The document discusses the approach to describing skin lesions. It notes that primary lesions are the initial visible changes, while secondary lesions represent evolved changes from skin disorders or infections. Primary lesions are usually more helpful for diagnosis. Key aspects for describing lesions include number, size, color, shape, border, texture, nature (flat, raised, fluid-filled), location and arrangement. Common pediatric skin lesions described include tinea capitis, impetigo, scabies, measles and diaper dermatitis.

1. Approach to Skin Lesions

2. Lesion type
• Primary lesions are either the first visible lesion or involve the initial
skin changes
• Secondary lesions of the skin represent evolved changes from the
skin disorder, due to secondary manipulation or as a result of
infection

3. • One must also decide whether the changes are those of the primary
lesion itself or whether the clinical pattern has been altered by a
secondary factor such as infection, trauma, or therapy
• Primary lesions may change into secondary lesions, or secondary
lesions may develop over time where no primary lesion existed.
• Primary lesions are usually more helpful for diagnostic purposes than
secondary lesions.

4. PRIMARY & SECONDARY SKIN LESIONS
Primary
 Macule
 Patch
 Papule
 Nodule
 Tumor
 Plaque
 Vesicle
 Pustule
 Bullae
 Wheal
 Cysts
Secondary
 Scale
 Purpura, petechiae
 Excoriation
 Erosion
 Fissure
 Sinus
 Scar
 Atrophy
 Striae
 Lichenification

5. Primary Skin lesions

6. • A macule represents an alteration in skin
color but cannot be felt.
• When the lesion is >1 cm, the term patch is
used

7. • Papules are palpable solid
lesions <1 cm.
Molluscum contagiosum
Warts

8. Plaques
• A large >1cm, flat
topped/plateau like raised
lesion, edges may either be
distinct (in psoriasis) or gradually
blend with surrounding skin (in
eczematous dermatitis)
• Diameter greater than the
thickness.

9. Nodules are palpable lesions >1 cm with a
rounded surface.
Erythema nodosum
Tumor is solid, raised growth >2cm in
diameter, the word tumor may be used for a
large nodule that is suspected to be
neoplastic in origin.

10. • Vesicles are raised, fluid-filled
lesions <1 cm in diameter; when
larger, they are called bullae.
• Ex. Herpes simplex
Herpes zoster

11. Pustule
• Pustules are small,
circumscribed skin papules
containing purulent material
• Folliculitis

12. • Telangiectasia is a dilated superficial blood vessel

13. Wheal
• Wheals are flat-topped, palpable
lesions of variable size, duration,
and configuration that represent
dermal collections of edema
fluid.
• Wheals are irregularly elevated
edematous skin areas that are
often erythematous.

14. Cysts
• Cysts are circumscribed,
thick-walled lesions;
they are covered by a
normal epidermis and
contain fluid or semisolid
material.

15. Secondary skin lesions
• Scales consist of
compressed layers of
stratum corneum cells
that are retained on the
skin surface.

16. Crust
• Crusts consist of matted,
retained (dried) accumulations
of blood, serum, pus, and
epithelial debris
• might be either yellow ( serous
crust ) red (hemorrhagic crust )

17. Ulcer
• An area of skin from which the
whole of epidermis & at least
the upper part of dermis has
been lost.
• tend to heal with scarring.

18. Erosion
• Area of skin denuded(removed)
by complete or partial loss of
epidermis.
• No associated loss of dermis
• they heal without scarring.

19. Excoriation
• Linear, angular erosions (ulcers)
that may be covered by crust
and are caused by scratching.

20. Scar
• A change in the skin secondary
to trauma or inflammation
• Sites may be erythematous,
hypopigmented or
hyperpigmented depending
upon their age /character.

21. Lichenification
• A distinctive thickening of skin
that is characterized by
accenuated skin-fold markings.

22. • Purpura are the result
of bleeding into the skin
and have a red-purple
color; they may be flat
or palpable.
• Petechiae
are small purpura 2-3
mm.
• Ecchymosis larger than
petechiae

24. Describing a skin lesion

25. Integumentary system Examination
• Lighting, Equipment, and Dermoscopy.
• Exposure
• Position
• Seated, supine, or prone.
• Component
• Hair and scalp,
• Nails and
• Skin.

26. Examples
• Over 30 small round brown macules with symmetric pigmentation on
back, chest, and arms.
• Single 1.2 × 1.6 cm asymmetric dark brown and black plaque with
erythematous, uneven border, on left upper arm.”

27. Describing a skin lesion
• Number
• Size
• Color
• Shape
• Configuration
• Margin/ border
• Texture
• Nature of the lesion
• Location
• Arrangement

28. Number
• Lesions can be solitary or multiple.
• If multiple, record how many. Also consider estimating the total number
of the type of lesion you are describing.

