General dermatovenerology

Primary lesions
Secondary lesions
Configurations
Area alternations
Locations
Final stages
Functional changes
 SKIN
Epidermis – the thickness from 0,05mm
(eyelid) to 1,5mm (palms, soles)
Dermis (corium) – 0,3 to 3,0mm
Subcutis
Epidermis
Dermis
Pars papilaris
Pars reticularis
Fibres: elastic, collagen, reticular
Cells: fibroblasts fibrocytes macrophages, mast cells,
lymphocytes, histiocytes,..
Vessels: blood and lymphatic
Nervous fibres, corpuscles and endings
Skin appendages: hair follicles, sebaceous glands,
sweet apocrinne and eccrinne glands, nails,muscules
Examination of patients with skin conditions
Site
Type of lesion a) primary b) secondary
Form a) size b) shape c) margination
d) surrounding area
Color
Surface
Consistency (hard, soft,..)
Subjective symptome (burning, itchy,..)
 PRIMARY LESIONS
Macule
Papule
Nodule, tuber
Urtica, wheal
Vesicle, bulla
Pustule
MACULE (spot)
A circumscribed area of change in normal skin
color without elevation or depression of the
surrounding skin. It is not palpable.
Macules may be the result of :
hyperpigmentation or hemosiderin (e.g. brown as
in lentigos,ephelides,...)
depigmentation (e.g. vitiligo)
MACULE (spot) – cont.
permanent vascular dilation (telangiectasie,
capillary haemangioma or transient capillary
dilation (erythema)
Purpura, petechiae - the extravasation of the red
cells
Diascopy – pressure of a glass slide on
the red lesion.
If redness remains- the lesion may be
purpuric
If the redness disappears - the lesion is
erythematous and is due to vascular
dilatation.
PAPULE (pimple)

small solid elevation of skin generally

< 5 mm in diameter.
Papules may be:
- flat-topped •
, as in lichen planus;
- dome shaped ,, as in xanthomas;
- spicular  , if related to hair follicles.
PAPULE
Papules may result from:
dermal metabolic deposits,
localized dermal cellular infiltrates,
localized hyperplasia and/or hypertrophy of
cellular elements in the epidermis (wart)
neoplasms (benign, malignant– fibroma,
histiocytoma, basalioma, melanoma,..)
TUBER, NODULE

a palpable, solid, round or elipsoidal

lesion (more than 1 cm) and may
involve:
- the epidermis (keratoakantoma)
- epidermo-dermal zone (nevus, carcinoma)
- the dermis (granuloma anulare)
- dermo-subdermal zone (erytema nodosum)
- subcutaneous (lipoma)
URTICA, WHEAL
a rounded or flat-topped, pale-red elevation due
to vasodilatation and oedema in dermis.
The epidermis is not affected.
transitory, compressible papule or plaque
- last a few hours
- allergic or nonallergic reason
- pruritic
- various size from 3-4 mm to 10-12 cm
- Urtica profunda – oedema in subcutis –(lips, periorbicular
– oedema Quincke)
VESICLE, BULLA (blister)

is a circumscribed, elevated superficial cavity containing

fluid (serum, lymph, blood, or extracellular fluid). Fluid
can be accumulated within or below the epidermis.
locations:
- subcorneal- fluid just below stratum corneum
(streptococcal impetigo)
- intraepidermal - spongiotic vesicles or acantholytic
vesicles (acute eczema, herpes, pemphigus)
- subepidermal-due to changes in dermal-epidermal
junction (pemphigoid, epidermolysis)
 Subcorneal vesicle

Intraepidermal vesicle

Subepidermal vesicle
PUSTULE
superficial, elevated lesion that contains pus
(pus in a blister).
Pustules may vary in size and shape.
The color may appear white, yellow, or
greenish-yellow depending on the color of the
pus.
Pus is composed of leukocytes with or
without cellular debris.
It may also contain bacteria (non sterile) or
may be sterile (leukocytes only).
 Secondary Lesions
Squama
Crusta
Fissura, rhagas
Eschara
Erosio
Ulcus
SQUAMA (scale)
accumulation or abnormal shedding of
horny layer keratin (stratum corneum)
Scales usually indicate inflammatory change and
thickening of the epidermis.
The may be fine, as in pityriasis;
white and silvery, as in psoriasis;
or large and fish-like, as in ichtyosis.

