Vascular Lisions

Characteristics

Cause

Location

Pictures

Hemangioma

Bright red, raised lesion. Does not blanch with pressure. Typically disappears around age 10

A cluster of immature capillaries

Can appear on any part of the body

Port wine stain

Flat irregularly shaped lesion ranging from pale red to deep purple in color. A large, flat mass of blood vessels on the Color gets darker with emotion, exertion, surface of the skin. or temperature. Most are born with it and it doesnt fade. This type does blanch.

Most commonly appears on the face and head but may occur in other sites

Spider angioma

Flat bright red dot with tiny radiating blood vessels resembling a spider web

A type of telangiectasis (vascular dilation) caused by Elevated estrogen levels, pregnancy, estrogen therapy, vitamin b Most common on upper half of the body deficiency, or liver disease, it may not be pathologic. Does blanch with pressure.

Venous Lake

Flat, blue lesion with radiating, cascading, or linear veins extending from center. Gets blue color from deoxygenated blood

A type of telangiectasis caused by increased intravenous pressure in superficial veins.

Most commonly appears on the anterior chest and the lower legs near the varicose veins.

Petechiae

Flat red or purple rounded freckles

Minute hemorrhages resulting from Most commonly appear of dependent fragile capillaries, caused by septicemias, surfaces of the body (e.g. back and liver disease, or vitamin C or K deficiency. buttocks) but may occur elsewhere on the Can also be caused by anticoagulant body such as the face and the abdomen. therapy.

Purpura

Flat reddish Blue, irregularly shaped extensive patches of varying size.

Bleeding disorders, scurvy, and capillary fragility in the older adult.

Can appear anywhere on the body but manly on arms, legs, and backs of the hands

Ecchymosis

Release of blood from superficial vessels Is a flat, irregularly shaped lesion of into surrounding tissues due to trauma, Occurs anywhere on the body at the site varying size with no pulsation. Bruising hemophilia, liver disease, or a vitamin C or of trauma or pressure. on the surface level with no swelling. K deficiency

Hematoma

Raised, irregularly shaped lesion similar to ecchymosis except it elevates the skin and looks like swelling. A deep tissue bruise.

A leakage of blood into the skin and subcutaneous tissue as a result from trauma or surgical site

Can occur anywhere on the body at the site of trauma, pressure, or surgical site

Primary Lesions

Characteristics

Examples

Pictures

Macule and Patch

Flat, non palpable changes in skin color

Macules: freckles, measles, and petechiae. Patches: Mongolian spots, port-wine stains, vitiligo, and chloasma.

Papule and Plaque

Elevated, solid palpable mass with a circumscribed border

Papules: elevated moles, warts, and lichen planus. Plaque: psoriasis, actinic keratosis, and also lichen planus

Nodule and tumor

Elevated, solid, hard or soft palpable mass Nodules: small lipoma, squamous cell extending deeper into the dermis than a carcinoma, fibroma, and intradermal nevi. papule. Nodules have circumscribed Tumors: Large lipoma, carcinoma, and borders and tumors have irregular hemangioma shaped borders.

Vesicle and bulla

Elevated, fluid filled, round or oval shaped, palpable masses with thin, translucent walls and circumscribed borders

Vesicles: herpes simplex/zoster, early chickenpox, poison ivy, and small burn blisters. Bullae: contact dermatitis, friction blisters, and large burn blisters.

Wheal

Elevated, often reddish area with an irregular border caused by diffuse fluid in tissues rather than free fluid in a cavity. Kind of like a sponge

Insect bites and hives

Pustule

Elevated, pus filled vesicle or bulla with a circumscribed border.

Acne, impetigo, and carbuncles

Cyst

Elevated, fluid-filled or semisolid mass originating in the subcutaneous tissue or dermis.

