Vesicles are characteristic of herpes infections, acute allergic contact dermatitis, and some autoimmune blistering disorders (eg, dermatitis herpetiformis). Configuration is the shape of single lesions and the arrangement of clusters of lesions. Crust: The thickened, dried-out exudate left when vesicles/pustules burst or dry up. Pustules are common in bacterial infections and folliculitis and may arise in some inflammatory disorders including pustular psoriasis. Deeper than erosions, involve dermis and/or deeper layers. herpes simplex. Erosion: Partial thickness loss of epidermis (may be a primary lesion or secondary feature of another lesion such as an eroded papule) Ulcer: Loss of at least the full thickness of epidermis (may be a primary lesion or secondary feature) Petechia: Small (< 0.5 mm) nonblanching macule caused by bleeding of small blood vessels The Manual was first published in 1899 as a service to the community. Erosion: intraepithelial loss of epidermis, usually heals without scarring, moist, circumscribed, usually depressed lesion due to loss of all or part of the epidermis e.g. Plaques may be flat topped or rounded. Lichen planus frequently arises on the wrists, forearms, genitals, and lower legs. Lesions of psoriasis and granuloma annulare commonly form plaques. Full thickness sores are ulcers. The effort to use precise descriptive terms also encourages a clinician to look with more care and more closely at a patient’s skin lesions. Although few patterns are pathognomonic, some are consistent with certain diseases. Epub 2011 Apr 20 doi: 10.1159/000324903. Erosion: An erosion is a discontinuity of the skin exhibiting incomplete loss of the epidermis, a lesion that is moist, circumscribed, and usually depressed. To do that, you need to know how to describe a lesion with the associated language. Merck and Co., Inc., Kenilworth, NJ, USA (known as MSD outside the US and Canada) is a global healthcare leader working to help the world be well. hsalqahtani. This site complies with the HONcode standard for trustworthy health information: verify here. Are ulcers primary or secondary. Insect … WikiMatrix Their age is also shown by the rather mild nature of the reliefs, with a few peaks over 1000 m of altitude, presenting what remains of the superficial erosion which has partly left untouched the magmatic intrusions and the metamorphic rocks originated before the Variscan orogeny. Pustules are vesicles that contain pus. Examples include granuloma annulare, some drug eruptions, some dermatophyte infections (eg, tinea [ringworm]), and secondary syphilis. Examples include cysts, lipomas, and fibromas. Other examples of vesicle Impetigo Insect bite Herpes simplex Dermatitis herpetiformis 26. The trusted provider of medical information since 1899, Lesion Configuration (Secondary Morphology). Lichenification is thickening of the skin with accentuation of normal skin markings; it results from repeated scratching or rubbing. The term maculopapular is often loosely and improperly used to describe many red rashes; because this term is nonspecific and easily misused, it should be avoided. Verrucous lesions have an irregular, pebbly, or rough surface. Examples include nevi, warts, lichen planus, insect bites, seborrheic keratoses, actinic keratoses, some lesions of acne, and skin cancers. (NICHD) Examples of vesicle Chicken pox Herpes zoster 25. Existing feature sets have defined many low-level ... where A B and A B are morphological erosion and dilation, defined as: A B = \ b2B A b (3) A B = [b2B A b (4) where A ... this example, fB 1 = 0:0910 Thus the points of the shape border are transformed into An aphtha is a painful, sharply circumscribed, round erosion with a diameter of 1 cm or less in the mucous membrane (Fig. Black skin lesions may be melanocytic, including nevi and melanoma. [21] [33] Excoriation : a punctate or linear abrasion produced by mechanical means (often scratching), usually involving only the epidermis, but commonly reaching the papillary dermis . Obviously, before we discuss them, we need to know what a skin lesion is! Fissure: linear, often painful breaks within the skin surface, as a result of excessive xerosis (dryness of skin). Umbilicated lesions have a central indentation and are usually viral. Distribution is random or patterned, symmetric or asymmetric. Macules are flat, nonpalpable lesions usually < 10 mm in diameter. Vascular lesions or tumors, such