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subcutaneous fat. Examples: epidermal inclusion and pilar cysts.
xi. Wheal/Hive: A distinctive white to pink or pale, red, edematous, solid elevation formed by local,
superficial, transient edema. They characteristically disappear yet may reappear within a period of
hours. Examples: dermographism, insect bites, and urticaria.
xii. Telangiectasia: Blanchable (fades with fingertip pressure), small, superficial dilated capillaries.
Examples: rosacea, lupus erythematosus and basal cell skin cancer.
xiii. Purpura: Non-blanchable, purple area of the skin that may be flat/nonpalpable or raised/palpable.
Examples: hemorrhagic lesions of some fevers.
b. Secondary lesions represent evolution (natural) of the primary lesions or patient manipulation of
primary lesions. Although helpful in differentiating lesions, they do not offer the same diagnostic
descriptive power as the primary lesion.
i. Atrophy: Thinning and wrinkling of the skin resembling cigarette paper
ii. Crusts (Scab): Dried serum, blood, or pus.
iii. Erosion: Loss of part or all of the epidermisthat will heal without scarring.
iv. Ulcer: Loss of epidermis and at least part of dermis that results in scarring.
v. Excoriation: Linear or hollowed-out crusted area caused by scratching, rubbing, or picking.
vi. Lichenification: Thickening of the skin with accentuation of the skin lines.
vii. Scales: Accumulation of retained or hyperproliferative layers of the stratum corneum
viii. Scar: Permanent fibrotic changes seen with healing after destruction of the dermis.
II. Shape of Lesion
a. Annular: Ring shaped, round or circular
b. Nummular: Coin shaped
c. Oval: Oblong
d. Polycyclic: Rings within rings
e. Polygonal: Geometric shaped
f. Serpiginous: Snake-like
III. Arrangement of the lesions in relationship to each other
a. Grouped Arrangement
i. Annular: Circular, round or like a ring
ii. Arciform: Shaped in curves
iii. Herpetiform: Like or in the shape of a herpetic lesion
iv. Linear: Geometrically forming a straight line
v. Reticulated: Net-like
vi. Serpiginous: Shape or spread of lesion in the fashion of a snake
b. Disseminated Arrangement: Diffuse involvement without clearly defined margins or scattered discre
telesion.
IV. Distribution of Lesions
a. Isolated single lesions
b. Localized to specific body region
c. Universal over the entire body surface
d. Patterned
i. Sun-exposed areas
ii. Symmetrical
iii. Follicular based
iv. Flexure or extensor surfaces
Assessment:
Synthesize, integrate, and form a hypothesis by combining the history and the primary and secondary
characteristics of the lesion(s) together with their shape, arrangement and distribution.