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Morphology of skin lesionsMorphology of skin lesions
Dr Mesfin HunegnawDr Mesfin Hunegnaw
Consultant Dermatologist & Vener...
Morphology of skin lesionsMorphology of skin lesions
Includes:Includes:
 Type of the lesion,Type of the lesion,
 Size of...
Types of skin lesions…Types of skin lesions…
Generally;Generally;
-Asymmetrical- exogenous cause,-Asymmetrical- exogenous ...
ClassificationClassification
Primary:Primary:
--The original uncomplicated patternThe original uncomplicated pattern
 Mac...
Primary skin lesions:Primary skin lesions:
1-Macule:1-Macule:
 ‘‘macula’: ‘spot’macula’: ‘spot’
 Flat, change in skin co...
Macule…Macule…
As a result of:As a result of:
 Hyper pigmentationHyper pigmentation
- Cafe-au-lait spots,- Cafe-au-lait s...
Macule…Macule…
 Vascular abnormalityVascular abnormality
- Erythema Vs pupura- Erythema Vs pupura
Macules + fine scales= ...
PurpuraPurpura
Macules of café au lait spots in NFMacules of café au lait spots in NF
Patch of vitiligoPatch of vitiligo
Patch of leprosy in 27 yrs EthiopianPatch of leprosy in 27 yrs Ethiopian
Patch of leprosy in 43 yrs EthiopianPatch of leprosy in 43 yrs Ethiopian
TelangectasiaTelangectasia
2-Papule2-Papule
 ‘‘Papula’: ’pimple’Papula’: ’pimple’
 Small solid elevation,Small solid elevation,
 Most of the its p...
Papule…Papule…
 Epidermal:Epidermal: epidermal thickening, hyperkeratosisepidermal thickening, hyperkeratosis
-Wart-Wart
...
Papule…Papule…
Can have d/t shape, colorCan have d/t shape, color
- Flat-topped: LP…- Flat-topped: LP…
- Dome shaped: MC, ...
Keratosis pilarisKeratosis pilaris
MCMC
DPN in 48 yrs old EthiopianDPN in 48 yrs old Ethiopian
Papules of SMx in 25yrs EthiopianPapules of SMx in 25yrs Ethiopian
Papules of mastocytosis in 1 yr EthiopianPapules of mastocytosis in 1 yr Ethiopian
Same…Same…
3-Nodule3-Nodule
 ‘‘Nodulus’: ‘small knot’Nodulus’: ‘small knot’
 Palpable, solid, round lesion (big papule).Palpable, s...
??
SC nodulesSC nodules
Keloid noduleKeloid nodule
Nodules of leprosy in 45 yrs EthiopianNodules of leprosy in 45 yrs Ethiopian
4-Blister (vesicle, bullae)4-Blister (vesicle, bullae)
 ‘‘Vesicula’- ‘little bladder’Vesicula’- ‘little bladder’
 ‘‘Bull...
Blister…Blister…
 Cleavage can be due to:Cleavage can be due to:
-Intracellular edema—HS-Intracellular edema—HS( herpes s...
Blister….Blister….
 According to contentAccording to content::
-Fluid: p.vulgaris-Fluid: p.vulgaris
-Pus: impetigo-Pus: i...
Photo toxic blistersPhoto toxic blisters
HZHZ
HZ in 32 yrs Ethiopian pt with HIVHZ in 32 yrs Ethiopian pt with HIV
HSHS
HZHZ
5-Pustule5-Pustule
 Small pus containing swelling.Small pus containing swelling.
 Usually ass. with infection—from papul...
pustulespustules
Pustular plantar psoriasisPustular plantar psoriasis
Pustules & plaques in 33 yrs EthiopianPustules & plaques in 33 yrs Ethiopian
Palmoplantar pustulosis in Ethiopian pt.Palmoplantar pustulosis in Ethiopian pt.
6-Wheal6-Wheal
 Also called urticaria,Also called urticaria,
 Round or flat topped red, purple papule/plaque thatRound o...
