examination of skin
DESCRIPTION
Examination Of SkinTRANSCRIPT
Examination of the Skin
(L.CUTIS)
Dr. Sudeesh ShettyFinal Year P.G ScholarDept of RoganidanaGAMC Banglore.
1.Epidermis The epidermis is composed of 4 or 5 layers depending on the region
of skin being considered The epidermis is the topmost layer, and consists primarily of
keratinocytes. The epidermis is separated from the dermis, its underlying tissue,
by a basement membrane. The epidermis is avascular, nourished by diffusion from the dermis,
constituted at 95% of keratinocytes but also containing melanocytes, Langerhans cells, Merkel cells, and inflammatory cells.
Epidermis is divided into the following 5 sublayers or strata: Stratum corneum Stratum lucidum Stratum granulosum Stratum spinosum Stratum germinativum (also called "stratum basale").
Stratum besale
Stratum spinosum(spiny layer)
Stratum granulosum(granular cell layer)
Stratum corneum
Stratum lucidum
Those layers in descending order are cornified layer (stratum corneum) Composed of 10 to 30 layers of polyhedral, anucleated corneocytes (final step of keratinocyte
differentiation), with the palms and soles having the most layers. Corneocytes are surrounded by a protein envelope (cornified envelope proteins), filled with water
retaining keratin proteins, attached together through corneodesmosomes and surrounded in the extracellular space by stacked layers of lipids.
Most of the barrier functions of the epidermis localize to this layer. [10]clear/translucent layer (stratum lucidum, only in palms and soles)
The skin found in the palms and soles is known as "thick skin" because it has 5 epidermal layers instead of 4.granular layer (stratum granulosum)
Keratinocytes lose their nuclei and their cytoplasm appears granular. Lipids, contained into those keratinocytes within lamellar bodies, are released into the extracellular space through exocytosis to form a lipid barrier. Those polar lipids are then converted into non-polar lipids and arranged parallel to the cell surface. For example glycosphingolipids become ceramides and phospholipids become free fatty acids.[spinous layer (stratum spinosum)
Keratinocytes become connected through desmosomes and start produce lamellar bodies, from within the Golgi, enriched in polar lipids,glycosphingolipids, free sterols, phospholipids and catabolic enzymes.[4] Langerhans cells, immunologically active cells, are located in the middle of this layer.[9]basal/germinal layer (stratum basale/germinativum).
Composed mainly of proliferating and non-proliferating keratinocytes, attached to the basement membrane by hemidesmosomes. Melanocytes are present, connected to numerouskeratinocytes in this and other strata through dendrites.
Merkel cells are also found in the stratum basale with large numbers in touch-sensitive sites such as the fingertips and lips. They are closely associated with cutaneous nerves and seem to be involved in light touch sensation.The term Malpighian layer (stratum malpighi) is usually defined as both the stratum basale and stratum spinosum.
2.Dermis The dermis lies below the epidermis, and consists
primarily of fibroblasts, collagen, and elastic fibers The dermis is the layer of skin beneath the epidermis
that consists of connective tissue and cushions the body from stress and strain.
The dermis is tightly connected to the epidermis by a basement membrane.
The dermis is structurally divided into two areas: a superficial area adjacent to the epidermis, called the papillary region, and a deep thicker area known as the reticular region
It also harbors many nerve endings that provide the sense of touch and heat.
.
It is between 1-4 mm thick (depending on age and body location), making it much thicker than the epidermis.
It contains the hair follicles, sweat glands, sebaceous glands, apocrine glands, lymphatic vessels and blood vessels. The blood vessels in the dermis provide nourishment and waste removal from its own cells as well as from the Stratum basale of the epidermis.
3.Hypodermis Below the dermis lies fat, also called
subcutis, panniculus, or hypodermis. Blood capillaries are found beneath the
epidermis, and are linked to an arteriole and a venule.
Arterial shunt vessels may bypass the network in ears, the nose and fingertips.
