Primary, Secondary Skin and Vascular Lesions Dermatology

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Macule
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flat, < 1cm in diameter
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Macule Example
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Freckles
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Patch
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flat, > 1cm in diameter
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Patch Example
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Vitiligo
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Papule
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elevated, < 1cm in diameter
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Plaque
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elevated, > 1cm in diameter
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Wheal
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Palpable, elevated, solid mass, cutaneous edema, changes over time, *Variable diameter
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Wheal Example
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Hives, urticaria
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Nodule
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elevated firm lesion, 1-2 cm in diameter; deeper into dermis than papule
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Nodule Example
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Lipoma
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Tumor
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elevated, solid mass, > 2 cm in diameter, deep into dermis
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Vesicle
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superficial, fluid filled lesion, serous fluid, < 1 cm diameter
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Vesicle Example
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Acne, herpes
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Bulla
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large vesicle, > 1 cm
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Bulla Example
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Blister
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Pustule
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elevated, superficial, pus filled lesion (similar to vesicle)
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Pustule Example
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Impetigo, acne
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Cyst
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elevated, encapsulated lesion containing liquid or semi-solid material, stable in dermis or subcutaneous layer
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Abcess
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walled-off collection of pus, within dermis or deeper (needs to be drained*)
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Furuncle (boil)
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walled-off enclosed, firm or fluctuant collection of pus, deep and painful mass evolving from superficial folliculitis (S. aureus)
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Carbuncle
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A bunch of furuncles that come together
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Burrow
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elevated channel caused by parasite; tunnel in skin (seen in webs of feet and hands)
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Burrow Example
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Scabies
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Comedone
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plug of sebaceous and keratinous material in hair follicle opening
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Comedone Example
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Acne lesions
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Open comedo acne lesion
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A blackhead
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Closed comedo acne lesion
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A whitehead
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Milia
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benign, superficial keratin cysts; no visible opening
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Milia Example
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Seen in adults secondary to trauma, sun exposure
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Scale
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superficial, sits on skin plane; flaky skin, irregular, various size and thickness
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Scale Example
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psoriasis, fungal infections
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Crust
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dried sebum, blood or exudate from original lesion; elevated, varying color/size
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Crust Example
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Scab
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Lichenification
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rough, thick epidermis due to excessive rubbing, scratching, chronic trauma (commonly on flexor surface of arms)
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Keloid
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irregular shaped, elevated scar, enlargement past the original wound; excess collagen formation (more common in African Americans)
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Scar
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fibrous tissue, replaces normal skin after injury
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Excoriation
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loss of epidermis, linear, hollowed out crusted area
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Fissure
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crack/break in skin, more linear from epidermis to dermis
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Fissure Example
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Tinea pedis (cracks in foot)
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Erosion
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loss of part of epidermis; depressed, moist appearance
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Erosion Example
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Lesion after rupture of bulla (blister)
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Ulcer
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Deeper than erosion, concave, varying size; required surgical treatment with advancement
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Atrophy
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thickening of skin surface with loss of markings, becomes more white with time “paper-like”, translucent appearance
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Atrophy Example
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Pregnancy stretch marks
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Telangiestacia
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fine, irregular red lines; due to capillary dilation; **blanches with pressure
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Spider angioma
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red central body with radiating legs; **blanches with pressure
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Spider Angioma Example
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When more than 1, associated with liver disease, vitamin B deficiency
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Venous star
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blueish, spiderlike, linear or irregular shape; **NO blanching with pressure
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Capillary hemangioma
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red, irregular patches or macules due to dilation of dermal capillaries
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Petechiae
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less than .5cm, **non-blanching, red to purple lesions
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Purpura
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> .5cm, non-blanching (similar to petechiae)
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Purpura Example
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Meningococcal disease (bad)
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Ecchymosis
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red-purple lesion, **non blanching, due to vascular wall destruction

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