DERMATOLOGICAL CHANGES DUE TO SKIN DISEASE.

1. LESIONS AND
ABRASIONS OF SKIN

2. PRESENTED BY

4. According to luck mans
Lesions is a region in an organ or tissue
which has suffered damage through
injury or disease, such as a wound, ulcer,
abscess, or tumor.
According to Lewis
A skin lesion is a part of the skin that has
an abnormal growth or appearance
compared to the skin around it.

5. Types Of Lesions
Primary Lesions
Secondary Lesions
Tertiary Lesions

6. Primary Lesions
Definition : lesion occurring on non pathological
skin which have not been altered by trauma,
manipulation (scratching, scrubbing), or natural
regression over time.

7. Examples
• Macule
• Papule
• Patch ???
• Plaque
• Nodule
• Wheal
• Vesicle
• Bulla
• Pustule
• Cyst

8. Macule
• Definition : Flat, circumscribed skin
discoloration that lacks surface elevation or
depression, less than 1 cm in diameter*

9. • TYPES
1)Hypopigmented : due to decrease in number of
melanocytes or the amount of pigment they produce
E.g. : tuberous sclerosis , nevus achromicus , etc
nevus achromicus

10. 2)Depigmented : due to complete loss of
melanocytes E.g.: vitiligo , halonaevus
3)Hyperpigmented : due to excess of melanin in skin
A)brown or black : due to excess of melanin in epidermis
E.g.: freckles or chloasma

11. B)Bluish-grey : due to increase melanin in dermis (
tyndall effect )
E.g : Mongolian spot, nevus of Ota

12. C)Erythema: increased blood flow through the skin
causing capillary dilatation
E.g : macular viral and
drug rash
D)Purpura/Ecchymosis: extravasation of RBCs in
Dermis
(large purpura : ecchymosis)
E)g : thrombocytic purpura
Schamberg’s purpura

13. Papule
Solid , well circumscribed elevated lesion, less than one cm
in diameter
Formed by
1)hyperplasia of epidermis , dermis or both
E.g : verruca vulgaris
2)Metabolic deposits or cellular infiltrates
E.g : xanthelasma

14. SHAPE
COLOUR

15. Shape
• Pointed : Follicular Lichen planus
• Papulosquamous : Guttate Psoriasis
• Dome : Molluscum contagiosum
• Flat topped : lichen plannus

16. Colour
• Red : Psoriasis
• Pearly white : molluscum contagiosum
• Violaceous : Lichen planus
• Coppery : seccondary syphilis
• Yellowish : Xanthelasma
• Blue/Black : Mallignant Melanoma
• Purpuric : henoch-schönlein purpura

17. Plaque
•Elevated well circumscribed more than 1 cm in
diameter ,occupying relatively large surface area
in comparison with its height above the skin
surface

18. Types
Scaly Plaque : Psoriasis , P.Rosea
• Lichenified plaque : Lichen Simplex Chronicus
• Erythematous plaque : Tuberculoid
leprosy

19. Patch
• Patch / Large macule ???

20. Nodule
• Palpable solid round lesion ,usually larger than
1cm in diameter .occupying relatively larger
vertical diameter as compared to suface
diameter.
• PAPULE
• SEEN BETTER
NODULE
FELT BETTER

21. • E.g : erythema nodosum,Lipoma,Sebaceous cyst
kerato acanthoma,xanthelasma,

22. Wheals
• Evanescent , edematous , platue-like
elevations of various sizes
• Usually oval or arcuate , pink to red ,
surrounded by a flare of macular erythema
• Caused by transient vascular reaction in the
upper dermis mainly due to vasodilatation and
increased permeability of capillaries
• It is the characteristic lesion of urticaria

23. Wheals

24. Vesicle AND Bullae
• Elevated ,superficial well circumscribed lesion containing
clear fluid , less than 0.5 cm in diameter
• A vesicle larger than 0.5 cm is known as Bullae
• They can arise by separation of skin at different levels i.e
a) interepidermal eg bullous impetigo
b) supra basal e.g Pemphigus vulgaris
c) dermoepidermal eg erythema
multiforme

25. • Lesions may be
• A) tense : Pompholyx
• Flaccid : Pemphigus Vulgaris
• Umblicated : varicella zoster

26. Pustule
• Well-circumscribed, elevated lesion containing
visible purulent exudate
• Pustules are characteristic of pustular
psoriasis, pyoderma, rosacea

27. Cyst
• A sac that contains liquid or semisolid material
in a well-defined cavity
• 2 most common type-
• A) Epidermal cyst: lined with squamous
epithelium and produce keratinous material
• B) pilar cyst: originate from hair follicle lined
with multilayered epithelium

28. Abscess
• An abscess is a collection of pus below the
skin
• Pus in an abscess is invisible but clinically be
interpreted as sign of inflammation in the
overlying skin
•
• Abscess cavities do not have well-defined
lining as cyst

29. Secondary lesions: modification of primary skin lesions
that result from traumatic injury , evolution from
primary lesion , or other external factors
• Crust
• Scale
• Erosion
• Ulcer
• Fissure
• Scar
• Atrophy
• Telangiectasia

30. Crust
• A collection of cellular debris
,dried serum,pus or blood and
sometimes bacterial debries
• antecedent primary lesion is
usually a vesicle,bulla or
pustule

31. Types
• Golden yellow,soft friable : Impetigo
• Yellowish : Flavus
• Thick hard and tough : third degree burns
• Lamillated,elevated, black or green : syphillus
(oyster shell)

32. Erosion
• Partial focal loss of the epidermis alone. Heals
without a scar
• Eg herpes zooster,TEN,Erosion interdigitale

33. Scale
• Abnormal shedding or accumulation of the
stratum corneum in visible flakes is called scaling
• Formed due to - a) formation of epidermal cells is
rapid
OR
b) process of normal keratinisation is
interferred with

34. Types
• Fine and delicate : P.versicolor
• Coarse : eczema
• Stratified : Psoriasis

35. Ulcer
• A full-thickness, focal loss
of epidermis along with
parts of dermis ,heals
with scarring
• E.g : bed sores , Syphillus
Diabetic foot

36. Fissure
• Linear cleft in the skin through the epidermis and part of dermis
may be single or multiple ranging from microscopic to a few
millimeters having well defined margins
They occur most commonly when
skin is dry and thickened due to
inflamation
Pain is often produced by movement of part,
Which opens or deepens the fissure
Commonest sites a) tips and flexural creases of thumb , finger and
palms
b) edges of heel
c)clefts between fingers and toess
d) angle of mouth,the lips,nares auricles and anus

37. Scar
• A collection of new connective tissue, that
replaces lost substances in the demis or deep
dermal tissues
• They may be atrophic or hypertrophic
• Hypertrophic scars / Keloid develop when
fibrous components predominate

40. An abrasion is a type of open wound that's caused
by the skin rubbing against a rough surface. It may
be called a scrape or a graze. When an abrasion is
caused by the skin sliding across hard ground, it may
be called road rash. Abrasions are very common
injuries. They can range from mild to severe.
According to lippincott

41. An abrasion is a partial thickness wound
caused by damage to the skin and can be
superficial involving only the epidermis to
deep, involving the deep dermis.
According to luckmans

42. Abrasion
Punctate or linear abrasion produced by mechanical means
Usually involving only the epidermis
Caused by scratching with fingernails in a variety of disease
E.g : atopic dermatitis , Scabies
If the damage is due to constant
friction or mechanical trauma
the word Abrasion may be used

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