as Kaposi sarcoma and hemangiomas, can appear purple. (See also Evaluation of the Dermatologic Patient andDiagnostic Tests for Skin Disorders.). Causes include venous stasis dermatitis, physical trauma with or without vascular compromise (eg, caused by decubitus ulcers or peripheral arterial disease), infections, and vasculitis. Cutaneous tumors are often pink or red. HA Integumentary Physical Exam 67 Terms. Close inspection Size of the lesion(s) Assess the size of the lesion(s): measure their width and height (if raised). Examples include nevi, warts, lichen planus, insect bites, seborrheic keratoses, actinic keratoses, some lesions of acne, and skin cancers. Deep dermal nevi appear blue. Red skin (erythema) can result from many different inflammatory or infectious diseases. Indurated skin has a hard, resistant feeling. In this lesson, we are going to discuss secondary lesions found on the skin. A patch is a large macule. Telangiectases are foci of small, permanently dilated blood vessels that may occur in areas of sun damage, rosacea, systemic diseases (especially systemic sclerosis), or inherited diseases (eg, ataxia-telangiectasia, hereditary hemorrhagic telangiectasia) or after long-term therapy with topical fluorinated corticosteroids. This pathology can occur on any part of the body. Each type of injury creates a complex set of skin responses, such as erythema, macules, papules, pustules, vesicles/bullae, erosion, and ulcers. Examples include freckles, flat moles, tattoos, and port-wine stains, and the rashes of rickettsial infections, rubella, measles (can also have papules and plaques), and some allergic drug eruptions. Hidradenitis suppurativa involves skin containing a high density of apocrine glands, including the axillae, groin, and under the breasts. Violet skin may result from cutaneous hemorrhage or vasculitis. Atrophy also may result from long-term use of potent topical corticosteroids. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. Thousands of new, high … Induration is characteristic of panniculitis, some skin infections, and cutaneous metastatic cancers. Erosion. Vitiligo may be patchy and isolated or may group around the distal extremities and face, particularly around the eyes and mouth. Causes include platelet abnormalities (eg, thrombocytopenia, platelet dysfunction), vasculitis, and infections (eg, meningococcemia, Rocky Mountain spotted fever, other rickettsioses). Herpetiform describes grouped papules or vesicles arranged like those of a herpes simplex infection. The term maculopapular is often loosely and improperly used to describe many red rashes; because this term is nonspecific and easily misused, it should be avoided. Unless they are peracute, these lesions are typically accompanied by inflammation in the superficial dermis and may be accompanied by epidermal hyperplasia, particularly at … Disease or impairment of the skin’s normal function can lead to significant morbidity and mortality 1.. 11. The legacy of this great resource continues as the Merck Manual in the US and Canada and the MSD Manual in the remainder of the world. Erosion is an eating away of a surface. The typical wheal lasts < 24 hours. Plaques are palpable lesions > 10 mm in diameter that are elevated or depressed compared to the skin surface. Examples include cutis marmorata and livedo reticularis. Nodules are firm papules or lesions that extend into the dermis or subcutaneous tissue. Petechiae are nonblanchable punctate foci of hemorrhage. Papules are elevated lesions usually < 10 mm in diameter that can be felt or palpated. Last full review/revision Feb 2019| Content last modified Feb 2019, © 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA), © 2021 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, Cross-section of the skin and skin structures, Musculoskeletal and Connective Tissue Disorders. It is accompanied by peripheral inflammatory flush. Example: Scratching, minor skin … Ulcers on lower leg trauma. Psoriasis frequently affects the scalp, extensor surfaces of the elbows and knees, umbilicus, and the gluteal cleft. The major types and characteristics of skin lesions are given in . Superficial vascular lesions such as port-wine stains may appear red. The term maculopapular is often loosely and improperly used to describe many red rashes; because this term is nonspecific and easily misused, it should be avoided. Atrophy may be caused by chronic