Describing Skin Lesions

It is quite common for you to need to describe rashes for documentation purposes, to senior colleagues or to refer to various specialties including dermatology. Here is a refresher of the terminology to describe common skin lesions. For more detail, check our source.

Systematic Examination

  1. Inspect – Observe the overall appearance of the lesion i.e. site, number, pattern of distribution
  2. Describe – Inspect the individual lesions i.e. size, colour, morphology.
  3. Palpate – Feel the texture, temperature, tenderness, consistency and mobility.
  4. Expose – Thoroughly examine the other systems as appropriate i.e. nails, hair, mucous membranes and any other body system required.

Distribution

  • Acral (distal extremities)
  • Dermatomal (confined to a single spinal nerve)
  • Extensor or flexural
  • Follicular (around the hair follicles)
  • Generalised (not fitting any specific area)
  • Photosensitive 
  • Pressure areas
  • Seborrhoeic (around secretion of sebum) 
  • Specific body parts

Colour of individual lesion

  • Hyper or hypopigmented
  • Erythematous (blanching redness)
  • Purpuric (non-blanching redness)
    • Petechiae are spots (less than 2mm)
    • Purpura are usually below 10mm
    • Ecchymoses/bruises are usually above 10mm

Morphology of an individual lesion

  • If it is flat (i.e. no palpable contour)
    • Macule: less than 5mm
    • Patch: more than 5mm
  • If it is mildly raised
    • Plaque: more than 1 cm of skin which is usually slightly elevated from the skin
    • Wheal/weal: dermal oedema causing blanching erythema with central paleness usually a feature of urticaria
  • If it is elevated
    • Papule: solid lesion less than 5mm
      • Pustule: pus filled papule
      • Vesicle: fluid-filled papule
    • Nodule: solid lesion more than 5mm
      • Abscess: pus-filled nodule
      • Bullae: fluid-filled nodule

Surface

  • Scaling or hyperkeratosed
    • Exfoliating means peeling
    • Lichenoid are tight scales
    • Psoriaform are large silver flakes
  • Crusting: yellow or bloody dried discharge
  • Excoriated (itched)
  • Granular (fibrous healing tissue)
  • Lichenification (thickened skin from rubbing)
  • Ulcers
Written by Dr Thujina Thillainathan & Dr Akash Doshi CT2

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