WhealWheal
7-Scale (squames)7-Scale (squames)
 ‘‘Squama’ – ‘scale’Squama’ – ‘scale’
 Flakes of stratum corneumFlakes of stratum cor...
scalesscales
 Types of scalesTypes of scales
-Pityriasiform-Pityriasiform: fine, bran-like: P.versicolor: fine, bran-like...
Psoriasis scalesPsoriasis scales
Psoriatic scale in 32 yrs Ethiopian ptPsoriatic scale in 32 yrs Ethiopian pt
P.rosea scalesP.rosea scales
Scales, IchthiosisScales, Ichthiosis
8-Plaque8-Plaque
 Well defined plateau like elevationWell defined plateau like elevation
 Confluent papules… Psoriasis, ...
Plaque,LSCPlaque,LSC
Lichen simplex chronicus
Psoriatic plaquePsoriatic plaque
Plaques of keloids in 42 yrs EthiopianPlaques of keloids in 42 yrs Ethiopian
Plaques of leprosy in 42 yrs EthiopianPlaques of leprosy in 42 yrs Ethiopian
Plaque of Leprosy in 44 yrs EthiopianPlaque of Leprosy in 44 yrs Ethiopian
Plaque of Leprosy in 18 yrs EthiopianPlaque of Leprosy in 18 yrs Ethiopian
Plaques of Leprosy in 18 yrs EthiopianPlaques of Leprosy in 18 yrs Ethiopian
9-Crust9-Crust
 ‘‘Crusta’-’bark, shell’Crusta’-’bark, shell’
 Serum, blood, purulent exudates dries on the skinSerum, bl...
HZ,crustHZ,crust
Impetigo,crustImpetigo,crust
Crusts in Ethiopian ptCrusts in Ethiopian pt
Crusts in Ethiopian ptCrusts in Ethiopian pt
Crusts in Ethiopian ptCrusts in Ethiopian pt
Crusts in Ethiopian ptCrusts in Ethiopian pt
10-Lichenification10-Lichenification
 Grouped papules asso. with exaggerationGrouped papules asso. with exaggeration
of s...
Lichenified eczemaLichenified eczema
11-Erosion, ulcer, wound11-Erosion, ulcer, wound
 Different types of tissue loses varying in their depthDifferent types o...
11.2-Ulcers11.2-Ulcers
 ‘‘Ulcus’- ’sore’Ulcus’- ’sore’
 Larger defect involving the dermis and SCLarger defect involving...
Erosion.pemphigusErosion.pemphigus
ulcerulcer
Ethiopian pt with ulcerEthiopian pt with ulcer
Erosions in Ethiopian pt with SSSSErosions in Ethiopian pt with SSSS
Erosions, Crusts & bullae in Ethiopian ptErosions, Crusts & bullae in Ethiopian pt
12-Excoriation, fissure12-Excoriation, fissure
12.1-Excoriation12.1-Excoriation
 Small superficial defect at epidermis, p...
ExcoriationsExcoriations
Ethiopian pt with PPEEthiopian pt with PPE
Ethiopian pt with PPEEthiopian pt with PPE
Ethiopian pt ?Ethiopian pt ?
14-Scar14-Scar
 Happens when tissue defect is healed by fibrous tissueHappens when tissue defect is healed by fibrous tis...
15-Atrophy15-Atrophy
 Thinning of the skin.. Epidermis, dermis or bothThinning of the skin.. Epidermis, dermis or both
 ...
Atrophy,steroidAtrophy,steroid
II-DistributionII-Distribution
 Area of predilectionArea of predilection
Can be :Can be :
 LocalizedLocalized
 Widespre...
III-ArrangementIII-Arrangement
 Solitary Vs multipleSolitary Vs multiple
 Multiple ones : grouped Vs random arrangementM...
Grouped lesions.HSGrouped lesions.HS
Epidermal naevus, linearEpidermal naevus, linear
Linear arrangement,HZLinear arrangement,HZ
IV-SizeIV-Size
 Exact measurement of the lesions onExact measurement of the lesions on
cm or mmcm or mm
 Two perpendicul...
