Professional Documents
Culture Documents
>>firstidentifylesion:
1. Macule
a. Circumscribed,FLATlesionthatdiffersfromsurroundingskinbecauseof
itsCOLOR
b. Capillarydilatation(erythema);extravasatedRBC(purpura),
telangiectasia(PERMANENTdilatationscapillaries),petechiae(small
pinpointpurpura),sugillations(swollenblackandbluemarks)
c. applicationofpressurewithtwoglassslidesoranunbreakableclearlens(
diascopy)onaredlesionisasimpleandreliablemethodfor
differentiatingrednessduetovasculardilatation(erythema)fromredness
duetoextravasatederythrocytesorerythrocyteproducts(purpura).Ifthe
rednessremainsunderthepressureoftheslide,thelesionispurpuric.
d.
2. Papule
a. Smallsolidelevatedlesionlessthan1cm
b. Obliquelightingwithaflashlightinadarkenedroomisoftennecessaryto
detectslightelevation
c. SHAPEAcuminated(pointed)miliariarubra,surmountedwithscale
(secondarysyphilis),domeshaped(molluscumcontagiosum)
d. COLORRedpapules(psoriasis),coppercolor(secondarysyphilis),with
violaceoushue,netlikewhitemarkings(lichenplanus),yellowpapules
(xanthomosis)
3. Plaque
a. Mesalikeelevationthatoccupiesalargersurfaceareaincomparisonwith
itsheight
4. Nodule
a. Epidermal(verrucavulgaris,keratocoacanthoma,basalcellcarcinoma),
epidermaldermal(compoundnevi,malignantmelanoma,invasive
squamouscell),dermal(dermatofibromas),dermalsubdermal,
subcutaneous
5. Wheal
a. roundedorflattoppedpapuleorplaquethatischaracteristically
evanescent,disappearingwithinhours
b. resultfromedemaintheupperportionofthedermis
c. Thewhealproducedinresponsetothestrokingofareddishbrownor
brownishmacule(Darier'ssign)ispathognomonicofurticariapigmentosa
(mastocytosis)
d.
6. Vesicleandbullae
a. Elevated,fluidfilledlessthan0.5cmvesicle,morethanbullae
b. Arisefromcleavagefromvariouslevelsoftheskin
7. Erosions
a. Lossofallportionofviableepidermis
8. Pustules
a. circumscribed,raisedlesionthatcontainsapurulentexudate
9. Cyst
10. Atrophy
a. diminutioninthesizeofacell,tissue,organ,orpartofthebody.
Epidermalatrophyreferstothinningoftheepidermisandisassociated
withadecreaseinthenumberofepidermalcells
11. Ulcers
a.destructionoftheepidermisandatleasttheupper(papillary)dermis
12. scar
13. sclerosis
a. circumscribedordiffuseHARDENINGoftheskin
14. calcinosis
a. hardnodulesorplaques(dermisorsubcutaneoustissue)withorwithout
alterationinskinsurface
15. desquamation
a. abnormalsheddingofstratumcorneum(usuallyepidermiscompletely
replacedafter27days)
>>thendetermineSHAPE,ARRANGEMENTINRELATIONTOEACHOTHER
ANDEXTENT
1. Linear
a. May suggest exogenous cause
b. Koebner phenomenon trauma is followed by new lesion in
otherwise healthy skin (lesion would be identical to those
seen in traumatized skin)
2. Annular
a. Most acute erythemas associated with inflammation
b. Iris/ bulls eye lesion characteristic of erythema
multiforme syndrome
3. Grouped
a. Little diagnostic value unless there is a pattern
4. Reticular
a. Netlike/lacy
b. Livedo reticularis
Distribution of skin lesion can be localized, regionalized, generalized
1. bilateral, symmetric distribution endogenous cause, may
suggest hematogenous dissemination (usually indicative of
hypersensitivity)
examination
stain/culture
if suspecting bacterial or yeast infection
ulcers and nodules require scalpel biopsy wedge of tissue
consisting of all three layers of the skin, biopsy minced in
sterile mortar and cultured