The Language of Dermatology

Tim Lambert, DOMunson Family Practice Residency

OBJECTIVES

• Understand primary and secondary dermatologic lesions

• Improve ability to properly describe dermatologic lesions or rashes

• Learn about dermatolgy resources

Dermatologic Nomenclature

• Primary Lesions• Secondary Lesions• Patterns• Distribution and Arrangement• Color

Primary Lesions

• Macule and patch

• Papule

• Nodule

• Tumor

• Pustule

• Plaque

• Wheal

• Vesicle and bulla

• Plaque

Macules and patches

• Macules do not rise above the level of the skin and can not be felt. They are recognized as a change in skin color.

• Patches are larger macules.

Papules and nodules

• Papules are palpable solid, round or ellipsoidal lesions that may involve the epidermis, dermis or subcutaneous tissue.

• Nodules are larger papules

Nodules

Solid lesion > 1 cm in size

Tumor

Pustules

• Pustules are epidermal or upper dermal collections of pus.

• Deeper lesions are referred to as abscesses

Plaques

• Plaques are raised lesions that have a flat top. The rise in elevation is much less than the width of the lesions.

Wheals

• Wheals are rounded or flat topped, pale red papules or plaques caused by extravasation of fluid into extracellular space.

Wheels/Dermatographia

Vesicles

• A vesicle is a lesion formed by fluid creating a cleavage plane beneath the stratum corneum.

• Bullae are larger vesicles.

Bullae

Burrow

Telangiectasia

Secondary Lesions

• Scale• Lichenification• Crusting• Excoriation• Fissure• Erosion• Ulceration

• Fungating• Keloid• Atrophy• Petechiae• Purpura• Ecchymoses

Examples of Scales

Scale

• Desquamation (skin coming off in scales) • Psoriasiform (large white or silver flakes) • Pityriasiform (branny powdery scale) • Lichenoid (apparent scale is tightly adherent to skin surface) • Keratotic (horny scale) • Exfoliation (peeling skin) • Maceration (moist peeling skin) • Verrucous (warty) • Descriptive terms for scale include: • Desquamation (skin coming off in scales) • Psoriasiform (large white or silver flakes) • Pityriasiform (branny powdery scale) • Lichenoid (apparent scale is tightly adherent to skin surface) • Keratotic (horny scale) • Exfoliation (peeling skin) • Maceration (moist peeling skin) • Verrucous (warty)

Lichenification

• Lichenification is caused by chronic rubbing, which results in palpably thickened skin with increased skin markings and lichenoid scale. It occurs in chronic atopic eczema and lichen simplex.

Crusting

• Crust occurs when plasma exudes through an eroded epidermis. It is rough on the surface and is yellow or brown in colour. Bloody crust appears red, purple or black.

Excoriation

• An excoriation is a scratch mark. It may be linear or a picked scratch (prurigo). Excoriations may occur in the absence of a primary dermatosis.

Fissure

•A fissure is a thin crack within epidermis or epithelium, and is due to excessive dryness.

Erosion

• Erosion is caused by loss of the surface of a skin lesion; it is a shallow moist or crusted lesion.

Ulcer

•An ulcer is full thickness loss of epidermis or epithelium. It may be covered with a dark-coloured crust called an eschar.

Fungating

• Refers to a large malignant tumour that is erupting like a mushroom or fungus.

Keloid

• A scar is enlarged or has grown excessively.

Atrophy

Atrophy thinned skin.

Petechiae and Purpura

Ecchymosis

Patterns and Distribution

• Annular• Nummular• Linear• Oval• Target• Serpiginous• Reticulate• Stellate

Annular

• Annular lesions are empty circles and ring- like in appearance

Nummular

• Nummular lesions take on the appearance of a filled circle or coin

Linear

• Linear lesions are long relative to their width and generally straight

Oval

• Oval shaped lesion

Target

• Target lesions are made up of concentric rings of red and white coloration with a bullseye appearance

Stellate

• Stellate lesions are “star like” usually by radial spread from a central focus

Reticulate

• Lesions with a lace-like appearance

Serpigenous

• Lesions which are linear and wavy or snake-like in appearance

LESION DISTRIBUTION

• HANDS• FACE• EXTENSOR• FLEXURAL• SCALP• AXILLAE• FEET• NAIL• GENITAL• INGUINAL

LESION ARRANGEMENT

• Grouped• Disseminated• Dermatomal• Confluent• Symmetric• Photosensitive

Grouped

• Multiple similar lesions occurring together in a localized body location

Disseminated

Lesions which are scattered randomly and covering all or most of the body

Dermatomal

• Following the path of a peripheral sensory nerve

Confluent

• The process of smaller lesions growing until they merge together

Symmetry

• Lesions are mirror images of each other on opposite sides of the body

Photosensitive

• Lesions limited to the sun exposed regions of the body

COLOR

• Hypo pigmented• Hyper pigmented• White• Black• Blue• Yellow• Violaceous• Variegated

Hypopigmented

Hyperpigmentation

White

Black

Blue

Red

Green

Yellow

Violaceous

Varigated

Dermatology Nomenclature tool: http://www.pediatrics.wisc.edu/education/derm/tutorials.html

Dermatology References

Required Derm module: Access through GME Resident or https://www.aad.org/education/basic-dermatology-curriculum

The End