Skin Function Coloring/Complexion Protective barrier Mechanical barrier Temperature regulator Sensor Vitamin D producer Repairer Excreter Expresser
PigmentsThere are at least five different pigments that determine the color of the skin.These pigments are present at different levels and places.1. Melanin: It is brown in color and present in the
germinative zone of the epidermis.2. Melanoid: It resembles melanin but is present
diffusely throughout the epidermis.3. Carotene: This pigment is yellow to orange in color. It
is present in the stratum corneum and fat cells of dermis and superficial fascia.
4. Hemoglobin (also spelled haemoglobin): It is found in blood and is not a pigment of the skin but develops a purple color.
5. Oxyhemoglobin: It is also found in blood and is not a pigment of the skin. It develops a red color. [email protected]
Nutrition for healthy skin1. Vitamin A, also known as retinoids, benefits the skin
by normalizing keratinization, downregulating sebum production which contributes to acne, and reversing and treating photodamage, striae, and cellulite.
2. Vitamin D and analogs are used to downregulate the cutaneous immune system and epithelial proliferation while promoting differentiation.
3. Vitamin C is an antioxidant that regulates collagen synthesis, forms barrier lipids, regenerates vitamin E, and provides photoprotection.
4. Vitamin E is a membrane antioxidant that protects against oxidative damage and also provides protection against harmful UV rays. [email protected]
• Chief complaint• History of present illness (HPI)• Past medical history (PMH)-previous problems and systemic
disease,Medications,Allergies
• Family history-skin CA, psoriasis, allergy, infestations and infections
• Psychosocial-personal habits,exposures,Health-related behaviors
• Social history-• Review of systems-
The Skin: History
HPI:
• When did it start?• Does it itch, burn, or hurt? • Associated symptoms• Is this the first episode?• Where on the body did it start?-Location• How has it spread (pattern of spread)?• How have individual lesions changed (evolution)?• Provoking/Alleviating/aggravating exacerbating
factors?• Previous treatments and response?o Timing of Attackso Occupationo Topical agentso Drug historyo Season of yearo Environment
The Total Body Skin Exam (TBSE) includes
inspection of the entire skin surface, including:
• the scalp, hair, and nails
• the mucous membranes of the mouth, eyes, anus, and
genitals
History-Hair
TimingAssociated symptomsNutritionAlleviating/aggravatingTreatment(s)Exposures
History-NailsTimingAssociated symptomsNutritionAlleviating/aggravatingTreatment(s)Exposures
Examination aides/Diagnostic aids/Essential elements for the skin exam:
RulerLightingPenlightGlovesMagnifying
glassWoods lamp
Adequate lighting Undressed patient, in a
gown• Preferably without
makeup, watches, jewelry
Privacy An open mind about what
you are seeing
Accurately records the size of a lesion on successive examinations
Measure in the longest axis first, then in the perpendicular axis• e.g., this papule is 6x4 mm
Dermatoscopes --Magnify the lesions with a hand lens or using epiluminescence microscopy (using a hand lens with magnification and lighting built in to better visualize lesions)
Inexpensive magnifying glasses may help detect fine details
• Avoid LED lights, which cast a blue hue
A penlight is used for side lighting Detects atrophy and fine wrinkling Distinguishes
• Flat from raised lesions• Whether lesions are solid or fluid-filled
Also helps look inside the mouth
Use diascopy (press a transparent, firm object such as a glass slide against a lesion) to determine if an erythematous lesion blanches.
Use a wood’s lamp (long wavelength ultraviolet light) to examine if a lesion is hypo or depigmented or to see if a fungal infection fluoresces.
Examination (exposure!)
Inspection– Color– Uniformity– Thickness– Hygiene– Lesions
Palpation– Moisture– Temperature– Texture– Turgor– Mobility
Sequence– Regional – System
Skin- or flesh-coloredHypopigmented vs hyperpigmentedWhiteBrownGreyBlackRed BlueViolaceousDark purple (purpura)YellowOrangeGreen
Colour
Lesion Description Size, Shape, Color Edges Texture Elevated or depressed Exudates Configuration Location&Distribution PICTURE!!
