This document describes and classifies various types of skin lesions. It discusses primary lesions including macules, papules, plaques, nodules, wheals, vesicles, bullae, pustules and cysts. It also covers secondary lesions such as crusts, scales, erosions, ulcers, fissures and scars which result from changes to primary lesions. Tertiary lesions involve further modifications of primary or secondary lesions over time. Each lesion is defined and examples are provided.

1. Lesions Of Skin
Dr.Gurjot Singh Marwah
JUNIOR RESIDENT
(Dept. of Dermatology)
M.G.M Hospital, Aurangabad

2. Types Of Lesions
Primary Lesions
Secondary Lesions
Tertiary Lesions

3. Primary Lesions
Definition : lesion occurring on non pathological
skin which have not been altered by trauma,
manipulation (scratching, scrubbing), or natural
regression over time.

4. Examples
• Macule
• Papule
• Patch ???
• Plaque
• Nodule
• Wheal
• Vesicle
• Bulla
• Pustule
• Cyst

5. Macule
• Definition : Flat, circumscribed skin
discoloration that lacks surface elevation or
depression, less than 1 cm in diameter*

6. • TYPES
1)Hypopigmented : due to decrease in number of
melanocytes or the amount of pigment they produce
E.g. : tuberous sclerosis , nevus achromicus , etc
nevus achromicus

7. 2)Depigmented : due to complete loss of melanocytes
E.g.: vitiligo , halonaevus
3)Hyperpigmented : due to excess of melanin in skin
A)brown or black : due to excess of melanin in epidermis
E.g.: freckles or chloasma

8. B)Bluish-grey : due to increase melanin in dermis
( tyndall effect )
E.g : Mongolian spot, nevus of Ota

9. C)Erythema: increased blood flow through the skin
causing capillary dilatation
E.g : macular viral and
drug rash
D)Purpura/Ecchymosis: extravasation of RBCs in
Dermis
(large purpura : ecchymosis)
E.g : thrombocytic purpura
Schamberg’s purpura

10. Papule
Solid , well circumscribed elevated lesion, less than one cm
in diameter
Formed by
1)hyperplasia of epidermis , dermis or both
E.g : verruca vulgaris
2)Metabolic deposits or cellular infiltrates
E.g : xanthelasma

11. SHAPE
COLOUR

12. Shape
• Pointed : Follicular Lichen planus
• Papulosquamous : Guttate Psoriasis
• Dome : Molluscum contagiosum
• Flat topped : lichen plannus

13. Colour
• Red : Psoriasis
• Pearly white : molluscum contagiosum
• Violaceous : Lichen planus
• Coppery : seccondary syphilis
• Yellowish : Xanthelasma
• Blue/Black : Mallignant Melanoma
• Purpuric : henoch-schönlein purpura

14. Plaque
•Elevated well circumscribed more than 1 cm in
diameter ,occupying relatively large surface area
in comparison with its height above the skin
surface

15. Types
Scaly Plaque : Psoriasis , P.Rosea
• Lichenified plaque : Lichen Simplex Chronicus
• Erythematous plaque : Tuberculoid
leprosy

16. Patch
• Patch / Large macule ???

17. Nodule
• Palpable solid round lesion ,usually larger than
1cm in diameter .occupying relatively larger
vertical diameter as compared to suface
diameter.
• PAPULE NODULE
• SEEN BETTER FELT BETTER

18. • E.g : erythema nodosum,Lipoma,Sebaceous cyst
kerato acanthoma,xanthelasma,

19. Wheals
• Evanescent , edematous , platue-like
elevations of various sizes
• Usually oval or arcuate , pink to red ,
surrounded by a flare of macular erythema
• Caused by transient vascular reaction in the
upper dermis mainly due to vasodilatation and
increased permeability of capillaries
• It is the characteristic lesion of urticaria

20. Wheals

21. Vesicle AND Bullae
• Elevated ,superficial well circumscribed lesion containing
clear fluid , less than 0.5 cm in diameter
• A vesicle larger than 0.5 cm is known as Bullae
• They can arise by separation of skin at different levels i.e
a) interepidermal eg bullous impetigo
b) supra basal e.g Pemphigus vulgaris
c) dermoepidermal eg erythema
multiforme

22. • Lesions may be
• A) tense : Pompholyx
• Flaccid : Pemphigus Vulgaris
• Umblicated : varicella zoster

23. Pustule
• Well-circumscribed, elevated lesion containing
visible purulent exudate
• Pustules are characteristic of pustular
psoriasis, pyoderma, rosacea

