BEEN ALTERED BY
TRAUMA, MANIPULATION (SCRATCHING, SCRUBBING) .
 Macule
 Papule
 Patch
 Plaque
 Nodule
 Wheal
 Vesicle
 Bulla
 Pustule
 Cyst

4. SECONDARY LESIONS:
DEFINATION:MODIFICATION OF PRIMARY SKIN LESIONS THAT
RESULT FROM TRAUMATIC INJURY , EVOLUTION FROM PRIMARY
LESION OR OTHER EXTERNAL FACTORS.
 Crust
 Scale
 Erosion
 Ulcer
 Fissure
 Sinus
 Scar
 Atrophy
 Excoriation
 Lichenification
 Infarct

5. SPECIAL LESIONS
 Burrow
 Comedo
 Milium
 Striae
 Target lesion
 Horn
 Sclerosis
 Poikiloderma

6. THESE LESIONS MAY BE:
 Raised
 Depressed
 Flat
 Surface Change
 Fluid Filled
 Vascular

7. RAISED
PAPULE
PLAQUE
NODULE
CYST
WHEAL
SCAR
COMEDO
HORN
CALCINOSIS

8. PAPULE
Solid , well circumscribed, elevated lesion, less than 0.5cm
in size, significant portion raised above skin.
Formed by
1)Hyperplasia of epidermis , dermis or both
E.g : verruca vulgaris
2)Metabolic deposits or cellular infiltrates
E.g : xanthelasma

9. TYPES OF PAPULES
A-NODULAR
B-SESSILE
C-PEDUNCULATED
D-FILIFORM
E-VERRUCOUS(ROUGH)
F-MAMMILATED
• FLAT TOPPED
PAPULE

10. FILIFORM ACUMINATE(POINTED)
MAMMILLATED (MAMMILATED NAEVI) PEDUNCULATED(SKIN TAG)

11. UMBILICATED DOME SHAPED
PAPULE
(MOLLUSCUM CONTAGIOSUM)

12. PLAQUE
•Solid plateau-like elevation that occupies relatively
large surface area in comparison with its height above
the normal skin surface.
• Has a diameter larger than 0.5cm

13. TYPES
• Scaly Plaque : Psoriasis , P.Rosea
• Lichenified plaque : Lichen Simplex Chronicus
• Erythematous plaque : Tuberculoid
leprosy

14. NODULE
• Palpable solid round or ellipsoidal lesion
• larger than 0.5cm diameter
• Depth of involvement rather than diameter differentiates a nodule from large papule and
plaque.
PAPULE NODULE
SEEN BETTER FELT BETTER

15. TYPES OF NODULES
• Depending on the anatomic components , primarily involved,
nodules are of 5 main types:
1) Epidermal
2) Epidermal- Dermal
3) Dermal
4) Dermal- Subdermal
5) Subcutaneous

16. NODULAR BASAL CELL
CARCINOMA(EPIDERMAL)
Keratoacanthoma

17. NODULAR ACNE
XANTHOMA

18. CYST
• An encapsulated cavity or sac lined with true
epithelium that contains liquid or semisolid material
in a well-defined cavity .
• May be hard, doughy or fluctuant.

19. DERMOID CYST

20. WHEALS
• a rounded or flat-topped papule or plaque that is characteristically
evanescent, disappearing in few hours.
• Also known as ‘hives’ or ‘urticaria’
• Usually round ,oval ,annular or serpiginous , pink to red ,
surrounded by a flare of macular erythema
• Caused by transient vascular reaction in the upper dermis mainly
due to vasodilatation and increased permeability of capillaries

21. WHEAL

22. SCAR
• Arises from proliferation of fibrous tissue that replaces
previously normal collagen after a wound or ulceration
breaches the reticular dermis.
• Initially it may be pink to red colour, later it may become hypo/
hyper pigmented.
• Adnexal structures such as hair follicle are absent.
• They may be:
1)Hypertrophic
2)Keloid
3)Atrophic

23. HYPERTROPHIC SCAR
• Characterized by erythematous, pruritic, raised fibrous lesions.
• Do not expand beyond the boundaries of the initial injury.
• May undergo partial spontaneous resolution.

24. KELOID
• Keloids are the result of an overgrowth of dense fibrous
tissue that usually develops after healing of a skin
injury.
• The tissue extends beyond the borders of the original
wound, does not usually regress spontaneously(web –
like extension).
• Tends to recur after excision.
Clawlike
outline of a
keloid

25. ATROPHIC SCAR
• These are thin wrinkled plaques.
Cribriform scar is perforated with multiple small pits. E.g.
pyoderma gangrenosum

26. COMEDO
COMEDO IS A HAIR FOLLICLE INFUNDIBULUM THAT IS DILATED AND PLUGGED BY
KERATIN AND LIPIDS.
• Open comedo(Black Heads):
- In this the pilosebaceous unit is open to the surface of the
skin with a visible keratinaceous plug.
-Black colour of the comedo is due to the
oxidized sebaceous content.
• Closed comedo(White Heads) :
In this the follicular opening is unapparent which accumulates
whitish keratin due to closed infundibulum.