Three categories of observation :
1.Anatomic distribution of the lesion2.Configuration of groups of lesions3.The morphology of the individual lesions
Distribution means location on the bodyConfiguration means how the lesions are
arranged or relate to each other
Primary skin lesion:1 Macule 7 Bulla 13 Ecchymosis
2 Papule 8 Postule 14 Hemotoma
3 Plaque 9 Wheal 15 Poikiloderma
4 Nodule 10 Telangictasia 16 Erythema
5 Papilloma 11 Petechiae 17 Burrow
6 Vesicle 12 Purpura 18 Comedo
MACULE
Macule – A flat, colored lesion, <2cm in diameter, not raised above the surface of surrounding skin
Freckle – prototype of pigmented macule Non-palpable lesion with distinct borders,
less than 1 cm in diameter
Non-palpable change in skin color with distinct borders localized changes in skin color.
Areas may be small or large; occur in many shapes and colors.
Not palpablemay be associated with desquamation or
scalinge.g- rubeola, rubella, secondary syphilis,
rose spots of typhoid fever, drug eruptions, petechiae, purpura, first degree burns, systemic lupus erythematosus, pityriasis rosea and vitiligo
PATCH
Non-palpable lesion with distinct borders, greater than 1 cm in diameterNon-palpable change in skin color with distinct borders
VESICLE
Fluid-containing, superficial, thin-walled cavity less than 1 cm
Small, raised, fluid-filled lesions are called vesicles
e.g-varicella with vesicles and bullae acute eczematous dermatitis, second-degree burns
BULLA
Fluid-containing ,superficial, thin-walled cavity greater than 1 cm
e.g-bullous pemphigoid, contact dermatitis, second-degree burns, bullous impetigo
Pustule
*Pus containing, superficial,thin-walled cavity, frequently arise from hair follicles or sweat glands. Pus is made up of leukocytes and a thin fluid called liquor puris (L. “pus liquid”)
examples: acne,furuncles,and bromide and iodide eruptions, Inflammatory acne, furuncles, and bromide and iodide eruptions.
.
Papule *Palpable, solid lesion less than 1 cm in diameter *A small, solid lesion, <0.5 cm in diameter, raised
above the surface of surrounding skin & hence palpable
Borders and tops may be in various forms–round or irregular --senile angiomas,
eczematous dermatitis, secondary syphilis
–pedunculate – neurofibromasEg: white head in acne, blue nevus
NODULES*A large ( 0.5 – 5.0 cm ), firm lesion raised above the surface of surrounding skin. *A raised area in the skin where the overlying epidermis looks and feels normal, but there is a proliferation of cells in deeper tissues is called a nodule.
*Differs from papule only in size
*Rubbery, Mobile, Non-tender
Palpable, solid lesion greater than 1 cm in diameter. A large >1cm, flat topped raised lesion, edges may either be distinct ( in psoriasis ) or gradually blend with surrounding skin ( in eczematous dermatitis )
Yellow -- xanthomasbrown -- seborrheic wartsRed scaling plaques -- psoriasis, pityriasis rosea E.g- Urticaria, psoriasis
Plaque
WHEAL /Hives
A raised, erythematous, edematous, papule / plaque, usually representing short-lived vasodilatation and vasopermeability
Eg: urticaria and insect bites
TelangiectasiaA dilated superficial blood vessel.
*Angioectasias (also known as spider veins) are small dilated blood vessels near the surface of the skin or mucous membranes, measuring between 0.5 and 1 millimeter in diameter.*They can develop anywhere on the body but are commonly seen on the face around the nose, cheeks, and chin. *They can also develop on the legs, specifically on the upper thigh, below the knee joint, and around the ankles. *They may be composed of abnormal aggregations of arterioles, capillaries, or venules. *Because telangiectasias are vascular lesions, they blanch when tested withdiascopy.*Telangiectasia is a component of the CREST variant of scleroderma (CREST is an acronym that stands for calcinosis, Raynaud's phenomenon,esophageal dysmotility, sclerodactyly, and telangiectasia.)
