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The Language of Dermatology

Tim Lambert, DO

Munson 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

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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.

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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

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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.

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Wheels/Dermatographia

Vesicles

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

• Bullae are larger vesicles.

Bullae

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Burrow

Telangiectasia

Secondary Lesions

• Scale

• Lichenification

• Crusting

• Excoriation

• Fissure

• Erosion

• Ulceration

• Fungating

• Keloid

• Atrophy

• Petechiae

• Purpura

• Ecchymoses

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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.

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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.

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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.

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Keloid

• A scar is enlarged or has grown excessively.

Atrophy

Atrophy thinned skin.

Petechiae and Purpura

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Ecchymosis

Patterns and Distribution

• Annular

• Nummular

• Linear

• Oval

• Target

• Serpiginous

• Reticulate

• Stellate

Annular

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

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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

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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

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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

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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

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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

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COLOR

• Hypo pigmented

• Hyper pigmented

• White

• Black

• Blue

• Yellow

• Violaceous

• Variegated

Hypopigmented

Hyperpigmentation

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White

Black

Blue

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Red

Green

Yellow

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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

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The End