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Skin terms

Descriptors
Macule a flat, non-palpable, coloured lesion which is less than 1cm in size. It is usually red, brown
or depigmented. Examples include a freckle or a solar lentigo

Patch as above but larger than 1cm in size. Examples include larger areas of vitiligo or the early
herald patch of pityriasis rosea

Papule a palpably raised lesion which is less than 1cm in diameter. For example, the papules seen
in facial acne

Nodule a palpably raised lesion which is more than 1cm in diameter. For example, a nodular BCC
or a dermatofibroma. If you can pinch the lesion between finger and thumb, it is a nodule rather
than a papule. In some cases, most of the nodule may lie beneath the skin surface as with a lipoma.

Plaque flat-topped, slightly raised, or palpably different areas of skin. For example, the scaly, well-
defined red plaques of psoriasis

Vesicle small fluid-filled blister less than 0.5cm in diameter. For example, the vesicles seen in
pompholyx eczema

Bulla larger fluid-filled blister more than 0.5cm in diameter. For example, the bullae seen in
bullous pemphigoid or following a burn

Pustule pustules result from accumulation of large numbers of leukocytes in the epidermis or
upper dermis. For example, the follicular pustules seen in facial acne or folliculitis elsewhere on the
body

Weal the result of a rapid leak of fluid from blood vessels into the dermis causing a localised area
of dermal oedema; usually with erythema and typically last less than 24 hours. For example, in
urticaria

Breaks in the skin surface

Erosion produced by surface loss chiefly involving only the epidermis


Ulcer tissue loss extends into the dermis. For example, leg ulcer
Fissure narrow, deep, cleft-shaped ulcer. For example, angular cheilitis or the deep
fissures that some patients develop in the heel skin
Excoriation scratch marks which can result in erosions or ulcers

Scale flaking of the skin due to loss of damaged stratum corneum (as in fungal infection) or
abnormal stratum corneum (as in psoriasis). This indicates an abnormality of the epidermis

Crust dried surface exudate of blood or serous fluid. For example, in impetigo
Results of changes in dermal blood vessels

Erythema - diffuse redness due to increased blood flow in vessels deep in the skin and the
individual vessels are not visible. For example, in urticaria
Telangiectasia presence of visible vessels close to the skin. For example, in rosacea
Purpura caused by blood that has leaked from dermal blood vessels and therefore cannot
be blanched by pressure. For example, in vasculitis
Petechiae pinpoint spots of purpura
Ecchymosis extravasated blood in fat and muscle is an ecchymosis or bruise

Shapes and patterns


Discoid circular or like a coin. For example, in discoid eczema or psoriasis

Oval oval shaped. For example, in pityriasis rosea

Annular ring shape. For example, in granuloma annulare

Target concentric rings of different colours or shades. For example, in erythema multiforme

Serpiginous wavy line. For example, scabies mites mites as they burrow through the skin

Reticulate lace-like pattern of a rash. For instance, parvovirus infection causing slapped cheek
syndrome (Fifth disease)

Symmetry and asymmetry symmetry implies an endogenous cause such as psoriasis or atopic
eczema. Asymmetry suggests an exogenous cause such as a skin infection like tinea

Flexural affecting predominantly the flexures. For example, atopic dermatitis in adults

Extensor affecting predominantly the extensor areas. For example, psoriasis

Dermatomal following a dermatomal distribution. For example, herpes zoster

Photosensitive Skin reactions caused by sun exposure affecting face, nape and V of the neck, and
dorsa of hands and arms

Arrangements of multiple lesions


Grouped - multiple but separate lesions centred around on area. For example, herpes simplex viral
infection

Disseminated multiple small lesions at different sites without any specific pattern. For example,
guttate psoriasis

Confluent multiple lesions becoming merged together. For example, pityriasis versicolor

Exanthematous multiple, red, usually truncal, lesions. For example, drug eruptions or viral
exanthems

Erythroderma total, or virtually total, redness of the skin. For example, with eczema or psoriasis