** only titles in BOLD Underline were mentioned by the doctor

The Primary Lesions

Primary lesions are physical changes in the skin considered to be caused directly by the
disease process. Types of primary lesions are rarely specific to a single disease entity.
1. MACULE
A macule is a change in the color of the skin (hypo or hyper). It is flat, if you were to
close your eyes and run your fingers over the surface of a purely macular lesion, you
could not detect it. A macule greater than 0.5 cm. may be referred to as a patch.
2. PAPULE
A papule is a solid raised lesion that has distinct borders and is less than 1 cm in diameter.
Papules may have a variety of shapes in profile (domed, flat-topped, umbilicated) and
may be associated with secondary features such as crusts or scales.
e.g acne vulgaris papules
3. NODULE
A nodule is a raised solid lesion more than 1 cm. Deeply seeded may be in the epidermis,
dermis, or subcutaneous tissue.
e.g leprosy nodules, nodular acne
4. PLAQUE
A plaque is a solid, raised, flat or rough lesion greater than 1 cm. in diameter with defined
edges.
5. VESICLE
Vesicles are small raised lesions (blisters) less than 0.5 cm. in diameter that are filled with
clear fluid.

e.g herpes simplex, dermaitis

6. BULLAE
Bullae are large circumscribed fluid-filled lesions (blisters) that are greater than 1 cm. in
diameter.
7. PUSTULE
Pustules are small circumscribed elevated lesions that contain pus. They are most
commonly infected (as in folliculitis) but may be sterile (as in pustular psoriasis). They
may develop spontaneously or from a papule.
e.g acne pustule
8. WHEAL
TRANSIENT solid swelling resembling an orange skin
e.g urticaria
9. ERYTHEMA
An area of redness or duskiness
e.g cellulitis, drug reaction
10. TUMOR
A tumor is a solid mass of the skin or subcutaneous tissue; it is larger than a nodule.
(Please bear in mind this definition does not at all mean that the lesion is a neoplasm.)
11. BURROW
Burrows are linear lesions produced by infestation of the skin and formation of tunnels
(e.g., with infestation by the scabitic mite or by cutaneous larva migrans).
12. TELANGIECTASIA

Telangiectasia are the permanent dilatation of superficial blood vessels in the skin and
may occur as isolated phenomena or as part of a generalized disorder, such as ataxia
telangiectasia.

The Secondary Lesions

Secondary lesions may evolve from primary lesions, or may be caused by external forces
such as scratching, trauma, infection, or the healing process. The distinction between a
primary and secondary lesion is not always clear.
1.EXUDATE
Fluid content of a broken papule, vesicle, bulla or pustule.
e.g Impetigo, eczema, dermatitis
2. SCAB
A mass of an incomplete dried exudate
e.g eczema or dermatitis,Impetigo
3. CRUST:
Friable mass of a completely dried exudate. If we remove the crust we will find the
erosion underneath
e.g scabies, Impetigo
Crusting is the result of the drying of plasma or exudate on the skin. Please remember
that crusting is different from scaling. The two terms refer to different phenomena and are
not interchangeable. One can usually be distinguished from the other by appearance
alone.
EXUDATE SCAB CRUST EROSION result from removing the crust

4. ULCER
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Deeper loss of skin and mucosa, extending below the dermo-epidermal junction.
(necrosis of the epidermis and dermis and sometimes of the underlying subcutaneous
tissue)
This heals with scarring
e.g ecthyma
** N.B an erosion will heal without scaring
5. SCALE
Heaped up stratum corneum cells fromed in many common skin diseases
e.g scabies
6. SCAR
The end result of a healed ulcer
The permanent fibrotic changes that occur on the skin following damage to the dermis.
Maybe flat or hypertrophic
Scars may have secondary pigment characteristics
7. KELOIDS
Keloids are an exaggerated connective tissue response of injured skin that extend beyond
the edges of the original wound.
(firm solid over growth of fibrous tissue)
8. CYST:
subcutaneous lump containing fluid or semisolid material
9. EXCORIATION (Scratch)
Irregular mark on the skin resulting from epidermal loss caused by scratching
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10. FISSURE (Crack)