Varieties include sebaceous cysts and epidermoid cysts

Secondary Lesions

Characteristics

Examples

Pictures

Atrophy

Translucent, dry, paper like, sometimes wrinkled skin surface resulting from thinning or wasting of skin due to loss of elastin and collagen

Striae, aged skin

Erosion

Wearing away of the superficial epidermis causing moist, shallow depression. They usually heal with out scarring

Scratch marks, ruptured vessels

Lichenification

Rough, thickened, hard area of epidermis resulting from chronic irritation such as scratching or rubbing.

Chronic dermatitis

Scales

Shedding flakes of greasy keratinized skin tissue. Can be white, grey, or silver. Dry skin, dandruff, psoriasis, and eczema. Texture may vary from fine to thick

Crust

Dry blood, serum, or pus left on the skin surface when vesicles or pustules burst. It can be red, brown, orange, or yellow. Large crust that adheres to skin surface is called a scab

Eczema, impetigo, herpes, or scabs following abrasion.

Ulcer

Deep irregularly shaped area of skin loss extending into the dermis or subcutaneous tissue

Decubitus Ulcers (pressure sores), stasis ulcers, chancres

Fissure

Linear crack with sharp edges extending into the dermis

Cracks in the corner of the mouth or in the hands, athletes foot

Scar

Flat irregularly area of connective tissue left after a lesion or wound has healed. Healed surgical wound or injury or healed New scars may be red or purple. Older acne ones have turned white or silver.

Keloid

Elevated, irregularly, darkened area of excess scar tissue caused by excess collagen formation during healing

Keloid from ear piercing or surgery.

Configurations and shapes of lesions Characteristics Examples PICTURES

Annular

Lesions with circular shape

Tinea Corporis, pityriasis rosea

Confluent

Lesions that run together

Urticaria

Discrete

Lesions that are separate and discrete

Molluscum

Grouped

Lesions that appear in clusters

Purpural lesion

Gyrate

Lesions that are coiled or twisted

N/A

Target

Lesions with concentric circles of color

Erythema multiforme

Linear

Lesions that appear as a line

Scratches

Polycyclic

Lesions that are circular but united

Psoriasis

Zosteriform

Lesions arranged in a linear manner along a nerve route

Herpes Zoster

Common skin lesions

Characteristics

Pictures

Tinea

Fungal infection infecting the body (tinea corporis), scalp (tinea capitas), or the feet (tinea pedis, also known as athletes foot). Secondary bacterial infections may also be present. The appearances of lesions vary, and they may present as papules, pustules, vesicles, or scales. A highly contagious viral disease that causes a rash or red and purple macules or papules. The rash begins on the face and then progresses over the neck, trunk, arms, and legs. It does not blanch. It may be accompanied by tiny, white spots that look like grains of salt (called Koplicks spots) on the oral mucosa. It occurs mostly in children

Measles

German measles (Rubella)

Highly contagious disease caused by a virus. Begins as a pink, papular rash that is similar to measles but paler. It begins on the face then spreads over the body. Unlike measles, it may be accompanied by swollen glands.it is not accompanied by kopliks spots.

Chickenpox is a mild infectious disease caused by herpes zoster virus. It begins as a small, red, fluid filled vesicles usually on the trunk and progresses to the face, Chickenpox (varicella) arms, and legs. Vesicles erupt over several days, forming pustules, the crusts. The condition may cause intense itching. It occurs mostly in children.

Herpes simplex

Viral infection that causes characteristic lesions on the lips and mucosa. Lesions progress from vesicles to pustules and then crusts. Herpes simplex also occurs in the genitals

Herpes Zoster

An eruption of dormant herpes zoster virus, which typically has invaded the body during an attack of chickenpox. Clusters of small vesicles form on the skin along the route of sensory nerves. Vesicles progress to pustules and then crusts. It causes intense pain and itching. Common and more severe in adults. Thickening of the skin in dry, silvery, scaly patches. It occurs with over production of skin cells, resulting in buildup of cells faster than they can shed. It may be triggered by emotional stress or generally poor health. May be located on the scalp, elbows, and knees, lower back, and perianal area

Psoriasis

Contact dermitis

Inflammation of the skin due to an allergy to a substance that comes in contact with the skin, such as clothing jewelry, plants, chemicals, and cosmetics. The location of the lesion may help determine the allergen. May progress from redness to hives, vesicles, or scales and is usually accompanied by intense itching.

