Primary And Secondary Lesions Pdf
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Discrepancies in the terminology of elementary lesions persist when texts from Dermatology and Semiology books are compared, which can cause some confusion in both the teaching of undergraduate medical students and the learning acquired by professionals in the field.
Integumentary System. Lesson 3: Primary and Secondary Skin Lesions. Table of Contents. About this Text. Nursing Contact Us. Links General Information. Generally, while the epidermis plays a leading role in the skin by being the barrier between the human's internal tissues, and so forth, and the environment, the dermis is the more indispensable. Of the two layers, the dermis is much thicker and measures up to four mm in depth. The dermis is composed of collagenous and elastic tissues.
These tissues provide the structural base for the epidermis as well as a site for vascular and nerve networks in the skin. Alteration in any component of the skin-- epidermis, dermis, or any skin appendage--can result in clinically visible skin lesions. Types of Skin Lesions. Skin lesions can be divided into three categories: primary skin lesions, secondary skin lesions, and special skin lesions.
Primary skin lesion s are basic and simple. Secondary skin lesions result from complications of primary skin lesions. Primary Skin Lesions.
A macule figure is a definite area of skin in which the skin color has changed from the normal skin color. This area is neither higher nor lower than the surrounding skin area. These flat, discolored spots are either hypopigmented abnormally diminished in pigmentation or hyperpigmented abnormally increased in pigmentation. The lesions are of varied size, less than one milliliter in diameter.
Macules may be adjacent to each other and cover a whole extremity for example, a leg or half of the face as in the disease capillary hemangioma. Macules may be cafe au lait colored color of coffee with milk as in Albright's syndrome, blue to black as in urticaria hives , or white as in certain forms of leprosy.
Figure A papule figure is a solid, elevated lesion usually 0. Most of the lesion is above the level of the surrounding skin rather than deep within the skin. Many skin diseases start with papules--warts, psoriasis, syphilis, drug eruptions, and some phases of acne. Different types of papules are different colors. The papules of psoriasis are flat-topped and red, often with a superimposed scale that produces bleeding when removed.
Skin lesions of a secondary syphilis are copper colored. Violet papules are typical of lichen planus skin lesions, and the papules of lichen sclerosis are whitish.
Rounded, red, bluish-red, or brownish-red papules characterize the skin disease pyogenicum. A nodule figure is a solid, elevated lesion that extends deeper into the dermis than the papule. A nodule is greater than 0. Examples of nodules include keratinous cysts, small lipomas benign tumors composed of mature fat cells , fibromas benign tumors derived from fibrous connective tissue , some types of lymphoma malignant diseases usually in the lymph nodes , and a variety of neoplasms abnormal, excessive, and uncontrolled multiplication of cells forming a mass or new growth of tissue.
Nodules are often an indication of systemic disease and can result from inflammation, neoplasms, or metabolic deposit in the dermis or subcutaneous tissue. For example, nodules are present in late syphilis, tuberculosis, and roundworm infestation. Sometimes local agents can produce nodules--foreign-body reactions, milker's virus, or tick bites. A tumor is an elevated, solid lesion greater than 2 cm.
Tumor, a general term for any mass, benign or malignant, is sometimes used to indicate a large nodule. The skin is an extremely common site for a wide variety of tumors; most are easily visible in the earliest stages. Therefore, it is possible to recognize and eradicate tumors in almost percent of the cases. The following are a few of the origins of skin tumors: tumors arising from the epidermis surface; tumors arising from epidermal appendages such as hair structures, sebaceous glands, and sweat glands.
Examples of common skin tumors are actinic keratoses, usually caused by repeated exposure to sunlight over the years. These tumors are frequently noted in. Actinic keratoses are more common in the Southwestern US than in areas with less sunlight. Fair-skinned people are more susceptible to these tumors than those with dark skin. People who are bald frequently develop multiple actinic keratoses. A wheal figure is an elevated lesion rounded or flat-topped. A wheal has increased tissue fluid, often itches, and usually disappears within a few hours.
Trace the wheal with a skin marking pencil, observing over a period of time. You will see the lesions shift rapidly from involved to uninvolved adjacent skin areas. The lesions are the result of excess fluid in the upper layer of the dermis. Wheals are pale red and may be an allergic response to any one of a number of irritants or to insect bites.
Twenty-five percent of the normal population can produce wheals merely by stroking their skin. This phenomenon is called dermatographism. The size of wheals varies from 3 to 4 mm in diameter as in the skin disease cholinergic urticaria or 10 to 12 mm as in the skin diseases composed of erythematous plaques. A plaque figure is a rather large surface area which is elevated above the surrounding skin surface.
In the skin disease psoriasis, a number of papules form the plaque. In the skin disease lichenification, the skin on the plaque appears thickened, and the skin markings are more visible than usual. Also, the surface of the skin lesions may resemble tree bark. Lichenification is caused by repeatedly rubbing a skin area.
A vesicle figure is an elevated, fluid-filled skin lesion that is less than 0. A bulla is the same as a vesicle with the exception that the bulla is greater than 0. A vesicle or bulla arises from a cleavage at various levels of the skin.
When the cleavage is just beneath the stratum corneum of the skin, a subcorneal vesicle or bulla results as in impetigo and corneal pustular dermatosis. Sometimes the vesicle or bulla walls are so thin that you can see through them.