Color: white – dry scales

yellowish - oily scales
CRUST
dried serum, blood, or pus on the
surface of skin.
Crusts are yellow, if from serum;
green or yellow-green if from pus;
or brown or dark red if formed from
blood.
RHAGAS, FISSURE

a linear split of epidermis and dermis

with sharply defined, nearly vertical
walls
– hands, feet, fingertip, anus,
ESCHARA (necrosis)
Circumscribed necrosis of the skin
Endogenous (vascular diseases,
diabetes, aterosclerosis, ischemia)
Exogenous (acids, alkalines, freezing,
burning...)
- Color: grey, black,
EROSIO
moist, circumscribed, usually
depressed lesion due to loss of all or
part of the epidermis
Often results from eruptions of vesicles
and bullae
Excoriation - linear or punctate
superficial excavations of epidermis
caused by scratching or picking.
ULCER
circumscribed area of skin loss
extending through the epidermis and at
least part of the dermis (papillary).
"hole in the skin".
Pathogenesis:
- exogenous factors (chill, freezing, burning,..)
- endogenous: result from the impairment of vascular
and nutrient supply to the skin (diabetes mellitus, AS)
- exulcerations of the certain lesions (mycosis
fungoides, tumors, skin tbc, syphilis)
 Morphology of ulcer:
location
number
shape
size, depth
base (pus, necrotis, granulation,...)
margine
surrounding skin (inflammation, eczematous,
swelling, madidation,...)
Configuration of the lesions
Linear: line-like
Anular: ring-like
Iris: concentric circles
Semicircinar: half-moon-like
Circinar: multiple half-moon- like
Numular: coin-like
Herpetiform: grouped vesicles (like herpes simplex)
Zosteriform: belt-like (herpes zoster)
Serpiginous: snake-like
Geographic: map-like
Dissemination: straggly
Generalised: spreading to all part of body
Follicular:
 Area alternations
Erythema
Cyanosis
Desquamation
Oozing, madidation
Lichenification
Papilomatosis, vegetation
 ERYTHEMA

redness of the skin

is due to active hyperemia
Erytrodermia = more than 80% skin is red
- primary e.- Sezaryho syndrome
- secondary e. – from generalisated dermatosis
(psoriasis, lichen, eszema,...
CYANOSIS (asphyxia)
Lilac color of the skin
is due to pasive hyperemia (venous blood)
Stasis blood in small venous vessels
Cyanosis - central
- peripheral
DESQUAMATION
Abnormal keratinization and shedding
Madidation, oozing, wetting
Is due to rupture of the vesicles,
pustules - result to erosion or ulcer
- surface is wet, red
Lichenification
chronic thickening of the skin along with
increased skin markings.
Results from scratching or rubbing.
Papilomatosis, vegetation
Cauliflower–like lesion (epidermis,
dermis)
- in intertriginous areas (e.c. condyloma)
 LOCALISATIONS
Solar
Seborrhoic
Intertriginous
Embolic
Predilected
Anatomic
SOLAR
Sun-exposed distribution (face, ears,
scalp, neck, backs of the hands,...)
Depend on seasion, geographic location and clothing,
Solar dermatoses, lupus erythemathosus, porphyria
SEBORRHOIC
parts of the body with largest and most
numerous sebaceous glands (scalp, forehead,
nasolabial folds, chin sternal part, mons
pubis, interscapular)
- seboroic dermatitis, acne
INTERTRIGINOUS
skin folds (axillar, submammary, inguinal,
perigenital, intergluteal, interdigital)
- candidosis, fungal infections
EMBOLIC
Lateral parts of the trunk,
flexural parts of the extremities-
symmetric!
- exanthema disseminated by blood
vessels (viral exanthemas, allergic or side
effects of the drugs,...)
PREDILECTED
Typical for certain dermatosis
Acne: seborhoic
- Psoriasis: scalp, elbows, knees, lumbosacral
part
- Scabies: interdigital, wrist , periumbilical,
ANATOMIC
According to anatomic name:

- Basalioma: upper lip

- Erysipelas: left calf
 FINAL STAGES
Atrophy
Rigid atrophy, sclerodermia
Scar, cicatrix
Elephanthiasis
Impregnation
Incrustation
 ATROPHY
paper-thin, wrinkled skin with
easily visible vessels. Results
from loss of epidermis, dermis
or both. Depresion of the
surface caused by regressive
changes involving the thinning
of the epidermis and dermis
and loss of the skin
appendages.
Seen in aged, some burns, and
long-term use of highly potent
topical corticosteroids.
SCLERODERMA
Rigid, hard atrophy
Loss of appendages
Shiny, smooth,
mirror-like surface
Due to alternation
and fibrosis of
connective tissue
CICATRIX, SCAR
replacement of normal
tissue by fibrous
connective tissue at the
site of injury to the
dermis.
Scar may be hypertrophic,
atrophic, sclerotic or hard
due to collagen
proliferation.
The skin appendages are
absent.
 ELEPHANTHIASIS
The end stage of
permanent swelling,
dermal fibrosis,
lymphoedema, and
epidermal thickening
Manifestation of lymphatis
obstruction and reactive
fibrosis, inflammation with
connective tissue
proliferation.
Filariosis, erysilas, ...
IMPREGNATION
deposition of the
foreign (alien)
bodies into the skin

- tatoo,
- gold salts (chrysiasis),
- silver salts (argyrosis)
INCRUSTATION
Deposition in the
skin of the proper
particles.

- deposits of calcium in
the skin - calcinosis
 FUNCTIONAL CHANGES
Keratosis
Steatosis
Hidrosis
Chromiae
Trichosis
Onychosis
 Functional changes:
Quantitative:
- afunction- loss of the function
- hypofunction
- hyperfunction
Qualitative:
- dysfunction – change of the function
Keratosis- the function changes of
keratinization:

- hyperkeratosis: excessive cornification,

hypertrophy of the stratum corneum over the
epidermis and/or in follicular opening (follicular
hyperkeratosis)
- hypokeratosis: reduced cornification
- dyskeratosis: wrong cornification
- parakeratosis: retention of nuclei in the cells of
stratum corneum due to defective keratinization
Steatosis- the function changes of
sebaceous glands

- asteatosis, sebostasis: absence of the sebaceous

glands
- steatosis: reduced sebum production (ichtyosis,
xerosis, atrophy skin)
- seborrhoea: excessive sebum production (acne)
- dyssteatosis: qualitative changes of sebum
composition (seborrhoea sicca, seborrhoea oleosa)
Hidrosis- the function changes of
eccrine sweat glands:

- anhidrosis: absence of the sweat glands

- hypohidrosis: reduced sweating (cold, atropine, atrophy sweat
glands, ichtyosis)
- hyperhidrosis: excessive sweating
– local: palms, soles, armpits (emotion,..)
- generalized (infectious diseases, hormonal diseases, diabetes
mellitus, pregnancy,.heat, drugs, sun, fever, alcohol,nicotin,..)
- dyshidrosis: production of pathologically changed sweat
chromhidrosis = color change
bromhidrosis = smell change
 Chromiae- the change of skin
(and mucous) color

- achromia, hypochromia: absence or reduced

production of melanin (naevus anemicus, pityriasis
versicolor alba, vitiligo, albinism...)
- hyperchromia: increased production of melanin of
external origin (chronic pressure, thermical cause,..)
or internal origin (M.Addison, chloasma, lentigo,
pigmented naevus, frenckles,...)
- dyschromie: deposition of other pigments (icterus,
xantelasm)
Trichosis – the change and
abnormalities of the hairs
Atrichia, hypotrichosis: congenital loss of hair
alopecia: aquiere loss of hair (local, diffuse, total, universal
- hypertrichosis: excessive growth of hair in the female, while the
arrangement remains typically feminine in respect of sites and
margination of the terminal hair.
- - may be congenital and aquire (androgenic and anabolic hormons,
Cushing‘s syndrome, ovarial or adrenal origin)
- hirsutismus: excessive hair growth in females in the male pattern
of thre pubic body and facial hair
Onychosis- the change and
abnormalities of the nails:

- anonychia: congenital loss of nails

- onychoschisis: the splitting of the nail into two
horizontal flakes
- onychorrhexis: abnormal tendency of the nail to
break, tear, split or splinter
- onycholysis: parcial separation of the nail
- onychodystrofia: change of shape of the nail