V-MarginsV-Margins
 Border of the lesionBorder of the lesion
 Sharp Vs indistinctSharp Vs indistinct
 Active/scaly----f...
Raised margins, granulomaRaised margins, granuloma
annulare.annulare.
VI-ShapeVI-Shape
 RoundRound
 OvalOval
 PolygonalPolygonal
 SerpiginousSerpiginous
 PolycyclicPolycyclic
 AnnularAnn...
 Clinical and laboratory aids toClinical and laboratory aids to
dermatologic diagnosisdermatologic diagnosis
Clinical signs:Clinical signs:
 Dimple signDimple sign
-Dermatofibrosis Vs malignant melanoma-Dermatofibrosis Vs malignan...
Clinical testsClinical tests
 Patch testPatch test
-Allergic contact dermatitis-Allergic contact dermatitis
-Identify the...
InstrumentalInstrumental
MagnificationMagnification
 Hand lensHand lens: better, closer visualization: better, closer vis...
Instrumental…Instrumental…
 Wood’s lampWood’s lamp
-Uses black light-Uses black light
-Hair, skin diseases-dermatophytes ...
MicroscopyMicroscopy
 KOH:KOH: different fungal infectionsdifferent fungal infections
 Gram stainGram stain with culture...
HistopathologyHistopathology
 Routine histologyRoutine histology
 Immunoflorescent microscopyImmunoflorescent microscopy...
SerologySerology
 Used for evaluation of infectious andUsed for evaluation of infectious and
autoimmune diseasesautoimmun...
BiopsyBiopsy
 Doubt about diagnosis-biopsy should be doneDoubt about diagnosis-biopsy should be done
 The slightest doub...
Morphology of skin lesions
Morphology of skin lesions
Morphology of skin lesions
Morphology of skin lesions
Morphology of skin lesions
Morphology of skin lesions
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Transcript of "Morphology of skin lesions"

  1. 1. Morphology of skin lesionsMorphology of skin lesions Dr Mesfin HunegnawDr Mesfin Hunegnaw Consultant Dermatologist & VenerologistConsultant Dermatologist & Venerologist AAU, Medical facultyAAU, Medical faculty Dept. of DermatovenerologyDept. of Dermatovenerology
  2. 2. Morphology of skin lesionsMorphology of skin lesions Includes:Includes:  Type of the lesion,Type of the lesion,  Size of the lesion,Size of the lesion,  Shape of the lesion,Shape of the lesion,  Distribution and arrangement,Distribution and arrangement,  Margination.Margination. Leads toLeads to DIAGNOSIS.DIAGNOSIS.
  3. 3. Types of skin lesions…Types of skin lesions… Generally;Generally; -Asymmetrical- exogenous cause,-Asymmetrical- exogenous cause, -Symmetrical- endogenous cause.-Symmetrical- endogenous cause. Exantum:Exantum: widespread cutaneous eruption,widespread cutaneous eruption, Enantum:Enantum:when there is mucosal involvement.when there is mucosal involvement.
  4. 4. ClassificationClassification Primary:Primary: --The original uncomplicated patternThe original uncomplicated pattern  Macule, papule, nodule, pustule, vesicle, bullae,Macule, papule, nodule, pustule, vesicle, bullae, wheals, erythema.wheals, erythema. Secondary:Secondary: --With further development like infection, trauma,With further development like infection, trauma, treatment…treatment…  Scale, plaque, crust, fissure, erosion, ulcer, scar,Scale, plaque, crust, fissure, erosion, ulcer, scar, lichenification, atrophy.lichenification, atrophy.
  5. 5. Primary skin lesions:Primary skin lesions: 1-Macule:1-Macule:  ‘‘macula’: ‘spot’macula’: ‘spot’  Flat, change in skin colour,Flat, change in skin colour,  No elevation or depression,No elevation or depression,  Not identified by mere touch,Not identified by mere touch,  <1.0 cm= macule,<1.0 cm= macule,  >1.0cm>1.0cmpatch.patch.