LINEAR or irregular breach in the skin muscosa. Usually ACCENTUATE TO NORMAL
SKIN LINES.
e,g candidal intertrigo, angular stomatitis in vitamin B deficiency
11. ATROPHY
Loss of substance of the skin showing palpable thinness
12. HYPOPIGMENTATION
13. HYPERPIGMENTATION
15. LICHENIFICATION
"Lichenification" refers to a thickening of the epidermis seen with exaggeration of
normal skin lines. It is usually due to chronic rubbing or scratching of an area.
16. EROSION
Erosions are slightly depressed areas of skin in which part or all of the epidermis has
been lost.
21. ESCHAR
An eschar is a hard, usually darkened, plaque covering an ulcer implying extensive tissue
necrosis, infarcts or gangrene.
23. PETECHIAE, PURPURA, AND ECCHYMOSES
Three terms that refer to bleeding that occurs in the skin are petechiae, purpura, and
ecchymoses. Generally, the term "petechiae" refers to smaller lesions. "Purpura" and
"ecchymoses" are terms that refer to larger lesions. In certain situations purpura may be
palpable. In all situations, petechiae, ecchymoses, and purpura do not blanch when
pressed. If there is any question, press on the lesions carefully with a glass slide. Don't
break the slide or cut the patient.
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Patterns and Distribution

Not only is the appearance of lesions important, but the pattern and distribution on the
skin is as well.
24. ANNULAR
Annular lesions are seen in a ring shape. Tinea corporis, erythema migrans (the lesion
associated with lyme disease), and granuloma annulare are three common examples.
25. DISCRETE
Discrete lesions tend to remain separate. This is a helpful descriptive term but has little
specific diagnostic significance.
26. CLUSTERED
Clustered lesions are those that are grouped together. They are commonly seen in herpes
simplex or with insect bites, for example.
27. CONFLUENT
Confluent lesions tend to run together.
28. DERMATOMAL, ZOSTERIFORM
Dermatomal, zosteriform lesions follow a dermatome. The lesions of varicella zoster
(also known as shingles) are the classic example, but there are other lesions which may
assume the same pattern.
29. ECZEMATOID
Eczematoid lesions are inflamed with a tendency toward clustering, oozing, or crusting.

30. FOLLICULAR
It is sometimes helpful to determine if lesions specifically involve the hair follicle.
31. GUTTATE
Guttate lesions look as though someone took a dropper and dropped this lesion on the
skin. Guttate lesions are characteristic of one form of psoriasis, though that is not the only
example.
32. IRIS OR TARGET LESIONS
Iris lesions are also known as target lesions and are a series of concentric rings. These
have a dark or blistered center. These lesions are frequently seen with erythema
multiforme but not exclusively so.
33. KOEBNER PHENOMENON
The Koebner phenomenon, also called the isomorphic response, refers to the appearance
of lesions along a site of injury. This phenomenon is seen in a variety of conditions; for
example, lichen planus, warts, molluscum contagiosum, psoriasis, lichen nitidus, and the
systemic form of juvenile rheumatoid arthritis.
34. LINEAR LESIONS
Linear lesions occur in a line or band-like configuration. This descriptive term may apply
to a wide variety of disorders. (One should be certain that the lesions are not following a
dermatome.)
35. MULTIFORM
Patients with multiform lesions have lesions of a variety of shapes.
36. RETICULAR
Reticular or net-like lesions can be seen in a variety of circumstances; e.g., very
commonly in newborns (or even grown children and adults) as cutis marmorata, or with
livedo reticularis. The former fades as the skin is warmed the latter becomes more florid.
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37. SERPIGINOUS
Serpiginous lesions wander as though following the track of a snake.
38. UNIVERSALIS
Universalis refers to a widespread disorder that affects the entire skin.
39. SCARLATINIFORM
Scarlatiniform rashes have the pattern of scarlet fever. The patient with a scarlatiniform
rash has innumerable small red papules that are widely and diffusely distributed. Note
that the term scarlatiniform does not mean that the patient has scarlet fever, although by
definition all patients with scarlet fever have a scarlatiniform rash. Patients with a variety
of other conditions such as Kawasaki disease, viral infections, or drug reactions may have
rashes with the same pattern.
40. STRAWBERRY TONGUE
Patients with scarlet fever, Kawasaki disease or other conditions may develop a
distinctive appearance of their tongues. Because of its resemblance to the well-known
berry, the appearance is called "strawberry tongue."
41. MORBILLIFORM
The term "morbilliform" means that the patient has a rash that looks like measles.
Patients with measles will have the rash but patients with Kawasaki disease, drug
reactions, or other conditions may also have a morbilliform rash. The rash consists of
macular lesions that are red and are usually 2-10 mm in diameter but may be confluent in
places.
42. SATELLITE LESIONS
The term is commonly used to describe a portion of the rash of cutaneous candidiasis in
which a beefy red plaque may be found surrounded by numerous, smaller red macules
located adjacent to the body of the main lesions.
43. PATTERNS OF INTENTIONAL OR UNINTENTIONAL INJURY
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One important category of skin lesions involve the form that skin lesions may take in
cases of child abuse or other intentional injury (bite marks, slap marks, strap marks,
burns, etc.) or in cases of unintentional injury. Abrasions are traumatically caused
erosions.