Telangiectasias may develop anywhere within the body but can be easily seen in the skin, mucous membranes, and whites of the eyes. Usually, they do not cause symptoms. However, some telangiectasias bleed and cause significant problems. Telangiectasias may also occur in the brain and cause major problems from bleeding.
e.g-Cushing's syndrome Venous hypertensionvaricose and telangiectatic leg veins liver disease. Chronic treatment with topical corticosteroidsCauses----Alcohol use,Aging,Genetics,Pregnancy,Sun exposureDiseases associated with this condition include:Ataxia - telangiectasiaBloom syndromeCutis marmorata telangiectatica congenitaHereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)Klippel-Trenaunay-Weber syndromeNevus flammeus such as port-wine stainRosaceaSpider angiomaSturge-Weber diseaseXeroderma pigmentosa
Petechiae Petechiae – pinhead-sized macules of extravascular
blood in the dermis. Petechiae are flat. A petechia (Lural petechiae) is a small (1 - 2 mm) red or
purple spot on the body, caused by a minor hemorrhage (brokencapillary blood vessels).
"Petechiae" refers to one of the three major classes of purpuric skin conditions.
Purpuric eruptions are classified by size into three broad categories.
Petechiae is generally used to refer to the smallest of the three classes of purpuric skin eruptions, those that measure less than 3 mm. [email protected]
Purpura
The larger ones are referred to as purpuraPurpura (from Latin: purpura, meaning
"purple") is the appearance of red or purple discolorations on the skin that do not blanch on applying pressure.
They are caused by bleeding underneath the skin usually secondary to vasculitis or dietary deficiency of vitamin C (scurvy).
Purpura measure 0.3–1 cm (3–10 mm), whereas petechiae measure less than 3 mm, and ecchymoses greater than 1 cm.
This is common with typhus and can be present with meningitis caused by meningococcal meningitis or septicaemia.
In particular, meningococcus (Neisseria meningitidis), a Gram-negative diplococcus organism, releases endotoxin when it lyses.
Endotoxin activates the Hageman factor (clotting factor XII), which causes disseminated intravascular coagulation (DIC).
The DIC is what appears as a rash on the affected individual.
Ecchymosis
If bleeding involves deeper structures then it is an ecchymosis
a discoloration of the skin resulting from bleeding underneath, typically caused by bruising.
An ecchymosis is the medical term for a subcutaneouspurpura (extravasation of blood) larger than 1 centimeter or a hematoma, commonly, but erroneously, called a bruise.
That is, bruises are caused by trauma whereas ecchymoses, a type of purpura, are not caused by trauma.
A broader definition of ecchymosis is the escape of blood into the tissues from ruptured blood vessels.
The term also applies to the subcutaneous discoloration resulting from seepage of blood within the contused tissue.
Erythema Erythema is a skin condition characterized by
redness or rash. Erythema (from the Greek erythros, meaning red)
is redness of the skin, caused by hyperemia of the capillaries in the lower layers of the skin.
There are many types of erythema, including photosensitivity, erythema multiforme, and erythema nodusum.
It occurs with any skin injury, infection, or inflammation.
Photosensitivity is caused by a reaction to sunlight and tends to occur when something, such as an infection or a medication, increases your sensitivity to ultraviolet radiation.
Erythema multiforme is characterized by raised spots or other lesions on the skin. It is usually caused by a reaction to medications, infections (especially herpes simplex virus), or illness.
Erythema nodosum is a form of erythema that is accompanied by tender lumps, usually on the legs below the knees, and may be caused by certain medications or diseases.
Erythema ab igne Erythema chronicum migrans Erythema induratum Erythema infectiosum (or fifth disease) Erythema marginatum Erythema migrans Erythema multiforme (EM) Erythema nodosum Erythema toxicum Keratolytic winter erythema Palmar erythema
Hematoma A hematoma or haematoma, is a localized
collection of blood outside the blood vessels, usually in liquid form within the tissue.
An ecchymosis, commonly called a bruise, is a hematoma of the skin larger than 10mm.