sun exposure, aging, and some inflammatory and neoplastic skin diseases, including cutaneous T-cell lymphoma and lupus erythematosus. Download MORPHOLOGY OF SKIN LESIONS: Secondary Skin Lesions Scheme, Print MORPHOLOGY OF SKIN LESIONS: Secondary Skin Lesions Scheme, MORPHOLOGY OF SKIN LESIONS: Secondary Skin Lesions. The link you have selected will take you to a third-party website. Primary lesions are abnormalities that result as a direct effect of a disease. Auspitz sign is the appearance of pinpoint bleeding after scale is removed from plaques in psoriasis. Annular lesions are rings with central clearing. The diagnosis of any skin lesion starts with an accurate description of it. Sclerosis: Sclerosis refers to a circumscribed, diffuse hardening or induration in the skin. Koebner phenomenon describes the development of lesions within areas of trauma (eg, caused by scratching, rubbing, or injury). Atrophy is thinning of the skin, which may appear dry and wrinkled, resembling cigarette paper. Erosion of the stomach is a lesion of the walls of the stomach, accompanied by one or more ulcers, or placed on the bottom surfaces of the body, as shown in the photo. Induration, or deep thickening of the skin, can result from edema, inflammation, or infiltration, including by cancer. Specific types are listed below. Plate 6 shows the definition and appearance of common primary lesions. Circumscribed and elevated. Discoid lupus erythematosus has characteristic lesions on sun-exposed skin of the face, especially the forehead, nose, and the conchal bowl of the ear. These may be caused by burns, bites, irritant contact dermatitis or allergic contact dermatitis, and drug reactions. EX: impetigo, weeping, eczematous, dermatitis, scab after abrasion Bullae are clear fluid-filled blisters > 10 mm in diameter. Nummular lesions are circular or coin-shaped; an example is nummular eczema. Zosteriform describes lesions clustered in a dermatomal distribution similar to those of herpes zoster. Wheals are a common manifestation of hypersensitivity to drugs, stings or bites, autoimmunity, and, less commonly, physical stimuli including temperature, pressure, and sunlight. Primary lesions of the skin are the first recognizable lesions in the skin. Now on sale in the Medical Bookstore. Surface sores are called erosions; these may start off as blisters or pustules. Pressure ulcers (PUs) are defined as areas of necrosis and ulceration where tissues are compressed between bone and hard surfaces, such as a bed or chair. Click for word document: Approach to Skin Lesions Background. Xanthomas, which are yellowish, waxy lesions, may be idiopathic or may occur in patients who have lipid disorders. We do not control or have responsibility for the content of any third-party site. EXCORIATION - A skin abrasion that is usually superficial and due to scratching of the skin. Psoriasis frequently exhibits this phenomenon, as may lichen planus, often resulting in linear lesions. Purpura is a larger area of hemorrhage that may be palpable. Such a lesion of the skin as erosion, often bothers men, women. Serpiginous lesions have linear, branched, and curving elements. Skin erosion: Skin erosion is a loss of some or all of the epidermis (the outer layer) leaving a denuded surface. Nikolsky sign is epidermal shearing that occurs with gentle lateral pressure on seemingly uninvolved skin in patients with toxic epidermal necrolysis and some autoimmune bullous diseases. Large areas of purpura may be called ecchymoses or, colloquially, bruises. 4.25). Particular body parts are affected (eg, palms or soles, scalp, mucosal membranes). Secondary lesions, on the other … Up to 5% of normal patients may exhibit this sign, which is a form of physical urticaria. Translations in context of "skin erosion" in English-French from Reverso Context: Heat, moisture and sweat retention coupled with friction cause maceration, inflammation with erythema, burning and exsudation, and sometimes skin erosion. Ischemic skin appears purple to gray in color. Traumatically induced lesions, including excoriations caused by the patient's fingernails, are typically linear. Excoriations may be linear or focal. Lesions are on sun-exposed or protected skin. Rash is a general term for a temporary skin eruption. cjmeshia PLUS. Partial loss of epidermis. Fluid is often visible and the lesions are translucent 24. The following are examples of skin lesions: Freckles