Intro & Morphology

    Skin Structure

    • 5 main layers
    1. Stratum Corneum (Keratin Layer)
    2. Stratum Lucidum
    3. Stratum Granulosum
    4. Stratum Spinosum
    5. Stratum basale
    • 4 types of cells
      • Keratinocytes (epidermal cells)
      • Melanocytes
      • Langerhan cells
      • Merkel Cells

    SkinLayers.png

     

    Morphology

    <1cm >1cm
    Macule Patch
    Papule Plaque
    Nodule Tumour
    Vesicle Bulla
    Pustule Abscess
    Wheal(hive) Wheal (hive)

     

    Macule/Patch

    • Flat
    • <1cm in diameter (macule), >1cm (patch)
    • Differs by color

     

    Papule & Plaque

    • Elevated above level of skin
    • <1cm (papule), >1cm (plaque)
    • Papule Plaque
      Papule.png Plaque.png

    Pustule & Vesicle/Bulla

    • Pustule:pustule.png
      • Elevated above skin level
      • Contains purulent fluid (white, yellow, or greenish-yellow)
    • Vesicle
      • Elevated above skin level
      • Contains fluid (blood, serum lymph)
      • <1cm in diameterVesicle.png
    • Bulla
      • Elevated above skin levelBulla.png
      • Contains fluid (blood, serum, lymph)
      • >1cm in diameter

     

     

     

     

     

     

    Seconary Morphology

    Erosion

    • Depressed
    • Break involving only epidermis
    • Does not scar
    Erosion.png

    Ulcer

    • Depressed
    • Break involving epidermis + dermis or deeper
    • Often exudate or crust
    • Results in scar
    Ulcer.png

    Scar

    • Fibrosis of dermis and subQ tissue
    • Elevated/Flat/Depressed
    • Permanent
    Scar.png

    Scale

    • Accumulation/shedding of keratin
     

    Crust

    • A hardened deposit due to drying 

    of serum/blood/pus

    Crust.png

    Fissure

    • Linear cleavage or crack in skin
    Fissure.png

    Excoriation

    • Localized, linear or pinpoint damage to skin
    • Often due to scratching
    • Often forms erosion or crust
    Excoriation.png

    Lichenification

    • Epidermal thickening
    • Accentuated normal skin markings
    • Due to persistent scratching/rubbing
    • E.g. Atopic dermatitis, lichen simplex chronicus
    Lichenification.png

    Atrophy

    • Thinning of epidermis, dermis or subQ tissue
    • Depression, wrinlking, transulcence or

    loss of skin markings

    Atrophy.png

     

     

    P-SCALDA

    Example:

     

    Example.png

     

    Fitzpatric Skin Type

    Size

    • i.e. "numerous lesions ranging 2-4mm in diameter"

    Colour of Lesions

    • Example colors:
      • Red
      • Erythematous = Red & blanchable
      • Purple = Violaceous
      • White = Hypopigmented
      • Very White = Depigmented
      • Brown = Hyperpigmented
    • E.g. "There are numerous erythematous lesions ranging from 2-4mm in diameter"

     

    Arrangement of lesions

    • Types:
      • Solitary
      • Linear
      • Annular
      • Serpiginous
      • Reticular
      • Grouped
      • Herpetiform
      • Zosteriform
      • Guttate
      • Targetoid
      • Satellite
      • Scattered
      • Disseminated
      • Generalized

    Solitary

    (E.g. BCC)

    Solitary.png

    Linear

    (E.g. Lichen striatus, contact dermatitis - poison ivy)

    Linear.png

    Annular/Arciform

    (Ring shaped, central clearing, Tinea corporis)

    Annular.png

    Reticular

    (Livedo reticularis)

    Reticular.png

    Serpiginous

    (E.g. Cutaneous larva migrans)

    Serpiginous.png

    Grouped

    (Bed bugs)

    Grouped.png

    Herpetiform 

    (Herpes Simplex)

    Herpetiform.png

    Zosteriform

    (Herpes Zoster - Shingles)

    Zosteriform.png

    Guttate

    (Raindrop, scattered/discrete, guttate psoriasis)

    Guttate.png

    Targetoid

    (concentric ring, erythema multiforme)

    Targetoid.png

    Satellite

    (Candida infection)

    Satellite.png

    Scattered (normal skin in between - Guttate psoriasis)

    Disseminated (Coering large area - back)

    Generalized (covering most body surface - SJS)

    Other Arragnement.png

     

    • E.g. There were numerous erythematous scattered "lesions" ranging from 2-4mm in diameter