Internal bleeding is generally considered to be a spreading of blood within the abdomen or skull, not within muscle
It is not to be confused with hemangioma which is an abnormal build up of blood vessels in the skin or internal organs. [email protected]
Types Subdermal hematoma (under the skin) Head/brain:
– Subgaleal hematoma – between the galea aponeurosis and periosteum– Cephalohematoma – between the periosteum and skull. Commonly caused by
vacuum delivery and vertex delivery.– Epidural hematoma – between the skull and dura mater– Subdural hematoma – between the dura mater and arachnoid mater– Subarachnoid hematoma – between the arachnoid mater and pia mater (the
subarachnoid space)– Othematoma – between the skin and the layers of cartilage of the ear
Perichondral hematoma (ear) Perianal hematoma (anus) Subungual hematoma (nail)
Degrees Petechiae – small pinpoint hematomas less than 3 mm in diameter Purpura (purple) – a bruise about 1 cm in diameter, generally round in shape Ecchymosis – subcutaneous extravasation of blood in a thin layer under the skin,
i.e. bruising or "black and blue," over 1 cm in diameter
Comedones A plug of keratin and sebum wedged in dilated pilosebaceous orifice. Comedones are the skin-coloured, small bumps (papules) frequently found on
the forehead and chin of those with acne. Open comedones are blackheads; black because of surface pigment (melanin)
rather than dirt Closed comedones are whiteheads; the follicle is completely blocked Macrocomedones are facial closed comedones that are larger than 2-3 mm in
diameter Solar comedones are found on the cheeks and chin of older people, and are
thought to be due to sun damage. Larger and deeper uninflamed bumps are called nodules. They are more
common on the trunk than on the face The cells lining the sebaceous duct proliferate excessively in acne (cornification)
and may block the sebaceous duct forming a comedone. These may be so small that they are not visible to the naked eye
(microcomedones). [email protected]
• A comedo is a clogged hair follicle (pore) in the skin.[1] Keratin (skin debris) combines with oil to block the follicle.
• A comedo can be open (blackhead) or closed by skin (whitehead), and occur with or without acne.
• The word comedo comes from Latin to suggest the worm-like look of a blackhead that has been secreted.
• The plural of comedo is comedones.• The chronic inflammatory condition that usually includes both
comedones and inflamed papules and pustules (pimples) is called acne.[2][4] Infection causes inflammation and the development of pus.
• Whether or not a skin condition classifies as acne depends on the amount of comedones and infection.
• Comedo-type ductal carcinoma in situ (DCIS) is not related to the skin conditions discussed here.
• DCIS is a non-invasive form of breast cancer, but comedo-type DCIS may be more aggressive and so may be more likely to become invasive.
Burrow A linear or cuvillinear papule, caused by
burrowing scabies mite Burrows are linear lesions produced by infestation
of the skin and formation of tunnels (e.g., with infestation by the scabitic mite or by cutaneous larva migrans)
Linear or serpiginous (wavy, serpent-like borders) tunnels within the epidermis. The small and short tunnels ofscabies are an example.
Microscopic examination of a skin biopsy or the skin scrapings done at time of clinical examination. The outer layers of eggs ( called ‘egg casings) and mites appear eosinophilic (pink) and scybala (feces) appear brown. These are present in the stratum corneum. The dermal inflammation contains eosinophils, as a response to the parasitic infection.
CYST
A cyst is a closed tumorous lesion covered by a membranous lining, which does not always elevate above the skin.
examples: sebaceous and epidermal cysts
The covering consists of epithelial tissue or connective tissue containing keratinous substances (observed in epidermal cysts, for example) or fluid components (e.g., in eccrine and apocrine hydrocystomas) elevated lesions containing fluid or viscous material appear as papules or nodules
distinction is made by puncturing to examine their contents and depth
Abscess
Thick-walled cavity containing pus The organisms or foreign materials kill
the local cells, resulting in the release of cytokines.
The cytokines trigger an inflammatory response, which draws large numbers of white blood cells to the area and increases the regional blood flow.