  6. 6. Macule…Macule… As a result of:As a result of:  Hyper pigmentationHyper pigmentation - Cafe-au-lait spots,- Cafe-au-lait spots, - Post inf. hyper pigmentation.- Post inf. hyper pigmentation.  Hypo pigmentationHypo pigmentation - post inf. Hypopigmentation,- post inf. Hypopigmentation, - Leprosy,- Leprosy, - Vitiligo.- Vitiligo.
  7. 7. Macule…Macule…  Vascular abnormalityVascular abnormality - Erythema Vs pupura- Erythema Vs pupura Macules + fine scales= maculosquamousMacules + fine scales= maculosquamous - P.versicolor- P.versicolor - P.rosea- P.rosea  TelangiectasiaTelangiectasia: permanent dilatation of: permanent dilatation of capillariescapillaries
  8. 8. PurpuraPurpura
  9. 9. Macules of café au lait spots in NFMacules of café au lait spots in NF
  10. 10. Patch of vitiligoPatch of vitiligo
  11. 11. Patch of leprosy in 27 yrs EthiopianPatch of leprosy in 27 yrs Ethiopian
  12. 12. Patch of leprosy in 43 yrs EthiopianPatch of leprosy in 43 yrs Ethiopian
  13. 13. TelangectasiaTelangectasia
  14. 14. 2-Papule2-Papule  ‘‘Papula’: ’pimple’Papula’: ’pimple’  Small solid elevation,Small solid elevation,  Most of the its part is above the plane unlike nodule,Most of the its part is above the plane unlike nodule,  <0.5cm in diameter,<0.5cm in diameter,  Epidermal, dermal or combined changes.Epidermal, dermal or combined changes.
  15. 15. Papule…Papule…  Epidermal:Epidermal: epidermal thickening, hyperkeratosisepidermal thickening, hyperkeratosis -Wart-Wart -Epidermal nevus-Epidermal nevus  Dermal papuleDermal papule -Syringoma-Syringoma -Hemangiomas-Hemangiomas -Neurofibromas…-Neurofibromas…  Mixed papuleMixed papule -Hypertrophic lichen planus…-Hypertrophic lichen planus…
  16. 16. Papule…Papule… Can have d/t shape, colorCan have d/t shape, color - Flat-topped: LP…- Flat-topped: LP… - Dome shaped: MC, fox Fordyce..- Dome shaped: MC, fox Fordyce.. - Pointed : Miliaria rubra- Pointed : Miliaria rubra Can have d/t shape, colorsCan have d/t shape, colors  Red papule: Rosacea, Acne fulminance folliculitis…Red papule: Rosacea, Acne fulminance folliculitis…  Purple: LP…Purple: LP…  Skin colouredSkin coloured:: lichen nitidus, Keratosis pilaris…lichen nitidus, Keratosis pilaris…
  17. 17. Keratosis pilarisKeratosis pilaris
  18. 18. MCMC
  19. 19. DPN in 48 yrs old EthiopianDPN in 48 yrs old Ethiopian
  20. 20. Papules of SMx in 25yrs EthiopianPapules of SMx in 25yrs Ethiopian
  21. 21. Papules of mastocytosis in 1 yr EthiopianPapules of mastocytosis in 1 yr Ethiopian
  22. 22. Same…Same…
  23. 23. 3-Nodule3-Nodule  ‘‘Nodulus’: ‘small knot’Nodulus’: ‘small knot’  Palpable, solid, round lesion (big papule).Palpable, solid, round lesion (big papule).  Felt > seen.Felt > seen.  According to anatomy:According to anatomy: -Epidermal….Verruca vulgaris,-Epidermal….Verruca vulgaris, -Epidermo-dermal: Melanoma,-Epidermo-dermal: Melanoma, -Dermal: dermato-fibroma,-Dermal: dermato-fibroma, -Dermal-SC: Granuloma annulare-Dermal-SC: Granuloma annulare -SC: lipoma.-SC: lipoma. Can have different consistency: hard/soft.Can have different consistency: hard/soft. Color and shape can also be different.Color and shape can also be different.
