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Chapter 10: Dermatology

Jolie LeBlanc

DIAGNOSIS OF DERMATOLOGIC DISEASE

Terminology

Skin lesions may be characterized as primary (ie, associated directly with a disease process; see Table 10.1) or as secondary (changes resulting from a variety of factors; see Table 10.2). They may also be distinguished by their configuration (see Table 10.3) and distribution (eg, localized or generalized).

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Table 10.1Descriptions of Primary Dermatologic Lesions
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Table 10.1 Descriptions of Primary Dermatologic Lesions
LESION DESCRIPTION EXAMPLES
Macule Circumscribed, nonpalpable area of discoloration <1 cm Flat nevi, café au lait
Papule Circumscribed, elevated, solid area <1 cm. Top may be pointed, rounded, or flat Acne, warts
Patch Circumscribed, nonpalpable area of discoloration >1 cm Sacral melanocytosis aka “Mongolian spot,” vitiligo
Plaque Circumscribed, elevated, solid area >1 cm, usually flat topped Psoriasis
Vesicle Circumscribed, elevated lesion <1 cm containing clear fluid Blisters of herpes zoster, herpes simplex
Bulla Circumscribed, elevated lesion >1 cm containing clear fluid Bullous pemphigoid, second-degree burns
Pustule Circumscribed, elevated lesion <1 cm containing purulent material Acne, folliculitis
Nodule Palpable, solid area >1 cm, deep-seated mass with indistinct borders that elevates the overlying epidermis, usually found in the dermal or subcutaneous tissue Lipomas, tumors
Wheal Transient circumscribed elevated area (papules or plaques) of erythema, resulting from tense edema of the papillary dermis Urticaria
Table 10.2Descriptions of Secondary Dermatological Lesions
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Table 10.2 Descriptions of Secondary Dermatological Lesions
2° CHANGE DESCRIPTION EXAMPLES
Scale Dry, thin plates of keratinized epidermal cells (stratum corneum) Psoriasis, ichthyosis
Lichenification Thickening of skin, with exaggerated skin lines resulting from chronic rubbing or scratching Atopic dermatitis, lichen planus
Erosion and oozing Moist, circumscribed, depressed area due to loss of superficial layers of upper dermis, leaving denuded surface Burns, bullous erythema multiforme
Crust Dried exudate of plasma on the surface of the skin following trauma Impetigo, contact dermatitis
Fissure Sharply defined tear (linear or wedge-shaped) in the epidermis Angular cheilitis
Scar Flat, raised, or depressed area of fibrotic tissue as ulceration heals Acne scars, burn scars
Atrophy Thinning of one or more layers of skin, may have loss of skin markings or cause skin depression Striae or “stretch marks”
Color Red, pink, yellow, brown, tan, or blue; pay particular attention to blanching since failure to blanch suggests bleeding into the dermis (petechiae)  
Table 10.3Descriptions of Dermatologic Lesions by Configuration
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Table 10.3 Descriptions of Dermatologic Lesions by Configuration
CONFIGURATION EXAMPLES
Annular (circular) Granuloma annulare, urticaria, dermatophyte infections
Linear (straight lines) Lichen striatus, incontinentia pigmenti, scabies
Grouped Herpes simplex, herpes zoster
Discrete Insect bites
Reticular (net-like) Erythema infectiosum, telangiectasias of rosacea

Diagnostic Techniques

Key diagnostic techniques include the following:

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