27. Open comedo

28. HORN:
• Hyperkeratotic conical mass of cornified cells , arising over an abnormally
differentiating epidermis

29. CALCINOSIS
• Deposits of calcium in the dermis or subcutaneous tissue may be
appreciated as hard , whitish nodules or plaques , with or without
visible alteration of skin’s surface.
Calcinosis : in
dermatomyositis

30. DEPRESSED
EROSION
ULCER
ATROPHY
POIKILODERMA
SINUS
STRIAE
BURROW
SCLEROSIS

31. EROSION
• An erosion, is a moist, circumscribed, usually
depressed lesion that results from loss of all or a
portion of the viable epidermis.
• May result in pin point bleeding in a sieve like
fashion.
• Results from trauma, rupture of vesicles and bullae
become or epidermal necrosis.
• They do not scar on healing unless secondarily
infected.

32. EROSION FORMED AFTER RUPTURE OF BULLA

33. ULCER
• defect that remains after an area of epidermis and at
least part of the dermis have been destroyed or
removed.
• Because the dermis is involved, ulcers heal with
scarring.
• Borders may be rolled,undermined, punched
out,jagged or angular.
• Base may be clean, ragged or necrotic.

34. • DISCHARGE MAY BE PURULENT , GRANULAR OR
MALODOROUS.
SURROUNDING SKIN MAY BE RED, PURPLE , PIGMENTED,
RETICULATED, INDURATED, SCLEROTIC, INFARCTED

35. POIKILODERMA
• It refers to the combination of
- atrophy
- telangiectasia
- pigmentary changes(hypo- &hyper-)

36. SINUS
• It is a tract connecting deep suppurative cavities to each other or to the surface of skin.
• a cavity or track with a blind ending.

37. STRIAE
• These are linear depression of the skin that
usually measure several cms in length
• Result from changes in reticular dermis that
occur with rapid stretching of the skin.

38. BURROW
• It is a wavy thread like tunnel(Serpinginous
tunnel) through the outer portion of
epidermis made by parasite(Scabetic mite).
• About 5mm in length

39. SCLEROSIS
• Diffuse or circumscribed induration or hardening of
the skin that results from dermal fibrosis.
• Skin may feel board-like,immobile and difficult to pick
up.

40. FLAT
MACULE
PATCH
ERYTHEMA
ERYTHRODERMA

41. MACULE
•Definition : Flat, circumscribed skin
discoloration that lacks surface
elevation or depression, less than 1 cm
in diameter

42. •TYPES
1)Hypopigmented: due to decrease in number of
melanocytes or the amount of pigment they
produce
E.g. : tuberous sclerosis , nevus achromicus ,
etc
nevus achromicus

43. 2)Depigmented : due to complete loss of melanocytes
E.g.: vitiligo , halonaevus
3)Hyperpigmented : due to excess production of melanin in skin
E.g.: freckles or chloasma

44. ERYTHEMA
• Blanchable pink to red colour of skin or mucous membrane.
• Caused by increased blood flow through the skin due to capillary
dilatation.
• Easily blanched by pressure
E.g : macular viral and
drug rash

45. ERYTHRODERMA
• Generalized deep redness of the skin involving more than
90% of the body surface within days to weeks.
• E.g. drug reaction

46. SURFACE CHANGES
CRUST
SCALE
KERATODERMA
EXCORIATION
FISSURE
LICHENIFICATION
ESCHAR

47. CRUST
• Crusts result when serum, blood, or purulent exudate dries on the
skin surface
• Colour of crust when formed from
- serous dried secretion- yellow
-purulent secretion - tubid green or yellow-green
-haemorrhagic secretion - reddish-black

48. SCALE
• Scale is flat plate or flake arising from the outermost layer of the
stratum corneum.
• Can range in size from fine dust like particles to extensive parchment
like sheets.

