Primary and secondary lesions that could be found with respect to oral cavity and diseases that could affect the body.

1. Primary and secondary
lesions (oralmedicine)
Seminar presentation by:
Dr. Ivy S Tomy

2. Lesions
 This is a localized area of
disease or injury in a any tissue
or organ of the body

3. Skin lesionsare of
2 types
 Primary lesions
 Secondary lesions

4. Primarylesions
Examples are
 Macule
 Patch
 Papule
 Plaque
 Vesicle
 Bulla
 Pustule
 Nodule
 Purpura
 Petechiae
 Ecchymosis
 striae
These are basic reaction patterns with
definite morphology

5. Secondarylesions
Examples
 Erosion
 Ulcer
 Fissure
 Crust
 Sinus
 Scar
 Atrophy
These are lesions arising from primary lesion as a
result of traumatic injury or the external factors

7. Primary lesions

8. Macule
 Well circumscribed, flat lesion, size is less
than 1 cm and it is noticeable because of
their colour change from normal skin
colour.
 Macules are flat, nonpalpable lesions
usually < 10 mm in diameter. Macules
represent a change in color and are not
raised or depressed compared to the skin
surface.
 Examples
 Red macule
 Presence of vascular lesions
 Inflammation
 Brownish black
 The presence of melanin, hemosiderin

9. Macule

10. Patch
 Well circumscribed, flat lesion,
size is more than 1 cm.
 Examples
 Red
 Haemangioma
 Purpura, ecchymosis
 Inflammation
 Brownish black
 The presence of melanin,
haemosiderin and drugs

11. Patch

13. Papule
 Solid lesions raised above the skin
surface, which is less than 1cm in
diameter.
 Papules are elevated lesions
usually < 10 mm in diameter that
can be felt or palpated.
 Examples
 White
 Papulular lichen planus
 Yellowish white
 Fordyces granules
 Red
 Petechiae
 Apthous
 Erethema multiforme

14. Papule

15. Plaque
 Solid, raised lesions, which is
more than 1cm in diameter.
 Plaques are palpable lesions > 10
mm in diameter that are elevated
or depressed compared to the
skin surface. Plaques may be flat
topped or rounded
 Examples
 White
 Leukoplakia
 Lichen planus
 candidiasis
 Red
 Erythroplakia
 Black
 Melanoma

16. Plaque

17. Vesicle
 Vesicles are small, clear, fluid-
filled blisters < 10 mm in
diameter.
 Vesicles are characteristic of
 herpes infections,
 acute allergic contact
dermatitis,
 and some autoimmune
blistering disorders
(eg, dermatitis herpetiformis).

18. Vesicle

19. Bulla
 Bullae are clear fluid-filled
blisters > 10 mm in diameter.
 These may be caused by
 burns, bites, irritant contact
dermatitis or allergic contact
dermatitis, and drug reactions.
 Classic autoimmune bullous
diseases include
 pemphigus vulgaris and bullous
pemphigoid. Bullae also may
occur in inherited disorders of
skin fragility.

20. Bulla

21. Pustule
 Pustules are vesicles that
contain pus.
 Pustules are common in
bacterial infections and
folliculitis and may arise in
some inflammatory disorders
including pustular psoriasis.

22. Pustule

23. Nodule
 Nodules are firm papules or
lesions that extend into the
dermis or subcutaneous tissue
 . Examples include
 cysts,
 lipomas,
 and fibromas.

24. Nodule

25. Purpura
 Purpura is a larger area of
hemorrhage that may be
palpable.
 Palpable purpura is considered
the hallmark of
leukocytoclastic vasculitis.
 Purpura may indicate a
coagulopathy.
 Large areas of purpura may be
called ecchymoses or,
colloquially, bruises.

26. Purpura

27. Petechiae
 Petechiae are nonblanchable
punctate foci of haemorrhage.
 Causes include
 platelet abnormalities
 (eg, thrombocytopenia, platelet
dysfunction), vasculitis,
 and infections
 (eg, meningococcaemia, Rocky
Mountain spotted fever, other
rickettsioses).

28. Petechiae

29. Secondary lesions

30. Erosion
 Erosions are open areas of skin
that result from loss of part or
all of the epidermis.( without
involving connective tissue)
 Erosions can be traumatic or
can occur with various
inflammatory or infectious skin
diseases.
 An excoriation is a linear
erosion caused by scratching,
rubbing, or picking.

31. Erosion

32. Ulcer
 Ulcers result from loss of the
epidermis and at least part of
the dermis.
 Break in continuity of
epithelium involving connective
tissue.
 Causes include
 Vesiculobullous and ulcerative
lesions

33. Ulcer

34. Fissure
 Any clefts or grooves in the
tissue that are pathologically
present.
 Example
 Fissured tongue

35. Fissure

37. Crust
 Crusts (scabs) consist of dried
serum, blood, or pus.
 Crusting can occur in
inflammatory or infectious skin
diseases (eg, impetigo).

38. Crust

39. Sinus
 Blind tract leading from the
surface down to the tissues.
 It is lined by granulation
tissue, which maybe
epithelialized
 Examples
 Intraoral sinus
 Periapical abscess
 Periodontal abscess
 Extraoral sinus
 Periapical abscess
 Osteomyelitis
 Tuberculosis

40. Sinus

41. Scar
 Scars are areas of fibrosis that
replace normal skin after
injury.
 Some scars become
hypertrophic or thickened and
raised.
 Keloids are hypertrophic scars
that extend beyond the original
wound margin.

42. Scar

43. Atrophy
 Atrophy is thinning of the skin,
which may appear dry and
wrinkled, resembling cigarette
paper.
 Atrophy may be caused by
chronic sun exposure, aging,
and some inflammatory and
neoplastic skin diseases,
including cutaneous T-cell
lymphoma and lupus
erythematosus.
 Atrophy also may result from
long-term use of potent topical
corticosteroids.

44. Atrophy

48. Thank you