An abscess (Latin: abscessus) is a collection of pus (neutrophils) that has accumulated within a tissue because of an inflammatory process in response to either an infectious process (usually caused by bacteria or parasites) or other foreign materials (e.g., splinters, bullet wounds, or injecting needles). It is a defensive reaction of the tissue to prevent the spread of infectious materials to other parts of the body.
The organisms or foreign materials kill the local cells, resulting in the release of cytokines. The cytokines trigger an inflammatory response, which draws large numbers of white blood cells to the area and increases the regional blood flow.
The final structure of the abscess is an abscess wall, or capsule, that is formed by the adjacent healthy cells in an attempt to keep the pus from infecting neighboring structures. However, such encapsulation tends to prevent immune cells from attacking bacteria in the pus, or from reaching the causative organism or foreign object.
Abscesses must be differentiated from empyemas, which are accumulations of pus in a preexisting rather than a newly formed anatomical cavity. [email protected]
Papillomao Papilloma is a general medical term for
a tumor of the skin or mucous membrane with finger-like projections.
o Papillomas are also known as neoplasms. o While the vast majority of papillomas
are benign (noncancerous), they can occasionally be dysplastic (precancerous) or malignant (cancerous).
o Papillomas can occur in areas throughout the body. o Papillomas on the skin (cutaneous papillomas) are commonly
referred to as warts. o They occur on areas such as the hands, feet and knees.
Papillomas can also occur in the nose, brain, genitals, conjunctiva of the eye, and female breast ducts.
o Papilloma in the throat, windpipe and lungs is a rare disease called recurrent respiratory papillomatosis (RRP).
o Most papillomas are caused by a virus. o The human papillomaviruses (HPVs) are a group of more
than 150 viruses that can cause papillomas. HPVs can cause papillomas of the skin, genitals, mouth, eyes and throat. Certain HPVs can cause cervical cancer in women.
o Some types of papilloma have other, nonviral, causes. o For example, nasal papilloma may be caused by a tissue
injury. In addition, there are types of papillomas that do not have known causes. These include intraductal (breast duct) papilloma and choroid plexus papilloma (a rare benign brain tumor most often seen in young children). [email protected]
A benign papillomatous tumor derived from epithelium. Cauliflower-like projections that arise from the mucosal surface. It may appear white or normal colored. It may be pedunculated or sessile. The average size is less than 2.0 cm. No strong sex preference. The most common site was the palate-uvula area followed by tongue and lips. The durations ranged from weeks to 10 years. There is no evidence that papillomas are premalignant. Papilloma (plural papillomas or papillomata) refers to a benign
epithelial tumor growing exophytically (outwardly projecting) in nipple-like and often finger-like fronds.
In this context papilla refers to the projection created by the tumor, not a tumor on an already existing papilla (such as the nipple).
When used without context, it frequently refers to infections (squamous cell papilloma) caused by human papillomavirus (HPV), such as warts.
There are, however, a number of other conditions that cause papilloma, as well as many cases in which there is no known cause.Human papillomavirus infection is a major cause of cervical cancer, although most HPV infections do not cause cancer.
Poikiloderma Poikiloderma is a skin condition that consists of
areas of hypopigmentation, hyperpigmentation, telangiectasias and atrophy.
Poikiloderma is most frequently seen on the chest or the neck, characterized by red colored pigment on the skin that is commonly associated with sun damage.
e.g--Poikiloderma vasculare , atrophicans Poikiloderma of Civatte, Hereditary sclerosing poikiloderma
The exact cause of poikiloderma is unknown; however, extended sun exposure, namely the ultraviolet light emitted by the sun, is the primary factor
Causes Congenital Rothmund-Thompson Syndrome Dyskeratosis Congenita Mendes da Costa Syndrome
Other Heriditary Causes Hereditary Sclerosing Poikiloderma of Weary Weary-Kindler Syndrome Kindler Syndrome Diffuse and Macular Atrophic Dermatosis Degos-Touraine Syndrome Acquired Injury to cold, heat, ionizing radiation, exposure to sensitizing chemicals Lichen Planus Dermatomyositis Lupus Erythematosus Systemic Sclerosis Cutaneous T Cell Lymphomas
Secondary skin lesion:
1 Scale 7 Ulcer
2 Crust 8 Sinus
3 Excoriation 9 Scar
4 Lichenification 10 Keloid
5 Fissure 11 Atrophy
6 Erosion 12 Stria
Changes in skin which are superimposed or are the consequence of the primary process
SCALINING Scaling is the abnormal thickening of the skin surface
and formation of scaly white lamellae from the accumulation of horny cell layers.