Eczema

Internally provoked inflammation of the skin causing reddened papules and vesicles that ooze, weep, and progress to form crusts. Usually located on the scalp, face, elbows, knee, forearms, torso, and wrists. Usually causes intense itching

Impetigo

Bacterial skin infection that usually appears on skin around mouth and nose. It is contagious and common in children. It may begin as barely perceptible patch of blisters that break, exposing red weeping area beneath. A tan crust usually forms over the area and the infection may spread to the edges

Malignant skin lesions

Characteristics

Pictures

Most common but least malignant type of skin cancer. It is a proliferation of the cells of the stratum basal into the dermis and Basal cell carcinoma subcutaneous tissue. It begins as shiny papules that develop central ulcers with rounded, pearly edges. Occur most often in skin regions regularly exposed to sun

Squamous cell carcinoma

Arises from cells of the stratum spinosum. Begins as a redden, scaly papule and then forms a shallow ulcer with a clearly delineated, elevated border. Commonly appears on the scalp, ears, back of the hands, and lower lip and is thought to be caused by exposure to the sun. Grows rapidly

Least common but most serious type of skin cancer, it spreads rapidly to lymph nodes and blood vessels. Contains varied Malignant melanoma pigmentation from black to brown to blue to red. The edges are often irregular, with notched borders.

Kaposis sarcoma

Malignant tumor of the epidermis and internal epithelial tissues. Typically soft, blue, to purple and painless. Characteristics are variable: may be macular or popular and may resemble keloids or bruises. Kaposis sarcoma is common in people who are HIV positive

Abnormalities of the hair

Characteristics

Pictures

Common in infants. Appears as eczema of Seborrheic dermatitis yellow-white greasy scales on the scalp and forehead. Also known as cradle cap

Tinea capitis

Patchy hair loss on the head with pustules on the skin. Highly contagious fungal disease and is transmitted from the soil, animals, and person to person

Alopecia areata

No known for the sudden loss of hair in a round balding patch on the scalp

Folliculitis

Infections of the hair follicles, appears as pustules with underlying erythema

Furuncle/abscess

Infected hair follicle, hard, erythematous, pus filled lesion. Bacteria entering the skin cause abscesses. Larger than a furuncle

Hirsutism

Excess body hair in females on the face, chest, abdomen, arms, and legs following the male pattern. Typically due to endocrine or metabolic dysfunction, though it may be idiopathic.

Abnormalities of the nails

Characteristics

Pictures

Spoon nails

Concavity and thinning of the nails. Commonly a congenital condition

Paronychia

Infection of the skin adjacent to the nail, usually caused by bacteria or fungi. Infected area becomes red, swollen, and painful, and pus may ooze from it.

Beaus line

Occurs from trauma or illness affecting nail formation. A linear depression develops at the base and moves distally as the nail grows

Occurs as a result of trauma or Splinter hemorrhage endocarditis. Appears as a reddish brown spot on the nail.

Clubbing

Nail appears more convex and wide. Nail angle is greater than 160 degrees. Occurs in chronic respiratory and cardiac conditions in which oxygenation is compromised

Onycholysis

The nail plate loosens from the distal nail and proceeds to the proximal portion

Pediatric

Characteristics

Pictures

Milia

Tiny white facial papules

Mongolian Spots

Gray, blue, or purple spots in the sacral and buttocks areas of newborns

Pregnant Female

Characteristics

Pictures

Melasma

A skin condition that develops during pregnancy resulting in hyperpigmented patches on the face. Also refered to as chloasma, gravidum, or "the mask of pregnancy"

Linea nigra

A skin condition that develops during pregnancy resulting in a dark line running from the umbilicus to the pubic area.

Geriatric

Characteristics

Pictures

Skin Tenting

A slow return of the skin to its normal position after being pinched, a sign of either dehydration or aging, or both