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SKIN LESIONS
DR KOMAL JADHAV
PG SCHOLAR
DEPT OF AGADATANTRA
AGE
 INFANTS
Atopic dermatitis
 ADULTS
 OLD AGE
Senile pruritis
HISTORY
 Drug intake
 Administration of vaccine, sera, blood components…
 Contact agents like poison, toxic plant, cosmetics, insect
bite, poisonous animals
 Household contact is suggestive of infective disorder like
viral infection, scabies.
MENSTRUAL HISTORY
 In case of hirsutism – when there is androgen excess,
libido is increased and menstrual cycles become irregular
and scanty.
FAMILY HISTORY
 Eczema, atopic dermatitis, autoimmune disorder, vitiligo,
psoriasis
DISTRIBUTION OF SKIN LESIONS
 WRIST – Scabies
 EXTENSAR PART OF ELBOW, KNEE – Psoriasis
 FINGER WEBS – Scabies, atopic dermatitis
 SYMETRICAL – Systemic disease
 ASYMETRIC – Local infection
EXAMINATION OF SKIN
 It includes
 Inspection
 Palpation
 History
 Clinical TESTS
 Laboratory Tests
PRIMARY SKIN LESIONS
MACULES
 Flat, nonpalpable areas of colour
change of skin.
 May be erythematous, hypo or
hyperpigmented
 May be of any shape
 Border- regular or irregular
 Ex : moles, lentigines, freckles, café-
au- lait spots, vitiligo, Mongolian
blue spot and port wine stain
MOLE
 A pigmentary nevus
FRECKLES
 Small, < 0.5cm, discrete brown macules
that appear on the sun exposed areas of
skin.
 The condition is inherited as an
autosomal dominant trait in light
skinned red-haired people.
 Commonly seen on the face, back, upper
shoulders, sparing the mucous
membrens.
LENTIGINES
 Small, < 0.5cm, single or multiple brown to
black, variegated or uniformly colored
macules over the skin or mucosae.
 They are darker in colour than freckles and
are not affected by sunlight.
 They may be associated with LEOPARD
syndrome, FACES syndrome, sotos
syndrome, LAMB syndrome, NAME
syndrome and peutz–jeghers syndrome.
PAPULE
 Circumscribed raised skin lesions of
<1 cm in diameter.
 They may be dome- shaped, flat-
topped, conical, umblicated or
verrucous.
 Ex : mollusum contigiosum, warts,
miliary rubra
PAPILLOMA
 It is a pedunculated lesion projecting from skin.
NODULES
 Elevated skin lesions > 1cm in diameter.
 They may be located in epidermis, dermis
or subcutaneous tissues.
 Ex : epidermoid cysts, fibromas and
neurofibromas.
TUMOR
 Large nodule, generally > 2 cm in
diameter.
 They may be benign or malignant
and primary or metastatic.
PLAQUES
 Well circumscribed, broad based dicoid
lesions of altered skin texture often
formed by coalescence of the number
of papules.
 The diameter or size of the lesions is
greater than its height of elevation.
 It may be flat, elevated or depressed.
 Ex : psoriasis
TARGET LESION
 Annular patch or plaque with centra
vesicle or pigmentation and a halo of
erythema.
WHEALS
 They are transient, raised, edematous
skin lesion with irregular edges.
 The lesions are erythematous with a
central pallor.
 Intense itching is usually present.
 Show characteristics of urticaria and
insect bites.
VESICLES
 Elevated, fluid-containing lesions.
 Blisters of <1cm in diameter.
 Ex : chickenpox, herpes simplex or
zoster, contact dermatitis.
BULLAE
 Vesicles > 1cm diameter.
 They may be intraepidermal,
subepidermal.
 Ex : epidermolysis bullosa,
staphylococcal scaled skin syndrome.
CYSTS
 The circumscribed tumor containing
semisolid or fluid.
 E x : epidermal cysts that may occur
after puberty on the face and upper
back, dermoid, sebaceous cyst,
brachial cyst.