  24. 24. ??
  25. 25. SC nodulesSC nodules
  26. 26. Keloid noduleKeloid nodule
  27. 27. Nodules of leprosy in 45 yrs EthiopianNodules of leprosy in 45 yrs Ethiopian
  28. 28. 4-Blister (vesicle, bullae)4-Blister (vesicle, bullae)  ‘‘Vesicula’- ‘little bladder’Vesicula’- ‘little bladder’  ‘‘Bulla’- ‘bubble’Bulla’- ‘bubble’  Vesicle: small raised fluid filled lesion;<0.5cm inVesicle: small raised fluid filled lesion;<0.5cm in diameter.diameter.  Bullae:> 0.5cm in diameter.Bullae:> 0.5cm in diameter.  Cleavage at various levels of superficial skin.Cleavage at various levels of superficial skin.
  29. 29. Blister…Blister…  Cleavage can be due to:Cleavage can be due to: -Intracellular edema—HS-Intracellular edema—HS( herpes simplex)( herpes simplex) -Intercellular edema—ACD-Intercellular edema—ACD(allergic contact dermatitis)(allergic contact dermatitis) -Acantholysis--P.vulgaris-Acantholysis--P.vulgaris (pemphigus vulgaris)(pemphigus vulgaris)  According location of cleavage:According location of cleavage: -Subcorneal: Impetigo, Subcorneal pustulosis…-Subcorneal: Impetigo, Subcorneal pustulosis… -Intraepidermal: P.vulgaris-Intraepidermal: P.vulgaris -Subepidermal: B.pemphigoids-Subepidermal: B.pemphigoids -Dermal: Dystrophic epidermolysis bullosa.-Dermal: Dystrophic epidermolysis bullosa.
  30. 30. Blister….Blister….  According to contentAccording to content:: -Fluid: p.vulgaris-Fluid: p.vulgaris -Pus: impetigo-Pus: impetigo -Blood: B.pemphigoids-Blood: B.pemphigoids
  31. 31. Photo toxic blistersPhoto toxic blisters
  32. 32. HZHZ
  33. 33. HZ in 32 yrs Ethiopian pt with HIVHZ in 32 yrs Ethiopian pt with HIV
  34. 34. HSHS
  35. 35. HZHZ
  36. 36. 5-Pustule5-Pustule  Small pus containing swelling.Small pus containing swelling.  Usually ass. with infection—from papules or vesiclesUsually ass. with infection—from papules or vesicles  But they mayBut they may develop by their own—acne, nondevelop by their own—acne, non pyogenic bacteriapyogenic bacteria  Can be sterile---Can be sterile---pustular psoriasispustular psoriasis..
  37. 37. pustulespustules
  38. 38. Pustular plantar psoriasisPustular plantar psoriasis
  39. 39. Pustules & plaques in 33 yrs EthiopianPustules & plaques in 33 yrs Ethiopian
  40. 40. Palmoplantar pustulosis in Ethiopian pt.Palmoplantar pustulosis in Ethiopian pt.