24. Cyst
• A sac that contains liquid or semisolid material
in a well-defined cavity
• 2 most common type-
• A) Epidermal cyst: lined with squamous
epithelium and produce keratinous material
• B) pilar cyst: originate from hair follicle lined
with multilayered epithelium

25. Abscess
• An abscess is a collection of pus below the
skin
• Pus in an abscess is invisible but clinically be
interpreted as sign of inflammation in the
overlying skin
•
• Abscess cavities do not have well-defined
lining as cyst

26. Secondary lesions: modification of primary skin lesions
that result from traumatic injury , evolution from
primary lesion , or other external factors
• Crust
• Scale
• Erosion
• Ulcer
• Fissure
• Scar
• Atrophy
• Telangiectasia

27. Crust
• A collection of cellular debris
,dried serum,pus or blood and
sometimes bacterial debries
• antecedent primary lesion is
usually a vesicle,bulla or pustule

28. Types
• Golden yellow,soft friable : Impetigo
• Yellowish : Flavus
• Thick hard and tough : third degree burns
• Lamillated,elevated, black or green : syphillus
(oyster shell)

29. Erosion
• Partial focal loss of the epidermis alone. Heals
without a scar
• Eg herpes zooster, TEN,Erosion interdigitale

30. Scale
• Abnormal shedding or accumulation of the
stratum corneum in visible flakes is called scaling
• Formed due to - a) formation of epidermal cells is
rapid
OR
b) process of normal keratinisation is
interferred with

31. Types
• Fine and delicate : P.versicolor
• Coarse : eczema
• Stratified : Psoriasis

32. Ulcer
• A full-thickness, focal loss
of epidermis along with
parts of dermis ,heals
with scarring
• E.g : bed sores , Syphillus
Diabetic foot

33. Fissure
• Linear cleft in the skin through the epidermis and part of dermis
may be single or multiple ranging from microscopic to a few
millimeters having well defined margins
They occur most commonly when
skin is dry and thickened due to
inflamation
Pain is often produced by movement of part,
Which opens or deepens the fissure
Commonest sites a) tips and flexural creases of thumb , finger and
palms
b) edges of heel
c)clefts between fingers and toess
d) angle of mouth,the lips,nares auricles and anus

34. Scar
• A collection of new connective tissue, that
replaces lost substances in the demis or deep
dermal tissues
• They may be atrophic or hypertrophic
• Hypertrophic scars / Keloid develop when
fibrous components predominate

35. Excoriation And Abrasion
Punctate or linear abrasion produced by mechanical means
Usually involving only the epidermis
Caused by scratching with fingernails in a variety of disease
E.g : atopic dermatitis , Scabies
If the damage is due to constant
friction or mechanical trauma
the word Abrasion may be used

36. Atrophy
Reduction in the components of a tissue,Organ or part
of body
In skin
1) Epidermal Atrophy results from decrease in
epidermal cells .Gives rise to frequently transparent
epidermis and alteration of skin surface i.e(loss of
normal skin lines and fine wrinkling
2) Dermal Atrophy results from decrease in the
reticular or papillary dermis .Clinically seen as
depression of skin

37. • Usually dermal and epidermal atrophy seen
together E.g : D.L.E,Lichen sclerosus et atrophicus
3)Atrophy of paniculus caused due to lipoatrophy.
Clinically seen as deep depression

38. Lichenification
• Focal area of thickened skin
produced by chronic scratching
or rubbing
• Clinically triad of accentuation of
skin markings ,thickening of
epidermis and
Hyperpigmentation
• Eg : lichen Simplex Chronicus
usually seen superimposed on
pruritic conditions

39. Telangiectasia
• Small, dilated ,superficial blood vessels that
disappear with pressure
• E.g : Scleroderma , Rosacea

40. Special Lesions
• Lesions that are pathognomic to certain skin
conditions

41. COMEDO:Non inflamatory lesions of acne
resulting from impaction of pilosebaceous gland
• OPEN COMEDO
• Impaction occurs in
dilated follicular orifice
• Visible as black
keratinous mass i.e.
blackhead
• Closed Comedo
• Impaction occurs lower
down in follicular orifice
• They are not dilated
• Lesions appear slightly
lighter than skin colour
i.e. whitehead

42. Target lesions
• Pathognomic to erythema multiforme
Three zones1) central, dark sometimes blistered
2)surrounded by,pale edematous zone
3)rimmed by, zone of erythema

43. Milia
• Milia are small superficial
cyst with an epidermal
lining
• Commonly seen in neonates
• Especially in periorbital
areas

44. Burrow
Serpinginous tunnel in the skin
made by scabies mite.
About 5mm in length
Scabies