Detachment of scales from the skin surface is called desquamation. Since the normal horny cell layers exfoliate individually, individual desquamation lamellae cannot be seen by the naked eye.
Scales are observed when multiple horny cell layers pathologically exfoliate in diseases such as psoriasis
e.g-desquamating layers of stratum corneum in psoriasis [email protected]
CRUSTING
Crust is solidified keratin and exudate that forms on an erosion or on ulcerous skin.
A crust of clotted blood is called a bloody crust (commonly called a scab).
Crusts are a sign of pyogenic infection
e.g-Impetigo with honey colored crust
Erosion Erosions are loss of the epidermis They may occur after a vesicle forms and the top peels
off A skin defect where there has been loss of the
epidermis only e.g-toxic epidermal necrolysis A skin defect where there has been loss of the
epidermis only They weep and become crusted This is an example of a secondary change or
characteristic Area of skin denuded by complete or partial loss of
epidermis. No associated loss of dermis [email protected]
UlcerIf an erosion involves the dermis, it is
called an…ulcer.An area of skin from which the whole of
epidermis & atleast the upper part of dermis has been lost
A skin defect where there has been loss of the epidermis and dermis
e.g- Pyoderma gangrenosum traumatic ulcers, burns, and stasis ulcers
(L. ulcus, “sore”) Ulcers often heal with scarring; erosions usually
do not Erosions and ulcers are secondary lesions Secondary lesions (or changes) may evolve from
primary lesions, or may be caused by external forces such as scratching, trauma, infection, or the healing process.
Gangrene---extensive destruction of the skin -- may leave many dead cells that become blackened
Linear, angular erosions that may be covered by crust and are caused by scratching.
Superficial excavation of the epidermis that results from scratching
E.g- Linear excoriations in a patient with atopic dermatitis
EXCORIATION
FISSURE
o A slit- shaped deep ulcero In anatomy,a fissure (Latin fissura, plural
fissurae) is a groove, natural division, deep furrow, elongated cleft, or tear in various parts of the body.
Eg: Irritant dermatitis of hands/foot.
A skin fissure is a cutaneous condition in which there is a linear-like cleavage of skin, sometimes defined as extending into the dermis.
It is smaller than a skin laceration. A skin area on which there are many skin fissures is called cracked skin, and is most commonly a result of skin dryness.
Ichthyosis is a genetic disorder where there is often severe skin cracking.
ATROPHY
A accquired loss of substance . In skin,this may appear as a depression with intact
epidermis ( loss of dermal /subdermal tissues ) Or appear as sites of shiny, delicate, wrinkled lesions (epidermal atrophy )
Epidermal atrophy results from a decrease in the number of epidermal cell layers.
Dermal atrophy results from a decrease in the dermal connective tissue.
e.g-Steroid Induced Atrophy:Many years of inappropriate application of topical steroids have led to local changes and atrophy.
LICHENIFICATION
A distinctive thickening of skin that is characterized by accenuated skin-fold markings.
Lichenification – skin thickening that is the result of chronic rubbing leading to accentuation of normal skin lines.
Scar
A change in the skin secondary to trauma or inflammation
Sites may be erythematous,hypopigmented or hyperpigmented depending upon their age /character.
Scar- a lesion formed as a result of dermal damage.
KELOID
Keloid is a benign overgrowth of the connective tissue of the skin consequent to an abnormal healing process of the skin in predisposed individuals.
Keloid can cause serious aesthetic and occasionally functional disabilities.
Keloid occur in all races but it is most common and severe in the black race.
• A keloid (also keloidal scar) is the formation that a type of scar which, depending on its maturity, is composed mainly of either type III (early) or type I (late) collagen.