  41. 41. 6-Wheal6-Wheal  Also called urticaria,Also called urticaria,  Round or flat topped red, purple papule/plaque thatRound or flat topped red, purple papule/plaque that disappears in a day or twodisappears in a day or two  Due to edema in the upper dermis.Due to edema in the upper dermis.  If lower SC = AngioedemaIf lower SC = Angioedema  insect biteinsect bite
  42. 42. WhealWheal
  43. 43. 7-Scale (squames)7-Scale (squames)  ‘‘Squama’ – ‘scale’Squama’ – ‘scale’  Flakes of stratum corneumFlakes of stratum corneum  Increased Rate of production of epidermal cells and theIncreased Rate of production of epidermal cells and the outermost desquamation layers of skinoutermost desquamation layers of skin scalescale
  44. 44. scalesscales  Types of scalesTypes of scales -Pityriasiform-Pityriasiform: fine, bran-like: P.versicolor: fine, bran-like: P.versicolor -Psoriasiform-Psoriasiform: white, silvery, non-adherent: white, silvery, non-adherent psoriasis.psoriasis. -Ichthiosiform-Ichthiosiform: large discrete: large discrete Ichthiosis.Ichthiosis. -Collarete-Collarete: scales surrounding lesions: scales surrounding lesions -Inward pointing scales: P.rosea,-Inward pointing scales: P.rosea, -Trailing scales: EAC-Trailing scales: EAC
  45. 45. Psoriasis scalesPsoriasis scales
  46. 46. Psoriatic scale in 32 yrs Ethiopian ptPsoriatic scale in 32 yrs Ethiopian pt
  47. 47. P.rosea scalesP.rosea scales
  48. 48. Scales, IchthiosisScales, Ichthiosis
  49. 49. 8-Plaque8-Plaque  Well defined plateau like elevationWell defined plateau like elevation  Confluent papules… Psoriasis, LPConfluent papules… Psoriasis, LP
  50. 50. Plaque,LSCPlaque,LSC Lichen simplex chronicus
  51. 51. Psoriatic plaquePsoriatic plaque
  52. 52. Plaques of keloids in 42 yrs EthiopianPlaques of keloids in 42 yrs Ethiopian
  53. 53. Plaques of leprosy in 42 yrs EthiopianPlaques of leprosy in 42 yrs Ethiopian
  54. 54. Plaque of Leprosy in 44 yrs EthiopianPlaque of Leprosy in 44 yrs Ethiopian
  55. 55. Plaque of Leprosy in 18 yrs EthiopianPlaque of Leprosy in 18 yrs Ethiopian
  56. 56. Plaques of Leprosy in 18 yrs EthiopianPlaques of Leprosy in 18 yrs Ethiopian
  57. 57. 9-Crust9-Crust  ‘‘Crusta’-’bark, shell’Crusta’-’bark, shell’  Serum, blood, purulent exudates dries on the skinSerum, blood, purulent exudates dries on the skin surfacesurface - Clear, yellow: serum.- Clear, yellow: serum. - Yellow-green: purulent exudate…impetigo- Yellow-green: purulent exudate…impetigo - Brown, dark red: blood.- Brown, dark red: blood.
  58. 58. HZ,crustHZ,crust
  59. 59. Impetigo,crustImpetigo,crust
  60. 60. Crusts in Ethiopian ptCrusts in Ethiopian pt
  61. 61. Crusts in Ethiopian ptCrusts in Ethiopian pt
  62. 62. Crusts in Ethiopian ptCrusts in Ethiopian pt
  63. 63. Crusts in Ethiopian ptCrusts in Ethiopian pt
  64. 64. 10-Lichenification10-Lichenification  Grouped papules asso. with exaggerationGrouped papules asso. with exaggeration of skin markings and thickening: eg.of skin markings and thickening: eg.LSCLSC..