PUSTULES
 The elevated, well circumscribed lesions
containing prurulent material or pus .
 Unlike the transparent dew drop
appearance of vesicles, the postules may
be turbid or opaque and white or yellow in
color.
 Ex : folliculitis, pyoderma.
CALLUS
 Localized hyperplasia of horny
layer on the palm or sole due to
presser.
COMEDONS
 These are characteristic skin lesions of acne
due to dark horny keratin and sebaceous plug
which are distributed on the face and upper
back.
 Open comedons or black heads are 2-5mm
flesh colored papules with black centers
 The closed comedons or white heads are 1-
3mm flesh colored papules with a pinpoint
opening.
PETECHIE
 Pinhead sized macules of extravasated
blood.
 They cannot be blanched on pressure.
PURPURA/ ECCHYMOSIS
 The leakage of blood in the skin.
 Unlike erythematous macules, purpura cannot be
blanched by pressure with a finger or with a glass
side or a transperant plastic spatula.
 PETECHIAE - Small, pinpoint, <3mm.
 ECCHYMOSIS- larger areas of extravasation of
blood in the skin.
 Ecchymatic skin patches may be flat or raised above
the surface when there is associated with vasculitis,
Henoch – schonlein purpura and collagen vascular
or connective tissue disoreders.
HEMATOMA
 Swelling with or without fluctuation
due to gross bleeding under the skin.
TELANGIECTASIA
 Dilatation of superficial blood vessels
which can be blanched by pressure.
BURROWS
 They are linear, curved or seepentine
elevations or tunnels in the superficial skin
produced by the adult female mite as she
travels through the stratum corneum.
 There is the black dot at the leading edge of
the tunnel due to the lodgement of mite.
 Typically located in the interdigital areas of
palm and soles.
SECONDARY SKIN LESIONS
 Produced due to changes caused by scratching, touching,
secondary infection and because of local and systemic
effect of medications.
SCALES
 Desquamation or shedding of excess of
normal and abnormal horny layer of
skin.
CRUSTS
 Formed by drying of blood, serum and any
exudate overlying the diseased skin.
 They are often present in impetigo- in which
they appear horny colored and in weeping
eczematous lesion.
EXCORIATIONS
 Develop as a result of linear loss of skin
secondary to self – induced scratching
and rubbing.
 Ex : contact dermatitis, atopic dermatitis,
insect bites.
EROSIONS
 Partial loss of epidermis which heals without
scarring.
ULCERS
 Occur due to deeper loss of the skin
involving both epidermis and a variable
depth of dermis or subcutaneous tissue.
 They may result from infection, vascular
insufficiency or burns.
ESCHAR
 It is necrotic skin lesion covered with a
black crest.
FISSURES
 Linear clefts which are located deep in
the epidermal layer in thickened or
chronically inflamed skin.
LICHENIFICATION
 Thickening and hyperpigmentation of skin
which exaggeration of skin markings due
to chronic rubbing because of allergic or
infective skin lesions
ATROPHY
 Loss or thinning of the epidermis or dermis.
 Epidermal atrophy is characterized by
wrinkling of the skin with telengiectases.
 In dermal or subcutaneous atrophy, the skin
is depressed.
ECZEMATOUS SKIN LESIONS
 Inflammatory skin lesions which have
indistic margins with erythema and
vesiculation in the acute phase.
 Scaling, crusting and lichenification
may be seen as the disorder progresses.
STRIAE
 A trophic pink or white linear skin lesions over
the abdomen and buttocks due to alterations in
the connective tissue because of sudden
changes in the girth as a result of obesity,
pregnancy and ascites.
HYPERKERATOSIS
 Thickening of stratum corneum.
 The presence of thick rough scales over
skin lesions is a good clinical marker of
hyperkeratosis.
SCAR
 Healing occurs by replacement with fibrous
tissue.
 When formation of scar is excessive, it is called
keloid.