• It is a result of an overgrowth of granulation tissue (collagen type 3) at the site of a healed skin injury which is then slowly replaced by collagen type 1.
• Keloids are firm, rubbery lesions or shiny, fibrous nodules, and can vary from pink to flesh-coloured or red to dark brown in colour.
• A keloid scar is benign and not contagious, but sometimes accompanied by severe itchiness, pain,[2]
and changes in texture. • In severe cases, it can affect movement of skin.• Keloids should not be confused with
hypertrophic scars, which are raised scars that do not grow beyond the boundaries of the original wound. [email protected]
SinusA cavity or channel that permits the escape of pus or fluid
e.g-Pilonidal sinus, preauricular sinus, sinus caused by dental absces….
Striae
A streak like, linear , atrophic, pink, purple or white lesion d/t changes in connective tissue
Eg: cushings syndrome, pregnancy induced
Stretch marks or striae (singular stria), as they are called in dermatology, are a form of scarring on the skin with an off-color hue.
They are caused by tearing of the dermis, which over time may diminish, but will not disappear completely.
Stretch marks are often the result of the rapid stretching of the skin associated with rapid growth or rapid weight changes.
Stretch marks may also be influenced by hormonal changes associated with puberty, pregnancy, bodybuilding, hormone replacement therapy, etc.[1]
Medical terminology for these kinds of markings includes striae atrophicae, vergetures, stria distensae, striae cutis distensae, lineae atrophicae, linea albicante, or simply striae.
Stretch marks formed during pregnancy, usually during the last trimester, and usually on the belly, but also commonly occurring on the breasts, thighs, hips, lower back and buttocks, are known as striae gravidarum.
*(Greek. Sklerosis - a hardening) Sclerosis is an induration or hardening of the skin. It is often due to fibrosis.
*Sclerosis or sclerotizis (also spelled sclerosus in the names of a few disorders) is a hardening of tissue and other anatomical features
*In medicine, sclerosis refers to the stiffening of a structure, usually caused by a replacement of the normal organ-specific tissue with connective tissue.
Sclerosis
Amyotrophic lateral sclerosis, sometimes known as motor neuron disease or Lou Gehrig's disease, a progressive, incurable, usually fatal disease of motor neurons.Atherosclerosis, a deposit of fatty materials, such as cholesterol, in the arteries which causes hardening.Focal Segmental Glomerulosclerosis is a disease that attacks the kidney's filtering system (glomeruli) causing serious scarring and thus a cause of nephrotic syndrome in children and adolescents,[1] as well as an important cause of kidney failure in adults.[2]
Hippocampal sclerosis, a brain damage often seen in individuals with temporal lobe epilepsy.Lichen sclerosus, a disease that hardens the connective tissues of the vagina of women and the penis of men. An autoimmune disorder.Liver sclerosis is a common misspelling of cirrhosis of the liver.Multiple sclerosis, or Focal Sclerosis,[3] is a central nervous system disease which affects coordination.Osteosclerosis, a condition where the bone density is significantly increased.Otosclerosis, a disease of the ears.Systemic sclerosis (progressive systemic scleroderma), a rare, chronic disease which affects the skin, and in some cases also blood vessels and internal organs.Tuberous sclerosis, a rare genetic disease which affects multiple systems.Primary sclerosing cholangitis, a hardening of the bile duct by scarring and repeated inflammation.Primary lateral sclerosis, progressive muscle weakness in the voluntary [email protected]
Primary and Secondary Lesions
Raised Flat Depressed
Fluid-filled
Vascular
Papule Macule Erosion Vesicle Telangiectasia
Plaque Patch Ulcer Bulla Petechiae
Nodule Atrophy Pustule Ecchymosis
Tumor Sinus Furuncle
Wheal Stria Abscess
Burrow
Example Documentation
No abnormalities - General Statement about overall skin assessment:– Skin is warm, smooth and well hydrated.
Full hair distribution on scalp, axilla, and genitalia. Nails are neatly trimmed and without deformity. No discrete lesions noted.
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