Derma-osce 63634i

Skin lesions\ A skin lesion is a superficial growth or patch of the skin that does not resemble the area surrounding it. Types of the Skin Lesions Primary skin lesions\Primary skin lesions are variations in color or texture that may be present at birth, or that may be acquired during a person's lifetime (Macule ,Papule ,Nodule,Vesicle,Bulla,Pustule,Wheal) Secondary skin lesions\ 

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Secondary skin lesions are those changes in the skin that result from primary skin lesions, either as a natural progression or as a result of a person manipulating (e.g. scratching or picking ) at a primary lesion . Secondary skin changes result from external factors such as scratching, trauma, infection, or changes caused by healing. (Scale,Crust,Fissure,Scar,Keloid,Erosion,Ulcer,Excoriation,Lichenification)

Macule\A macule is a change in the color of the skin. It is flat. A macule greater than 1 cm may be referred to as a patch. Papule\A papule is a solid raised lesion that has distinct borders and is less than 1 cm in diameter. Papules may have a variety of shapes in profile (domed, flat-topped, umbilicated)

Plaque\is a plateau-like lesion > 10 mm or a group of confluent papules Nodule\A solid lesion that has distinct edges and that is usually more deeply rooted than a papule and more than 1cm in diameter

Vesicle\ is a circumscribed, elevated lesion containing serous fluid that is < 5 mm Bulla\Circumscribed collection of free fluid > 0.5 cm Pustule\Vesicle containing pus (inflammatory cells) Wheal\ Edematous, transitory plaque Scale\Epidermal thickening Crust\Dried serum Fissure\linear cleavage of skin which extends into the dermis Scars\permanent fibrotic changes that occur on the skin following damage to the dermis. Keloid\exaggerated connective tissue response of injured skin that extend beyond the edges of the original wound

Erosion\loss of epidermis (superficial) Ulcer\loss of epidermis and dermis Excoriations\traumatized or abraded skin caused by scratching or rubbing Lichenification\ Rough, thick epidermis with exaggerated skin lines. This is often a characteristic of scratch

Configuration \The term "configuration" refers to the shape or morphology of lesions Distribution\The term "distribution" refers to the clinical arrangement of skin lesions on the integument (Localized ,Generalized,,Symmetric,Asymmetric,Discrete,Grouped,Confluent,(

Majdy Naim skin lesions 2010-2011

Examples: Macule\(Small pox,Purpura,Roseola) Patch\(Measles,Flat moles,Freckles) apule\(Actinic jeratosis,Senile sebaceous hyperplasia,Dermatofibroma) Nodule\(Herpes simplex virus,Rheumatoid arthritis) Plaque\Psoriasis typically present with a plaque-like lesion Vesicles\(Impetigo, dermatitis,Insect bites) Bulla( Bullous pemphigoid,Pemphigus,Dermatitis herpetiformis ,Chronic,bullous dermatosis ,Cutaneous radiation syndrome,Epidermolysis Bullosa)

Pustule\(Acne vulgaris,Rosacea,Folliculitis

Description of a skin lesion When describing a skin lesion, it is important to note the following features: 1. Size 2. Type 3. Shape and symmetry 4. Colour and pigmentation 5. Surface features (smooth; rough) 6. Distribution over the body (extensor surfaces; flexor surfaces)

1) Types of skin lesions 2) ColourExamples of colour changes in lesions: Red/purple Erythema- redness due to increased blood flow to blood vessels (vasodilatation) in that area. Purpura- red/purple discolouration due to extravasation of blood into the skin from a blood vessel. Brown Melanin- a pigment found in the skin which gives a brown discolouration. Haemosiderin- the breakdown product of haemoglobin so can follow on from purpura and appears as a brown discolouration.

Yellow Lipid deposition- xanthelasma (cholesterol deposits around the eyelids) and xanthomata (cholesterol deposits in the tendons) can occur in hyperlipidaemia disorders.

Bilirubin- yellow discolouration due to jaundice (which is defined as bilirubin >35µmol) 3) Describe the surface features Normal- lesion lies below skin surface Or-There may be evidence at the skin surface such asBreak in epithelial surface- exudate, crust, ulcer or a fissure. Change in the size of epidermis/dermis-lichenificationor epidermal/dermal atrophy. Change in the stratum corneum (the outermost layer of the epithelium composed of dead cells)Hyperkeratinosis- thickening of the stratum corneum due to increased keratin deposition in these cells. Scales

4) Define the area involving the lesionIs the border well or poorly defined? Look at the centre of the lesion- is it continuous with the rest of the lesion or is it raised/depressed?

5) Desribe the shape of the lesionThe shape of the area on the skin surface- is it round, oval or irregular? Overall shape of the lesion- spherical, domed, pedunculated (lesion attached to skin by a narrow stalk), flat-topped.

6) Findings on palpationConsistencyis it soft, firm, hard or indurated (can feel thickening within the lesion)? or the lesion could have the consistency of normal skin.

Example OSCE station: "Please describe the lesion on the right." In order to describe the lesion follow the 6 steps detailed above1) TypeThis is a primary lesion as it is a pathology in its own right rather than a consequence of an existing pathology, thus you can rule out secondary lesions such as scale, crust, ulcer etc. It is a non-raised lesion- thus you can rule out raised lesion types such as papule, nodule and plaque There is no fluid so you can rule out fluid-filled lesions such as pustule and abscess, vesicle and bulla Thus the remaining two are macule and patch depending on the size of lesion, if it is >0.5cm it is a patch and <0.5cm it is a macule 2) Colour- the lesion is dark, a potential cause of this colour could be the pigment melannin 3) Describe the surface features- this is a non-raised lesion which lies below the skin surface 4) Define the area involving the lesion- the lesion has a poorly defined border 5) Describe the shape of the lesion- the lesion has an irregular shape 6) Findings on palpation- is it hard vs. soft? firm vs. moveable? Thus a summary of the description of this lesion could be something along the lines of: "This is a dark, non-raised macular lesion with a poorly defined border and an irregular shape. Given the dark discolouration and the nature of the shape and the lesion's border, a possible cause could be melanoma."