49. TYPES OF SCALES
1) Crack-like/Craquele
Desquamation giving the
appearance of dried,cracked skin.
E.g.Eczema Craquele(Asteatotic
eczema/ Winter eczema)

50. 2) EXFOLIATIVE:
• Scales split of from the epidermis in finer scales
or on sheets.
E.g.Drug Reaction(Exfoliative dermatitis)

51. 3) FOLLICULAR:
Scales appear as keartotic plug ,spines or
filaments.
E.g.Keratotic Pilaris

52. 4) GRITTY:
Densely
adherent scales
with a sand
paper texture.
E.g.Actinic
Keratosis

53. 5)ICHTHYOSIFORM:
Scales are regular
polygonal plates arranged
in parallel rows or
diamond patterns(fish-
like).
E.g. Ichthyosis
vulgaris

54. 6) KERATOTIC/HYPERKERATOTIC:
Scales appear
as heaped-up
column of
scales.
E.g. Cutaneous
Horn

55. 7) LAMELLAR:
Scales are
thin large plates or
shields attached in
the middle and
looser around the
edges.
E.g.Lamellar
Ichthyosis

56. 8) PITYRIASIFORM:
Scale is small and
branny.
E.g. Pityriasis
Rosea

57. 10) SEBORRHEIC:
Scales are
thick, waxy or
greasy, yellow to
brown, flakes.
E.g. Seborrheic
Dermatitis

58. KERATODERMA
• Keratoderma is excessive accumulation of
scales(hyperkeratosis) that results in a yellowish thickening of
the skin usually on palms and soles.
• May be inherited (abnormal keratin formation) or
acquired(mechanical stimulation)

59. EXCORIATION
• Punctate or linear excavation of epidermis produced by mechanical means(scratching).
• Caused by scratching with fingernails in a variety of disease
E.g : Atopic dermatitis , Scabies

60. FISSURE
• Linear cleft in the skin through the epidermis and part of dermis.
• May be single or multiple ranging from microscopic to a few
millimeters having well defined margins.
• They occur most commonly when
skin is dry and thickened due to
inflammation.
Commonest sites a) tips and flexural creases of thumb , finger and
palms
b) edges of heel
c)clefts between fingers and toes
d) angle of mouth, lips, nares, auricles and anus

61. LICHENIFICATION
• Focal area of thickened skin
produced by chronic scratching or
rubbing which may resemble tree
bark.
• Clinically triad of
Accentuation of skin markings
Thickening of epidermis
Hyperpigmentation
Eg : Lichen Simplex Chronicus (usually
seen superimposed on pruritic
conditions)

62. ESCHAR
• Circumscribed, adherent, hard, black crust on the
surface of the skin.
• Presence of an eschar implies tissue necrosis,
infarction, deep burns, gangrene or other ulcerating
process.

63. FLUID FILLED
VESICLE
BULLA
PUSTULE
FURUNCLE
ABSCESS

64. VESICLE AND BULLA
• Elevated ,superficial well circumscribed lesion containing clear fluid
, less than 0.5 cm in diameter is known as Vesicle
• A vesicle larger than 0.5 cm is known as Bulla.
• They can arise by separation of skin at different levels i.e
a) intraepidermal e.g. Pemphigus foliaceus
b) supra basal e.g Pemphigus vulgaris
c) dermoepidermal e.g. Bullous Pemphigoid

65. VESICLES
BULLA

66. PUSTULE
• Well-circumscribed, elevated lesion containing visible
purulent exudate.
• Composed of leukocytes with or withuot cellular debris and
may contain bacteria or may be sterile.

67. FURUNCLE
• Deep necrotizing folliculitis with suppuration.
• Presents as an inflamed follicle-centered nodule greater
than 1cm.
• Several furuncles coalesce to form “carbuncle”.

68. ABSCESS
• An abscess is a localized collection of pus below the
skin(dermis or subcutaneous tissue).
• It is erythematous, warm, tender, fluctuant nodule.
• Pus in an abscess is usually not visible and do not
have well-defined lining as cyst.

69. VASCULAR
PURPURA
TELANGIECTASIA
INFARCT

70. PURPURA/ECCHYMOSES:
• Purpura is discoloration of the skin or mucous membranes
due to
extravasation of red blood cells.
• Petechiae are small purpuric lesions usually 1–2 mm
(occasionally up to 4 mm) across, often occurring in crops.
• Ecchymoses or bruises are larger extravasations of blood

71. TELANGIECTASIA
• Persitent, dilatation of small capillaries in the
superficial dermis
• disappear with pressure
• Visible as fine,bright, non pulsatile red lines or
network like patterns on skin
E.g :
Scleroderma
Rosacea

72. INFARCT
• An area of cutaneous necrosis resulting from a bland or
inflammatory occlusion of blood vessels in skin.
• Presents as a tender, irregularly shaped dusky reddish gray
macule or firm plaque that may b depressed.
• E.g. cholesterol emboli

73. TARGET LESIONS
• Pathognomic to erythema multiforme
• Three zones:
1) central area of dusky erythema or purpura
2)middle pale edematous zone
3)outer ring of zone of erythema
• These are less than 3 cm in diameter

74. MILIA
• Milia are small superficial cyst with an epidermal
lining
• Occur on face especially in periorbital region.

75. THANK YOU