  65. 65. Lichenified eczemaLichenified eczema
  66. 66. 11-Erosion, ulcer, wound11-Erosion, ulcer, wound  Different types of tissue loses varying in their depthDifferent types of tissue loses varying in their depth and breadthand breadth 11.1-Erosion:11.1-Erosion: - Superficial loss of tissue- Superficial loss of tissue - Confined to the epidermis- Confined to the epidermis - Wide>depth- Wide>depth - No scaring- No scaring Can occur in: Ruptured blister,Can occur in: Ruptured blister, 22ndnd degree burn…degree burn…
  67. 67. 11.2-Ulcers11.2-Ulcers  ‘‘Ulcus’- ’sore’Ulcus’- ’sore’  Larger defect involving the dermis and SCLarger defect involving the dermis and SC  Occurs in damaged skinOccurs in damaged skin  Slow healer, always scarSlow healer, always scar -3-3rdrd degree burndegree burn -Decubitus ulcer-Decubitus ulcer 11.3-Wound11.3-Wound  Traumatic defect in normal skinTraumatic defect in normal skin  Heals rapidly, less scaringHeals rapidly, less scaring -Injury-Injury -Surgery-Surgery
  68. 68. Erosion.pemphigusErosion.pemphigus
  69. 69. ulcerulcer
  70. 70. Ethiopian pt with ulcerEthiopian pt with ulcer
  71. 71. Erosions in Ethiopian pt with SSSSErosions in Ethiopian pt with SSSS
  72. 72. Erosions, Crusts & bullae in Ethiopian ptErosions, Crusts & bullae in Ethiopian pt
  73. 73. 12-Excoriation, fissure12-Excoriation, fissure 12.1-Excoriation12.1-Excoriation  Small superficial defect at epidermis, papillary dermis,Small superficial defect at epidermis, papillary dermis,  Local traumaLocal trauma  scratchingscratching  itchy skin conditionsitchy skin conditions 12.2-Fissures12.2-Fissures  Deep linear lesionsDeep linear lesions -T.ungum-T.ungum -Intertrigo-Intertrigo
  74. 74. ExcoriationsExcoriations
  75. 75. Ethiopian pt with PPEEthiopian pt with PPE
  76. 76. Ethiopian pt with PPEEthiopian pt with PPE
  77. 77. Ethiopian pt ?Ethiopian pt ?
  78. 78. 14-Scar14-Scar  Happens when tissue defect is healed by fibrous tissueHappens when tissue defect is healed by fibrous tissue replacementreplacement  Can be :FlatCan be :Flat  good surgerygood surgery DepressedDepressed  acneacne ((Ice peak scar,Boxcar scar,Rolling scarIce peak scar,Boxcar scar,Rolling scar)) ElevatedElevated  hypertrophichypertrophic  keloidkeloid
  79. 79. 15-Atrophy15-Atrophy  Thinning of the skin.. Epidermis, dermis or bothThinning of the skin.. Epidermis, dermis or both  Epidermal : Thinning of epidermisEpidermal : Thinning of epidermis Transparent—visible vesselsTransparent—visible vessels Loss of skin textureLoss of skin texture  Dermal: loss of CTDermal: loss of CT : Depression: Depression
  80. 80. Atrophy,steroidAtrophy,steroid
  81. 81. II-DistributionII-Distribution  Area of predilectionArea of predilection Can be :Can be :  LocalizedLocalized  Widespread/disseminated :Chicken poxWidespread/disseminated :Chicken pox  Diffuse—involving wider area with no interveningDiffuse—involving wider area with no intervening normal skin: erysipelasnormal skin: erysipelas
  82. 82. III-ArrangementIII-Arrangement  Solitary Vs multipleSolitary Vs multiple  Multiple ones : grouped Vs random arrangementMultiple ones : grouped Vs random arrangement  Grouped: HS, DH…Grouped: HS, DH…  Linear: epidermal nevusLinear: epidermal nevus  Segmental….HZSegmental….HZ  Follow skin folds……P.roseaFollow skin folds……P.rosea
  83. 83. Grouped lesions.HSGrouped lesions.HS
  84. 84. Epidermal naevus, linearEpidermal naevus, linear
  85. 85. Linear arrangement,HZLinear arrangement,HZ
  86. 86. IV-SizeIV-Size  Exact measurement of the lesions onExact measurement of the lesions on cm or mmcm or mm  Two perpendicular diameters –oneTwo perpendicular diameters –one representing the max. lesion sizerepresenting the max. lesion size
  87. 87. V-MarginsV-Margins  Border of the lesionBorder of the lesion  Sharp Vs indistinctSharp Vs indistinct  Active/scaly----fungal infn.Active/scaly----fungal infn.
  88. 88. Raised margins, granulomaRaised margins, granuloma annulare.annulare.
