macule (Primary lesion)
Solely a color change, flat and circumscribed, of less than 1 cm. Examples: freckles, flat nevi, hypo pigmentation, petechiae, measles, scarlet fever.
Patch (Primary Lesion)
Macule's that are larger than 1 cm. Examples: Mongolian spot, vitiligo, cafe au last spot, chloasma, measles, rash.
Papule (Primary Lesion)
Something you can feel (solid, elevated, circumscribed, less than 1 cm in diameter) caused by superficial thickening in the epidermis. Examples: elevated nevus (mole), lichen, planus, molluscum, wart (verruca)
Plaque (Primary lesion)
Papules coalesce to form surface elevation wider than 1 cm. A plateau-like, disk-shaped lesion. Examples: psoriasis, lichen planus
Nodule (Primary lesion)
Solid, elevated, hard or soft, larger than 1 cm. May extend deeper into dermis than papule. Examples: xanthoma, fibroma, intradermal nevi.
Tumor (Primary lesion)
Larger than a few cm in diameter, firm or soft, deeper into dermis; may be benign or malignant, although "______" implies "cancer" to most people. Examples: lipoma, hemangioma
Wheal (Primary lesion)
superficial, raised, transient, and erythematous; slightly irregular shape due to edema (fluid held diffusely in the tissues). Examples: mosquito bite, allergic reaction, dermographism.
Urticaria (hives) (Primary lesion)
Wheals coalesce to form extensive reaction, intensely pruritic.
Vesicle (Primary lesion)
Elevated cavity containing free fluid, up to 1 cm; a "blister". Clear serum flows if wall is ruptured. Examples: herpes simplex, early varicella (chickenpox), herpes zoster (shingles), contact dermatitis.
Bulla (Primary lesion)
Larger than 1 cm diameter. Usually single chambered (unilocular). Superficial to epidermis; it is thin walled, so it ruptures easily. Examples: friction blister, pemphigus, burns, contact dermatitis.
Cyst (Primary lesion)
Encapsulated fluid-filled cavity in dermis or subcutaneous layer, tensely elevating skin. Examples: sebaceous cyst, wen.
Pustule (Primary lesion)
turbid fluid (pus) in the cavity. Circumscribed and elevated. Examples: impetigo, acne.
Crust (Secondary Lesion)
the thickened, dried-out exudate left when vesicles/pustules burst or dry up. Coor can be red-brown, honey, or yellow, depending on the fluid's ingredients (blood, serum, pus). Examples: Impetigo (dry-honey colored), weeping eczematous dermatitis, scab af
Scale (Secondary Lesion)
Compact, desiccated flakes of skin, dry or greasy, silvery or white, from shedding of dead excess keratin cells. Examples: after scarlet fever or drug reaction (laminated sheets), psoriasis (silver, mica-like), seborrheic dermatitis (yellow, greasy), ecze
Fissure (Secondary lesion)
Linear crack with abrupt edges, extends into dermis, dry or moist. Examples: cheilosis - at corners of mouth due to excess moisture; athlete's foot.
Erosion (Secondary lesion)
Scooped out but shallow depression. Superficial; epidermis lost; moist but no bleeding; heals without scar because erosion does not extend into dermis.
Ulcer (Secondary lesion)
Deeper depression extending into dermis, irregular shape; may bleed; leaves scar when heals. Examples: stasis ulcer, pressure sore, chancre.
Excoriation (Secondary lesion)
Self- inflicted abrasion; superficial; sometimes crusted; scratches from intense itching. Examples: insect bites, scabies, dermatitis, varicella.
Scar (Secondary lesion)
After a skin lesion is repaired, normal tissue is lost and replaced with connective tissue (collagen). This is a permanent fibrotic change. Examples: healed area of surgery or injury, acne.
Atrophic Scar (Secondary lesion)
The resulting skin level is depressed with loss of tissue; a thinning of the epidermis. Example: Striae.
Lichenification (Secondary Lesion)
Prolonged, intense scratching eventually thickens the skin and produces tightly packed sets of papules; looks like surface of moss (or lichen)
Keloid (Secondary lesion)
A hypertrophic scar. The resulting skin level is elevated by excess scar tissue, which is invasive beyond the site of original injury. May increase long after healing occurs. Looks smooth, rubbery, and "claw-like" and has a higher incidence among Blacks.
Contusion (bruise) (Lesion caused by trauma or abuse)
A mechanical injury (blow) results in hemorrhage into tissues. Skin is intact. Color in a light-skinned person is usually (1) red-blue or purple immediately after or within 24 hours of trauma, then generally progresses to (2) blue to purple (3) blue-green
Hematoma (Lesion caused by trauma or abuse)
Bruise that you can feel. It elevates the skin and is seen as swelling. Multiple petechiae and purpura may occur on the face when prolonged, vigourous crying or coughing raises venous pressure.
Ecchymosis (bruise)
A purplish patch resulting from extravastion of blood into the skin, >3mm in diameter.