29. Size
• Measure with a ruler in millimeters or centimeters.
• For oval lesions, measure in the long axis, then perpendicular to the axis.

30. Color
• Describe the color we see.
• Use shades
• Tan, light brown, brown, dark
brown
• Use “skin-colored” to describe a
lesion that is the same shade as
the patient’s skin.
• Flesh Neurofibroma, some nevi
• Pink Eczema
• Erythematous Tinea eruptions
• Salmon Psoriasis
• Tan-brown Most nevi
• Black Malignant melanoma
• Purple Kaposi sarcoma
• Yellow Lipoma
• Violaceous/ Violet
• White
• Pearly

31. • For red lesions or rashes, blanch
the lesion by pressing it firmly
with your finger or a glass slide to
see if the redness temporarily
lightens then refills.

32. Shape
• Circular,
• Oval,
• linear

33. Configuration
• It refers to the shape or outline of
the skin lesions.
• Annular ring-like, with central
clearing,
• Nummular  coin-like, no central
clearing and
• Polygonal/ Polycyclic formed from
coalescing circles.
• Target lesions concentric rings like
a dartboard

34. • Annular Round, active margins with central clearing Tinea corporis,
sarcoidosis
• Zosteriform (dermatomal)Following nerve or segment of bodyHerpes zoster
• PolycyclicPsoriasis, urticaria
• Linear dermatitis
• Iris/target lesion Erythema multiforme
• StellateStar Meningococcal septicemia
• Serpiginous/ Snakelike or wavy line Cutanea larva migrans
• Reticulate Netlike or lacy  Polyarteritis nodosa, lichen planus lesions of
erythema infectiosum
• Morbilliform/ Confluent Rubeola

35. Border/Margin
• Discrete Well demarcated or defined
• Psoriasis
• Indistinct Poorly defined;
• Eczema
• Active Margin of lesion shows greater activity than center
• Eruptions
• Irregular Nonsmooth or notched margin
• Malignant melanoma
• Border raised above center Center of lesion depressed compared to
edge/Dimpling/
• Basal cell carcinoma
• Advancing Expanding at margins

36. Texture
• Palpate the lesion to see if it is
• Smooth,
• Fleshy,
• Verrucous
• Warty,
• Scaly (fine, keratotic, or greasy scale).

37. Nature of the lesion
• Primary lesion: Primary lesions are flat or raised.
• Flat: You cannot palpate the lesion with your eyes closed. (Macule or Patch)
• Raised: You can palpate the lesion with eyes closed. (Papule or Plaque). Not fluid
filled
• Fluid filled
• Vesicle: Lesion is raised, <1 cm, and filled with fluid.
• Bulla: Lesion is raised, >1 cm, and fluid filled.
• Other lesions include erosions, ulcers, nodules, ecchymoses, petechiae,
and palpable purpura.

38. Arrangement
• Grouped or scattered
Additionally striking appearances should be mentioned
• Draining
• Hair growth over lesion
• Associated changes

39. Associated Changes Within Lesions
• Central clearing Erythematous border surrounds lighter skin
• Tinea eruptions
• Desquamation Peeling or sloughing of skin
• Rash of toxic shock syndrome
• Keratotic Hypertrophic stratum corneumCalluses, warts
• Punctation Central umbilication or dimpling
• Basal cell carcinoma
• Telangiectasias Dilated blood vessels within lesion blanch completely

40. Location
• Be as specific as possible.
• For single lesions, measure their distance from other landmarks (e.g., 1
cm lateral to left oral commissure).

41. • N Multiple
• S 2–4-mm
• C skin-colored to light brown
• S fleshy
• T Soft
• N Papules
• L axillae in skin folds

42. • Solitary 8-cm dusky oval
patch with smaller inner
violaceous patch and central
3.5-cm tense bulla, with well
demarcated border, on right
posterior lower back;

43. • Multiple
• 2–4-mm
• Vesicles & pustules on
erythematous base,
• Grouped together on left neck;

44. • N
• S
• C
• S
• T
• N
• L
• C

45. Common Skin Lesions in
Pediatrics

46. TINEA CAPITIS
Large, grey, round, well
defined scaly patches
with hair breaks
interspersed in the
middle located on the
scalp

47. IMPETIGO
Non-bullous impetigo -
Multiple usually measuring
less than 2cm papules to
vesicles surrounded by
erythema.
Could present as flaccid,
transparent bullae(Bullous
impetigo) or "punched-out"
ulcers covered with yellow
crust surrounded by raised
violaceous margins

48. SCABIES
slightly elevated, grayish,
tortuous lines in the skin.
multiple vesicles or
pustules containing is
also noted

49. MEASLES
generalized,
erythematous
maculopapules over the
face, trunk and
extremities

50. DIAPER DERMATITIS

51. Molluscum
Contagiosum
multiple firm white
nodules on the face.