THANK YOU

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EXAMINATION OF SKIN.pptx

  • 1. SKIN LESIONS DR KOMAL JADHAV PG SCHOLAR DEPT OF AGADATANTRA
  • 2. AGE  INFANTS Atopic dermatitis  ADULTS  OLD AGE Senile pruritis
  • 3. HISTORY  Drug intake  Administration of vaccine, sera, blood components…  Contact agents like poison, toxic plant, cosmetics, insect bite, poisonous animals  Household contact is suggestive of infective disorder like viral infection, scabies.
  • 4. MENSTRUAL HISTORY  In case of hirsutism – when there is androgen excess, libido is increased and menstrual cycles become irregular and scanty.
  • 5. FAMILY HISTORY  Eczema, atopic dermatitis, autoimmune disorder, vitiligo, psoriasis
  • 6. DISTRIBUTION OF SKIN LESIONS  WRIST – Scabies  EXTENSAR PART OF ELBOW, KNEE – Psoriasis  FINGER WEBS – Scabies, atopic dermatitis
  • 7.  SYMETRICAL – Systemic disease  ASYMETRIC – Local infection
  • 8. EXAMINATION OF SKIN  It includes  Inspection  Palpation  History  Clinical TESTS  Laboratory Tests
  • 9. PRIMARY SKIN LESIONS MACULES  Flat, nonpalpable areas of colour change of skin.  May be erythematous, hypo or hyperpigmented  May be of any shape  Border- regular or irregular  Ex : moles, lentigines, freckles, café- au- lait spots, vitiligo, Mongolian blue spot and port wine stain
  • 11. FRECKLES  Small, < 0.5cm, discrete brown macules that appear on the sun exposed areas of skin.  The condition is inherited as an autosomal dominant trait in light skinned red-haired people.  Commonly seen on the face, back, upper shoulders, sparing the mucous membrens.
  • 12. LENTIGINES  Small, < 0.5cm, single or multiple brown to black, variegated or uniformly colored macules over the skin or mucosae.  They are darker in colour than freckles and are not affected by sunlight.  They may be associated with LEOPARD syndrome, FACES syndrome, sotos syndrome, LAMB syndrome, NAME syndrome and peutz–jeghers syndrome.
  • 13. PAPULE  Circumscribed raised skin lesions of <1 cm in diameter.  They may be dome- shaped, flat- topped, conical, umblicated or verrucous.  Ex : mollusum contigiosum, warts, miliary rubra
  • 14. PAPILLOMA  It is a pedunculated lesion projecting from skin.
  • 15. NODULES  Elevated skin lesions > 1cm in diameter.  They may be located in epidermis, dermis or subcutaneous tissues.  Ex : epidermoid cysts, fibromas and neurofibromas.
  • 16. TUMOR  Large nodule, generally > 2 cm in diameter.  They may be benign or malignant and primary or metastatic.
  • 17. PLAQUES  Well circumscribed, broad based dicoid lesions of altered skin texture often formed by coalescence of the number of papules.  The diameter or size of the lesions is greater than its height of elevation.  It may be flat, elevated or depressed.  Ex : psoriasis
  • 18. TARGET LESION  Annular patch or plaque with centra vesicle or pigmentation and a halo of erythema.
  • 19. WHEALS  They are transient, raised, edematous skin lesion with irregular edges.  The lesions are erythematous with a central pallor.  Intense itching is usually present.  Show characteristics of urticaria and insect bites.
  • 20. VESICLES  Elevated, fluid-containing lesions.  Blisters of <1cm in diameter.  Ex : chickenpox, herpes simplex or zoster, contact dermatitis.
  • 21. BULLAE  Vesicles > 1cm diameter.  They may be intraepidermal, subepidermal.  Ex : epidermolysis bullosa, staphylococcal scaled skin syndrome.
  • 22. CYSTS  The circumscribed tumor containing semisolid or fluid.  E x : epidermal cysts that may occur after puberty on the face and upper back, dermoid, sebaceous cyst, brachial cyst.