  89. 89. VI-ShapeVI-Shape  RoundRound  OvalOval  PolygonalPolygonal  SerpiginousSerpiginous  PolycyclicPolycyclic  AnnularAnnular  UmblicatedUmblicated
  90. 90.  Clinical and laboratory aids toClinical and laboratory aids to dermatologic diagnosisdermatologic diagnosis
  91. 91. Clinical signs:Clinical signs:  Dimple signDimple sign -Dermatofibrosis Vs malignant melanoma-Dermatofibrosis Vs malignant melanoma  Auspitz’s signAuspitz’s sign -psoriasis-psoriasis  Nikolsky’s signNikolsky’s sign --Acantholytic disorders…pemphigus, SSSS,TENAcantholytic disorders…pemphigus, SSSS,TEN  Darier’s signDarier’s sign -Urticaria pigmentosa-Urticaria pigmentosa
  92. 92. Clinical testsClinical tests  Patch testPatch test -Allergic contact dermatitis-Allergic contact dermatitis -Identify the allergen-Identify the allergen  Photo patch testingPhoto patch testing -To determine photo allergy-To determine photo allergy  Prick testingPrick testing -Determine type 1 allergy-Determine type 1 allergy  Aceton whitingAceton whiting -Sub clinical penile or vulvar warts, 5% acetic acid-Sub clinical penile or vulvar warts, 5% acetic acid  Photo testingPhoto testing -Which WL of UVR causing photo induced illness:-Which WL of UVR causing photo induced illness: PMLE, AP, HV…PMLE, AP, HV…
  93. 93. InstrumentalInstrumental MagnificationMagnification  Hand lensHand lens: better, closer visualization: better, closer visualization - LP- LP wickham's streawickham's strea - SLE- SLE follicular pluging and atrophyfollicular pluging and atrophy - Scabies-mite- Scabies-mite  DiascopyDiascopy -Glass spatula-Glass spatula -Lab. Slides-Lab. Slides Erythma Vs purpuraErythma Vs purpura
  94. 94. Instrumental…Instrumental…  Wood’s lampWood’s lamp -Uses black light-Uses black light -Hair, skin diseases-dermatophytes of the hair shaft-Hair, skin diseases-dermatophytes of the hair shaft P.versicolour, Erythrasma…P.versicolour, Erythrasma… -Urine exam for porphyria-Urine exam for porphyria  UltrasoundUltrasound -Penetrate 2-3mm-Penetrate 2-3mm -Ass. skin thickness—sceleroderma-Ass. skin thickness—sceleroderma -Ass of effect of steroids on the skin-Ass of effect of steroids on the skin -Flow of blood-Flow of blood  PhotographyPhotography
  95. 95. MicroscopyMicroscopy  KOH:KOH: different fungal infectionsdifferent fungal infections  Gram stainGram stain with culture and sensitivitywith culture and sensitivity  Dark field:Dark field: T.pallidum detection.T.pallidum detection.  Tzank preparation:Tzank preparation: HS,HZHS,HZ Gaint multinuclated cells,Gaint multinuclated cells,  Wet mount,Wet mount,  Indian ink…Indian ink…
  96. 96. HistopathologyHistopathology  Routine histologyRoutine histology  Immunoflorescent microscopyImmunoflorescent microscopy  ImmunohistochemistoryImmunohistochemistory  Electron microscopeElectron microscope
  97. 97. SerologySerology  Used for evaluation of infectious andUsed for evaluation of infectious and autoimmune diseasesautoimmune diseases
  98. 98. BiopsyBiopsy  Doubt about diagnosis-biopsy should be doneDoubt about diagnosis-biopsy should be done  The slightest doubt that a lesion could be a malignancyThe slightest doubt that a lesion could be a malignancy is an indication for biopsyis an indication for biopsy  Area: fresh lesion, where healing is goodArea: fresh lesion, where healing is good TechniquesTechniques  Simple excision (excisional biopsy)Simple excision (excisional biopsy) .for simple lesions.for simple lesions  Punch biopsyPunch biopsy  Shave, tangential biopsyShave, tangential biopsy  CurretageCurretage  ElectrosurgeryElectrosurgery
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