    Distribution

    • Anatomical Site
    • Localized vs. Generalized
    • Symmetric vs. Asymmetric
    • Sun-exposed
    • Intertriginous - Body folds
    • Follicular - Surrounding hair follicles
    • Site of trauma - Koebnerization or isomorphic response

     

    Always Remember

    • Check:
      • Scalp & Hair
      • Nails
      • Mucous Membranes
      • Intertriginous Sites

     

     

    Morphological Groups

    Papulosquamous

    • Red, well demarcated and scaly

    Papulosquamous.png

     

    Dermatitic

    • Red, Not well demarcated, usually scaly.
    • Often see excoriations.  
    • Acutely can see vesicles

    Dermatitic.png

     

     

    Morbiliform

    • Blanchable erythematous macules and papules
    • AKA "maculopapular".

    Morbiliform.png

     

     

    Vesiculobullous

    • Vesicles, bulla, erosions, crust +/- ulceration

    VesiculoBullous1.pngVesiculobulous2.png

     

     

    Acneiform or Follicular

    • Lesions around hair follicles

     

     

    Urticarial

    • Blanchable papules and plaques

     

    Urticarial.png

    Tag page (Edit tags)
    • No tags
    Page statistics
    13011 view(s), 8 edit(s) and 11129 character(s)

    Comments

    You must login to post a comment.

    Attach file

    Attachments

    FileSizeDateAttached by 
     Annular.png
    No description
    54.4 kB03:23, 10 Jul 2012apavelActions
     Atrophy.png
    No description
    139.16 kB22:39, 10 Jul 2012apavelActions
    Bulla.png
    No description
    35.33 kB04:18, 10 Jul 2012apavelActions
     Crust.png
    No description
    46.97 kB22:39, 10 Jul 2012apavelActions
     Dermatitic.png
    No description
    60.43 kB04:18, 10 Jul 2012apavelActions
     Erosion.png
    No description
    60.62 kB22:40, 10 Jul 2012apavelActions
     Example.png
    No description
    59.25 kB03:23, 10 Jul 2012apavelActions
     Excoriation.png
    No description
    43.07 kB22:40, 10 Jul 2012apavelActions
     Fissure.png
    No description
    41.38 kB22:40, 10 Jul 2012apavelActions
     Grouped.png
    No description
    55.6 kB03:23, 10 Jul 2012apavelActions
     Guttate.png
    No description
    63.42 kB03:23, 10 Jul 2012apavelActions
     Herpetiform.png
    No description
    33.35 kB03:23, 10 Jul 2012apavelActions
     Lichenification.png
    No description
    71.39 kB22:40, 10 Jul 2012apavelActions
     Linear.png
    No description
    51.11 kB03:23, 10 Jul 2012apavelActions
    MaculePatch.png
    No description
    57.96 kB04:18, 10 Jul 2012apavelActions
     Morbiliform.png
    No description
    76.71 kB04:18, 10 Jul 2012apavelActions
     Other Arragnement.png
    No description
    101.12 kB03:24, 10 Jul 2012apavelActions
    Papule.png
    No description
    48.71 kB04:18, 10 Jul 2012apavelActions
     Papulosquamous.png
    No description
    127.25 kB04:18, 10 Jul 2012apavelActions
    Plaque.png
    No description
    52.26 kB04:18, 10 Jul 2012apavelActions
    pustule.png
    No description
    43.1 kB04:18, 10 Jul 2012apavelActions
     Reticular.png
    No description
    42.54 kB03:24, 10 Jul 2012apavelActions
     Satellite.png
    No description
    60.52 kB03:24, 10 Jul 2012apavelActions
     Scar.png
    No description
    72.57 kB22:40, 10 Jul 2012apavelActions
     Serpiginous.png
    No description
    35.17 kB03:24, 10 Jul 2012apavelActions
     SkinLayers.png
    No description
    126.7 kB03:24, 10 Jul 2012apavelActions
     Solitary.png
    No description
    36.98 kB03:24, 10 Jul 2012apavelActions
     Targetoid.png
    No description
    58.6 kB03:24, 10 Jul 2012apavelActions
     Ulcer.png
    No description
    51.37 kB22:40, 10 Jul 2012apavelActions
     Urticarial.png
    No description
    111.23 kB04:18, 10 Jul 2012apavelActions
    Vesicle.png
    No description
    28.77 kB04:18, 10 Jul 2012apavelActions
     VesiculoBullous1.png
    No description
    111.21 kB04:18, 10 Jul 2012apavelActions
     Vesiculobulous2.png
    No description
    82.9 kB04:18, 10 Jul 2012apavelActions
     Zosteriform.png
    No description
    36.84 kB03:24, 10 Jul 2012apavelActions