  • 23. PUSTULES  The elevated, well circumscribed lesions containing prurulent material or pus .  Unlike the transparent dew drop appearance of vesicles, the postules may be turbid or opaque and white or yellow in color.  Ex : folliculitis, pyoderma.
  • 24. CALLUS  Localized hyperplasia of horny layer on the palm or sole due to presser.
  • 25. COMEDONS  These are characteristic skin lesions of acne due to dark horny keratin and sebaceous plug which are distributed on the face and upper back.  Open comedons or black heads are 2-5mm flesh colored papules with black centers  The closed comedons or white heads are 1- 3mm flesh colored papules with a pinpoint opening.
  • 26. PETECHIE  Pinhead sized macules of extravasated blood.  They cannot be blanched on pressure.
  • 27. PURPURA/ ECCHYMOSIS  The leakage of blood in the skin.  Unlike erythematous macules, purpura cannot be blanched by pressure with a finger or with a glass side or a transperant plastic spatula.  PETECHIAE - Small, pinpoint, <3mm.  ECCHYMOSIS- larger areas of extravasation of blood in the skin.  Ecchymatic skin patches may be flat or raised above the surface when there is associated with vasculitis, Henoch – schonlein purpura and collagen vascular or connective tissue disoreders.
  • 28. HEMATOMA  Swelling with or without fluctuation due to gross bleeding under the skin.
  • 29. TELANGIECTASIA  Dilatation of superficial blood vessels which can be blanched by pressure.
  • 30. BURROWS  They are linear, curved or seepentine elevations or tunnels in the superficial skin produced by the adult female mite as she travels through the stratum corneum.  There is the black dot at the leading edge of the tunnel due to the lodgement of mite.  Typically located in the interdigital areas of palm and soles.
  • 31. SECONDARY SKIN LESIONS  Produced due to changes caused by scratching, touching, secondary infection and because of local and systemic effect of medications.
  • 32. SCALES  Desquamation or shedding of excess of normal and abnormal horny layer of skin.
  • 33. CRUSTS  Formed by drying of blood, serum and any exudate overlying the diseased skin.  They are often present in impetigo- in which they appear horny colored and in weeping eczematous lesion.
  • 34. EXCORIATIONS  Develop as a result of linear loss of skin secondary to self – induced scratching and rubbing.  Ex : contact dermatitis, atopic dermatitis, insect bites.
  • 35. EROSIONS  Partial loss of epidermis which heals without scarring.
  • 36. ULCERS  Occur due to deeper loss of the skin involving both epidermis and a variable depth of dermis or subcutaneous tissue.  They may result from infection, vascular insufficiency or burns.
  • 37. ESCHAR  It is necrotic skin lesion covered with a black crest.
  • 38. FISSURES  Linear clefts which are located deep in the epidermal layer in thickened or chronically inflamed skin.
  • 39. LICHENIFICATION  Thickening and hyperpigmentation of skin which exaggeration of skin markings due to chronic rubbing because of allergic or infective skin lesions
  • 40. ATROPHY  Loss or thinning of the epidermis or dermis.  Epidermal atrophy is characterized by wrinkling of the skin with telengiectases.  In dermal or subcutaneous atrophy, the skin is depressed.
  • 41. ECZEMATOUS SKIN LESIONS  Inflammatory skin lesions which have indistic margins with erythema and vesiculation in the acute phase.  Scaling, crusting and lichenification may be seen as the disorder progresses.
  • 42. STRIAE  A trophic pink or white linear skin lesions over the abdomen and buttocks due to alterations in the connective tissue because of sudden changes in the girth as a result of obesity, pregnancy and ascites.
  • 43. HYPERKERATOSIS  Thickening of stratum corneum.  The presence of thick rough scales over skin lesions is a good clinical marker of hyperkeratosis.
  • 44. SCAR  Healing occurs by replacement with fibrous tissue.  When formation of scar is excessive, it is called keloid.