In such instances, the serum, lymph, blood, or extracellular fluid is quite visible. Types of vesicles. A pustule figure is a pus-filled lesion that can result from infection of vesicles or bullae.
The pus is a thick fluid composed primarily of dead white blood cells leukocytes and a thin liquid and often the microbiologic agent responsible for the inflammation. The pustule may appear white, yellow, or greenish-yellow, depending on the color of the material being deposited in the tissue.
An example of a common pustule is a follicular or hair pustule. Hair pustules are usually shaped like a cone, have a hair in the center, and heal without scarring. Secondary Skin Lesions. Secondary lesions are the result of some primary lesion. A number of conditions such as crust and scale are characteristic of secondary lesions. The dried residue of fluid, blood, or pus on an area of lost or damaged skin surface is crust figure Crusts may be thin, delicate, and easily torn or damaged or the crust may be thick and sticking to the skin.
Crusts formed from dried serum the clear fluid of blood are yellow while crust formed from pus are yellow-green, and crusts formed from blood are dark red or brown.
When dealing with crust, it is most important to determine what is underneath the crust--dermatitis, superficial infection, or ulcer. Scales are a buildup of dry cells horny layer that is higher than usual. Although there are a large variety of scales, some are so distinctive that they can be used to diagnose specific skin problems.
For example, a chronic plaque-like scale that is silvery-white to gray is usually psoriasis. Greasy, yellowish scales may indicate seborrheic dermatitis. If the scales are dry and diffuse and look like fish scales on the lower legs, the skin disease is icthyosis. Skin lesions of pityriasis rosea and tinea corpis scale mainly at the edge of individual lesions. A fissure is a crack in the epidermis extending into the dermis.
They are linear cleavages in the skin, sometimes very painful. These cracks occur particularly in the hands and feet, especially after therapy has caused excessive drying of the skin. Fissures also occur at the angles of the mouth. A loss of epidermis that does not extend into the dermis is termed erosion. Erosion is often seen in herpes infections. An ulcer figure is a skin lesion in which there has been destruction of the epidermis and the upper papillary dermis.
An ulcer always results in a scar. To determine the cause of an ulcer, note the ulcer's location, borders, base, discharge, and any associated features of the lesion such as nodules, excoriations scratch marks , varicosities abnormal swellings , hair distribution, presence or absence of sweating, and adjacent pulses.
There are many causes of ulcers--skin trauma of all kinds heat, cold, electrical, chemical ; bacterial, viral, and fungal infections; parasitic infestations; and tumors to name just a few. A scar figure is a fibrous healing of a wound, healing that replaces the normal dermis and epidermis that have been damaged.
Integumentary System. Lesson 3: Primary and Secondary Skin Lesions. Table of Contents. About this Text. Nursing
Primary skin lesions are present at the onset of a disease. In contrast, secondary skin lesions result from changes over time caused by disease progression.
Description of Skin Lesions
Secondary lesions are those lesions that are characteristically brought about by modification of the primary lesion either by the individual with the lesion or through the natural evolution of the lesion in the environment. Tasneem Poonawalla, M. Core Concepts of Pediatrics. Secondary lesions Secondary lesions are those lesions that are characteristically brought about by modification of the primary lesion either by the individual with the lesion or through the natural evolution of the lesion in the environment. Atrophy : localized shrinking of the skin which results in paper-thin, wrinkled skin with easily visible vessels.
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If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus. Please consult the latest official manual style if you have any questions regarding the format accuracy. Identification and classification of a patient's skin lesions are important steps in the diagnosis of any skin disorder. The numerous descriptive terms used in dermatology can be overwhelming and at times confusing as there are some variations in the use and meaning of these words in the literature. Using proper terminology to describe skin findings is essential for both documentation and communication with other clinicians.
Primary skin lesions are those which develop as a direct result of the disease process. Secondary lesions are those which evolve from primary lesions or develop as a consequence of the patient's activities. This classification is naturally artificial; the same lesion type might be a primary lesion in one disease but a secondary lesion in another eg alopecia is a primary lesion in canine hypothyroidism [direct consequence of lack of thyroxine] but a secondary lesion in feline flea allergy [caused by the patient: hair removed by the itchy cat]. Do not confuse the term "secondary lesion" with "secondary pyoderma". The latter term implies a bacterial infection which is complicating an underlying skin disease common examples in dogs include allergy or demodicosis but that secondary pyoderma may present with primary lesions such as papules and pustules. Introduction to Skin Lesions 3 of 6 Definitions of Primary and Secondary Lesions Primary skin lesions are those which develop as a direct result of the disease process. Skin Lesions.
An extensive language has been developed to standardize the description of skin lesions, including. Lesion type sometimes called primary morphology. Lesion configuration sometimes called secondary morphology. Location and distribution. Macules represent a change in color and are not raised or depressed compared to the skin surface. A patch is a large macule. Examples include freckles, flat moles, tattoos, and port-wine stains , and the rashes of rickettsial infections , rubella , measles can also have papules and plaques , and some allergic drug eruptions.
Written and peer-reviewed by physicians—but use at your own risk. Read our disclaimer. Dermatology is the branch of medicine concerned with the skin , hair , and nails , as well as the conditions associated with them. In the United States, the most common conditions seen by dermatologists include acne , actinic keratoses , non- melanoma skin cancers, benign tumors , and contact dermatitis. Skin lesions may be primary or secondary.
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