are collections of brown pigment that typically occur in children, morphing into age-spots in adults. Pityriasis rosea and chronic dermatitis of any type may be scaly. Depressed Elevated Crust/Scab (dried serum, blood, or pus overlying the lesion) Scale (dry, thin or thick flakes of skin overlying the lesion) Lichenification (thickened skin with accentuation of normal skin lines) Hypertrophic Scar (within boundary of injury) Keloid Scar (extend beyond boundary of injury) Atrophic Scar (fibrotic replacement of tissue at site of injury) Ulcer (complete loss of epidermis extending into dermis or deeper; heals with scar) Erosion (partial loss of epidermis only; heals without scar) Fissure (linear slit-like cleavage of skin) Excoriation/Scratch (linear erosion induced by scratching). Definition (NCI) A circumscribed and often suppurating skin crater which usually includes loss of skin integrity of the superficial skin or the mucous membranes. Crusts (scabs) consist of dried serum, blood, or pus. Learn more about our commitment to Global Medical Knowledge. Purpura may indicate a coagulopathy. Classic autoimmune bullous diseases include pemphigus vulgaris and bullous pemphigoid. Crusting can occur in inflammatory or infectious skin diseases (eg, impetigo). It is usually produced by induration of the dermis and/or subcutaneous tissue. Examples include warts and seborrheic keratoses. Macule. About the signs and symptoms of skin erosion, its causes of appearance and methods of treatment in … Some scars become hypertrophic or thickened and raised. An extensive language has been developed to standardize the description of skin lesions, including, Lesion type (sometimes called primary morphology), Lesion configuration (sometimes called secondary morphology). Wheals are pruritic and red. Define and give an example of these secondary lesions: crust, scale, fissure, erosion, ulcer crust--thickened dried out exudate left when vesicles/postules burst or dry up. Green fingernails suggest Pseudomonas aeruginosa infection. Example: Scabies. Example of an Erosion. Yellow skin is typical of jaundice, xanthelasmas and xanthomas, and pseudoxanthoma elasticum. Target (bull’s-eye or iris) lesions appear as rings with central duskiness and are classic for erythema multiforme. But nevertheless, we note that erosive lesions are mainly localized on the epithelium of the face, genitals, hands, mucous membrane of the oral cavity, and also in the area of natural folds. Macules represent a change in color and are not raised or depressed compared to the skin surface. Scale is heaped-up accumulations of horny epithelium that occur in disorders such as psoriasis, seborrheic dermatitis, and fungal infections. EROSION - A shallow, moist, or crusted lesion resulting from the loss of the superficial layers of the upper epidermis only, as from friction or pressure. Linear lesions take on the shape of a straight line and are suggestive of some forms of contact dermatitis, linear epidermal nevi, and lichen striatus. Erosions can be subtle, shallow lesions with loss of only the upper layers of cells and may be difficult to identify. An excoriation is a linear erosion caused by scratching, rubbing, or picking. When brown spots begin to raise up, they may be benign seborrheic keratoses. A combination procedure with double C-shaped skin incision and dual-floor burr hole method to prevent skin erosion on the scalp and reduce postoperative skin complications in deep brain stimulation. Orange skin is most often seen in hypercarotenemia, a usually benign condition of carotene deposition after excess dietary ingestion of beta-carotene. Keloids are hypertrophic scars that extend beyond the original wound margin. Secondary lesions of herpes zoster. Examples include nevi, warts, lichen planus, insect bites, seborrheic keratoses, actinic keratoses, some lesions of acne, and skin cancers. In addition, the skin can serve as a window for the evaluation of internal health and disease. Some skin diseases are very prone to break down into sores. Freckles are treated with fading creams, the hydroquinones, or varying levels of chemical peels. Reticulated lesions have a lacy or networked pattern. Configuration of the lesion(s) Assess the configuration of the lesion(s).. Configuration refers to the shape or outline of skin lesions. Some skin lesions have visible or palpable texture that suggests a diagnosis. Find skin erosion stock images