DIFFERENT TYPES OF SKIN LESIONS

Primary Lesion - A primary lesion is directly associated with the disease process and is
described with established dermatological terminology. Identifying the primary lesion(s),
whenever possible, is the first step towards identification of the disease or cutaneous
process.
Primary lesions include the macule, papule, patch, plaque, vesicle, bulla, tumor, wheal, and
pustule. Secondary lesions are a modification of primary lesions.
1 .Macule - A circumscribed flat area, is a small spot that is not palpable and less than 1
cm diameter of discoloration without elevation or depression of surface relative to
surrounding skin. Macules come in a variety of shapes and are usually brown, white, or red.
Examples of macules include freckles and flat moles.

2. Papule - A circumscribed, and is small superficial bump that is elevated, solid lesion, less
than 1 cm diameter. Papules are associated with such conditions as warts, syphilis,
psoriasis, seborrheic and actinic keratosis and skin cancer.

3. Patch - A circumscribed area of discoloration, which is a large spot that is not palpable
greater than 1 cm, which is neither elevated or depressed relative to the surrounding skin.

4. Plaque - A well-circumscribed, and a large superficial bump that is elevated, superficial,

solid lesion, greater than 1 cm in diameter. It is analogous to the geological formation, the
plateau.

5. Vesicle - A small fluid-filled bubble that is usually superficial, with circumscribed

elevation of the skin, less than 0.5 cm, that contains serous fluid. These lesions may be the
result of sunburns, insect bites, chemical irritation, or certain viral infections, such as
herpes.

6. Bulla (pl. Bullae)- A

that is superficial or deep,
0.5 cm that contains serous fluid.

raised and large fluid-filled bubble

circumscribed lesion greater than

7. Nodule - A palpable, solid lesion, greater than 1 cm in diameter. These are usually found
in the dermal or subcutaneous tissue, and the lesion may be above, level with, or below the
skin surface. Nodules are associated with, among other conditions, keratinous cysts,
lipomas, fibromas, and some types of lymphomas.

8. Tumor is a large bump with a significant deep component. Its solid, firm lesions
typically > 2 cm that can be above, level with, or beneath the skin surface. Also known as a
mass.

9. Wheal - Transient, edematous, well circumscribed, elevated papules or plaques, often

with erythematous borders and pale centers, usually seen in urticarial. Wheals are
associated with an allergic reaction, such as to a drug or an insect bite.

10. Pustule - A small (< 1 cm in diameter), circumscribed superficial elevation of the skin
that is filled with purulent material. Can also be described as a vesicle filled with pus, often
categorized according to whether or not they are related to hair follicles. Pustule is usually
the result of an infection, such as acne, impetigo, or boils.

Follicular- generally indicative of local infection.

Folliculitis- superficial, generally multiple.
Furuncle- deeper form of folliculitis.
Carbuncle- deeper, multiple follicles coalescing.

Secondary Lesion - Modification of a primary lesion that results from traumatic injury,
evolution from the primary lesion, or other external factors. Secondary lesions
include scale, crust, erosion, fissure, ulceration, excoriation, or lichenification.
1. Scale - is the accumulation or excess shedding of visible fragments of the stratum
corneum as it is shed from the skin. A dry, horny build-up of dead skin cells that often flakes
off the surface of the skin. Diseases that promote scale include fungal infections, psoriasis
and seborrheic dermatitis.

Scale is very important in the differential diagnosis since its presence indicates
that the epidermis is involved.
Scale is typically present where there is epidermal inflammation, ex:
psoriasis,tinea, Eczema.
2. Crust A dried collection of blood, serum, or pus. Also called a scab, a crust is often part
of the normal healing process of many infectious lesions.

3. Erosion is a superficial open wound with loss of upper epidermis or mucosa by wearing
away as from friction or pressure.

4. Fissure - Sharply-defined, linear crack in the skin or wedge-shaped tears in the

epidermis with abrupt walls, often very painful.

5. Ulceration - A localized defect in the skin and is a deep open wound of irregular size and
shape where epidermis and some dermis have been loss. Ulcers can result from acute
conditions such as bacterial infection or trauma, or from more chronic conditions.

6. Excoriation - Skin abrasions, usually superficial open wound with loss of epidermis or
mucosa only, due to scratching of the skin.

7. Lichenification - Diffuse thickening of the epidermis, with an increase in skin lines and
creases from the chronic rubbing with resulting accentuation of skin lines. This is often a
characteristic of scratch dermatitis and atopic dermatitis.

Distinct Lesions of the skin

1. Burrow- are linear lesions produced by infestation of the skin and formation of tunnels.
ex: with infestation by the scabitic mite or by cutaneous larva migrants.

2. Comedone- is a small, pinpoint lesion, typically referred to as whiteheads or

blackheads.

3. Atrophy usually refers to thinning of the epidermis leaving an easily wrinkled/shiny

surface. Atrophy may also apply to dermal/subcutaneous tissue, with or without changes in
the epidermis.

4. Keloid- are an exaggerated connective tissue response of injured skin that extend
beyond the edges of the original wound.

5. Hypertrophic scar- on the other hand does not overgrow the wound boundaries.

6. Fibrosis or sclerosis- describes dermal scarring/thickening reaction.

7. Milium- is a small superficial cyst containing keratin (usually < 1-2 mm in size).

VASCULAR SKIN LESIONS

1. Petechiae- is a round or purple macule, associated with bleeding tendencies or emboli to
skin.

2. Ecchymosis- is a round or irregular macular lesion larger than petechiae, color varies and
changes from black, yellow and green hues. Associated with trauma and bleeding
tendencies.

3. Cherry Angioma- popular and round, red or purple, may blanch with pressure and a
normal age- related skin alteration.

4. Spider Angioma- is a red, arteriole lesion, central body with radiating branches.
Commonly seen on face, neck, arms and trunk. Associated with liver disease, pregnancy and
vitamin B deficiency.

5. Telangiectasia- shaped varies: spider-like or linear, bluish in color or sometimes red. Does
not blanch when pressure applied. Secondary to superficial dilation of venous vessels and
capillaries.