Birthmarks
may be tan-brown in color
Diaphoresis
profuse perspiration, accompanies increased metabolic rate, such as occurs with fever or exercise. Can occur with pain or thyrotoxicosis/anxiety.
Cyanosis
bluish mottled color signifying decreased perfusion, tissues don't have enough oxygenated blood. When looking for this in African Americans, consider change in level of consciousness and signs of respiratory distress.
Erythema
intense redness of skin due to excess blood (hyperemia) in dilated superficial capillaries. Expected with fever, local inflammation, emotional reactions (blushing)
Edema
fluid accumulating in interstitial space. Most evident in dependent parts of the body (feet, ankles, sacral areas) where skin looks puffy and tight. Makes hair follicles more prominent, so you can note a pigskin or orange peel look (beau d'orange) Graded
Freckles (ephelides)
small, flat macule of brown melanin pigment that occur on sun exposed skin
Herpes zoster (Shingles)
Small, grouped vesicles emerge along route of cutaneous sensory nerve, then pustulates, then crusts. Caused by varicella zoster virus, a reactivation of the dormant virus of chicken pox. (Pain severe, more common in older adults, commonly on trunk, but co
Hyperthermia
increased metabolic rate, with fever or heavy exercise. Localized area feels hot with trauma, infection, sunburn.
Cherry (senile) angiomas
small (1-5 mm), smooth, slightly raised, bright red dots that commonly appear on the trunk in all adults, older than 30 years. They normally increase in size and number with aging and are not significant.
Senile lentigines
Commonly called liver spots, small, flat, brown macule. These circumscribed areas are clusters of melanocytes that appear after extensive sun exposure. Appear on forearms and doors of hands. They are not malignant and require no treatment.
Pressure ulcer (decubitus ulcer)
Appears on skin over a bony prominence when circulation is impaired. Occurs when a person is confined to a bed or is immobilized. Assessed by stages depending on depth (More info in bk)
malignant melanoma
Half of these lesions arise from preexisting nevi. Usually brown; can be tan, black, pink-red, purple, or mixed pigmentation. Often irregular or notched borders. May have scaling, flaking, oozing texture. Common locations are on trunk and back of men and
Mole (nevus)
proliferation of melanocytes, tan to brown in color, flat or raised. Acquired _____ characterized by symmetry, small size (6 mm or less) smooth borders, single uniform pigmentation.
Junctional nevi (mole)
macular only and occurs in children and adolescents.
Compound nevi (mole)
macular and papular. Compounded from junctional nevi (picture shows progression)
Pallor
pale - red pink tones of oxygenated Hb in blood are lost, skin takes on the color of connective tissue (collagen) which is mostly white. Common in acute high stress states (anxiety/fear) b/c vasoconstriction from sympathetic NS. Also could be from exposur
Jaundice
yellowish skin color indicating rise in bilirubin in blood. 1st noticed @ junction of hard and soft palate in mouth and sclera (extends to edge of iris). As bilirubin rises, entire body can have yellow tint.
Pruritus
Skin itching most common with dry skin, aging, drug reactions, allergy, obstructive jaundice, uremia, lice.
Psoriasis
scaly, erythematous patch, with silvery scales on top. Usually on scalp, outside of elbows and knees, low back, and anogenital area.
Mobility
skin's ease of rising (decreases with edema)
Turgor
skin's ability to return to place promptly when released. Reflects elasticity of skin. Dehydration could cause skin to have decreased _______.
Hypothermia (generalized hypothermia)
generalized coolness. May be induced, (surgery or high fever). Localized coolness is expected with immobilized extremity, as when a limb is in a cast or with and IV infusion.
Annular
or circular, begins in center and spreads to periphery (tinea corporis or ringworm, tinea versicolor, pityriasis rosea)
Confluent
lesions run together (urticaria <hives>)
Discrete
distinct individual lesions that remain separate (acrochordon or skin tags, acne)
Grouped
Clusters of lesions (vesicles of contact dermatitis)
Gyrate
twisted, coiled, spiral, snakelike
Linear
a scratch, streak, line, or stripe
Polycyclic
annular lesions grow together (lichen planus, psoriasis)
Target
or iris, resembles iris of eye, concentric rings of color in the lesions (erythema muliforme)
Zosteriform
linear arrangement along a unilateral nerve route (herpes zoster)
capillary refill
depress nail and release, noting return of color (normally color return is instant or at least within a few seconds if cold) Sluggish color return = decreased peripheral circulation
clubbing
seen in congenital cyanotic heart disease and neoplastic and pulmonary diseases. Angle of nail base first straightens out to 180� and nail base feels spongy to the touch. Then nail becomes convex as digit grows.
profile sign - nail base angle
index finger's ____ ____ should be 160�. _____ ______ _____ should be viewed between nail base and nail. Nail base firm to palpation.
alopecia
hair loss
fine vellus
hair covering most of body (except palms and soles, dorsa of distal parts of fingers, umbilicus, glands penis, and inside labia.)
hirsutism
excess body hair. In females, this forms a male pattern on the face and chest and indicates endocrine abnormalities.