in HD and millions of other royalty-free stock photos, illustrations and vectors in the Shutterstock collection. Health Assessment Skin (chapter 12) 31 Terms. Define and give an example of these secondary lesions: crust, scale, fissure, erosion, ulcer. Stria (plural striae) are linear, atrophic, pink, purple, or white lesions of the skin and are sometimes called “stretch marks”. Often pathology develops in the process of chronic diseases, for example, such as liver failure. A lilac color of the eyelids or heliotrope eruption is characteristic of dermatomyositis. of skin lesion images obtained with standard cameras are presented. Example: Ruptured varicella vesicles. Scars are areas of fibrosis that replace normal skin after injury. Reserve your copy today. MORPHOLOGY OF SKIN LESIONS: Secondary Skin Lesions Skin Lesion Secondary Skin Lesion Lesion that develops from trauma, manipulation (rubbing, scratching), complication (infection) of initial lesion, or develops naturally over time Primary Skin Lesion Initial lesion not altered by trauma, manipulation (rubbing, scratching), complication (infection), or natural regression over time. Urticaria (wheals or hives) is characterized by elevated lesions caused by localized edema. Black eschars are collections of dead skin that can arise from infarction, which may be caused by infection (eg, anthrax, angioinvasive fungi including Rhizopus, meningococcemia), calciphylaxis, arterial insufficiency, or vasculitis. Erosions can be traumatic or can occur with various inflammatory or infectious skin diseases. Vesicle A small, fluid filled lesion, <0.5 cm in diameter, raised above the plane of surrounding skin. An enanthema is a lesion of the mucous membranes, such as the oral mucosa, conjunctiva and external genitalia. The pattern of multiple lesions or the shape of an individual lesion can be useful in narrowing the differential diagnosis. The word "erosion" comes from the Latin "erodere" meaning to eat out. The key features of skin lesions are (1) the type of lesion, (2) secondary changes to the surface of the lesion, (3) the color of the lesion, (4) the shape of the lesion, and (5) the arrangement and distribution of the lesions. Dermatographism is the appearance of an urticarial wheal after focal pressure (eg, stroking or scratching the skin) in the distribution of the pressure. Examples include molluscum contagiosum and herpes simplex. Please confirm that you are a health care professional. Erosions are open areas of skin that result from loss of part or all of the epidermis. Palpable purpura is considered the hallmark of leukocytoclastic vasculitis. This language, reviewed here, can be used to describe any skin finding. Shades of blue, silver, and gray can result from deposition of drugs or metals in the skin, including minocycline, amiodarone, and silver (argyria). MORPHOLOGY OF SKIN LESIONS: Secondary Skin Lesions Skin Lesion Secondary Skin Lesion Lesion that develops from trauma, manipulation (rubbing, scratching), complication (infection) of initial lesion, or develops naturally over time Primary Skin Lesion Initial lesion not altered by trauma, manipulation (rubbing, scratching), complication (infection), or natural regression over time. A lesionis any abnormal growth or area of skin that differs from the skin around it. ... Ch 23: Skin Lesions 58 Terms. To determine the cause of erosion is possible only if a full diagnostic study. There are many risk factors for PUs, which include age > 65 years, decreased mobility, and impaired sensation, among others. It occurs in patients with urticaria pigmentosa or mastocytosis. A disorder characterized by circumscribed, inflammatory and necrotic erosive lesion on the skin. Ulcers. Examples: impetigo, acne. Darier sign refers to rapid swelling of a lesion when stroked. Ulcers result from loss of the epidermis and at least part of the dermis. Vesicles are small, clear, fluid-filled blisters < 10 mm in diameter. Of the main factors that influence the development of PUs, which of the following contributes to PUs but is not a direct cause? Your skin is not only your largest organ but is also an integral component of the body’s defence system. Park YS, Kang JH, Kim HY, Kang DW, Chang WS, Kim JP, Chang JW Stereotact Funct Neurosurg 2011;89(3):178-84. Furthermore, skin lesions can be broken down into two major groups: primary and secondary. 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