Skin lesion

From Wikipedia, the free encyclopedia

Most dermatoses present with skin lesions of more or less distinct characteristics.
Macroscopically, these original lesions are known as the "primary lesion", and
identification of such lesions is "...the most important aspect of dermatologic
examination."[1] However, these lesions may continue to develop or be modified by
regression or trauma, producing "secondary lesions".[1] Additionally, on the microscopic
level, these lesions can also be characterized by a distinct set of vocabulary.[2]

Lack of standardization
The lack of standardization of basic dermatologic terminology has been one of the
principal barriers to successful communication among physicians in describing skin
lesions.[3] For example, in different dermatologic texts, the papule is variously described
as no greater than 1cm in size, less than 0.5cm, smaller than a pea, or ranging in size from
a pinhead to that of a split pea.[3] In 1987 the International League of Dermatologic
Societies published a glossary of basic lesions that has been a step towards
standardization of this basic nomenclature[4], but there is still no strict set of definitions
that have been universally agreed upon.[3]

Macroscopic nomenclature
Primary lesions

 Macule
 Patch
 Papule
 Plaque
 Vesicle
 Bulla
 Pustule
 Nodule
 Wheal
 Erosion
 Ulcer
 Telangiectasia
 Burrow

Secondary lesions

 Scale
 Crust
  Lichenification
 Excoriation
 Induration
 Atrophy

Microscopic nomenclature
 Hyperkeratosis
 Parakeratosis
 Hypergranulosis
 Acanthosis
 Papillomatosis
 Dyskeratosis
 Acantholysis
 Spongiosis
 Hydropic swelling
 Exocytosis
 Vacuolization
 Erosion
 Ulceration
 Lentiginous

Evolution
While most dermatoses present with skin lesions of more or less distinct characteristics,
skin lesions do evolve through time.[5]

See also
 Skin disease
 List of skin diseases

References
1. ^ a b James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the
Skin: Clinical Dermatology (10th ed.). Saunders. Page 15. ISBN 0721629210.
2. ^ Kumar, Vinay; Fausto, Nelso; Abbas, Abul (2004) Robbins & Cotran Pathologic Basis
of Disease (7th ed.). Saunders. Page 1230. ISBN 0721601871.
3. ^ a b c Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.).
McGraw-Hill Professional. Page 13. ISBN 0071380760.
4. ^ Winkelmann, R.K. International League of Dermatologic Societies Committee on
Nomenclature. Glossary of basic dermatologic lesions. Acta Derm Venereol Suppl 130,
(Stockh), 1987.
5. ^ Rapini, Ronald P. (2005). Practical dermatopathology. Elsevier Mosby. ISBN 0-323-
01198-5.
Macule
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Acne is a very common skin problem that shows up as outbreaks of bumps

called pimples or zits. These usually appear on the face, neck, back, chest,
and shoulders. Acne can be a source of emotional distress, and severe
cases can lead to permanent scarring.

What causes acne?

Acne begins when the pores in the skin become clogged and can no
longer drain sebum (an oil made by the sebaceous glands that protects
and moisturizes the skin.) The sebum build-up causes the surrounding hair
follicle to swell.

Hair follicles swollen with sebum are called

comedones. If the sebum stays beneath the skin,
the comedones produce white bumps called
whiteheads. If the sebum reaches the surface of
the skin, the comedones produce darkened bumps
called blackheads. This black discoloration is due
to sebum darkening when it is exposed to air. It is
not due to dirt. Both whiteheads and blackheads may stay in the skin for a
long time.

Bacteria called Propionibacterium acnes (P. acnes) that normally live on

the top of the skin can enter the clogged pores and infect the sebum. This
causes the skin to become swollen, red, and painful.

Infected sebaceous glands may burst, releasing sebum and bacteria into
the surrounding skin, creating additional inflammation. In severe cases,
larger nodules and cysts may form in the deeper layers of the skin.

What are the different types of acne?

Acne can be categorized by its severity:
1. Mild acne describes a few scattered comedones (whiteheads or
blackheads) with minimal inflammation (no pustules).
2. Moderate acne describes a denser collection of comedones as well
as red, inflamed, pus-filled lesions (pustules).
3. Severe acne, also called nodular or cystic acne, describes
widespread and deep lesions that are painful, inflamed, and red.
This form of acne is likely to lead to scarring if left untreated.
 Mild acne with comedones on the forehead Moderate acne with
pustules

Who gets acne?

Anyone can get acne, but it appears most often in teenagers, whose
surging levels of androgen (a type of hormone) create larger and more
active sebaceous glands. Acne may continue for people in their twenties
and thirties, and even women over forty. Acne also appears more
commonly in people whose parents had acne.

What factors make acne worse?

Acne lesions can come and go. These factors can cause acne to flare:

 Changing hormone levels in women 2 to 7 days before their

menstrual period, during pregnancy, or when starting or stopping
birth control pills
 Oil from skin products (moisturizers or cosmetics) or grease in the
workplace (for example, a kitchen with fry vats)
 Pressure from sports helmets or equipment, backpacks, tight collars,
or tight uniforms
 Environmental irritants, such as pollution and high humidity
 Squeezing or picking at blemishes
 Hard scrubbing of the skin

What are the treatment options for acne?

Almost all cases of acne can be effectively treated. Treatment goals are to
heal existing lesions, stop new lesions from forming, and prevent scarring.

Acne treatments aim to control one or more of the underlying causes of

acne. For instance, topical retinoids, such as Differin or Retin A Micro, may
help unclog sebaceous glands and keep pores open. Antibiotics may be
used to fight the P. acnes bacteria. Accutane or hormonal agents, such as
birth control pills, may be used to reduce sebum (oil) production.
 Before Treatment After Treatment

Topical medications (applied to the skin)

Over the counter

 Benzoyl peroxide—This is found in many products including

Clearasil and Proactiv. It is a mild antibiotic that kills the P. acnes
bacteria. It is available in different concentrations. Higher
concentrations are more likely to irritate the skin. It does not unclog
blocked pores so is not as helpful for reducing whiteheads and
blackheads.
 Sulfur and salicylic acid—These have some mild ability to break
down whiteheads and blackheads. This is found in many non-
prescription products including Sensiclear

Prescription

 Topical retinoids (Differin, Epiduo, Retin A Micro, Tazorac, tretinoin,

Ziana)—These are among the most effective and commonly used
acne medications. Topical retinoids are unique in their ability to
unclog swollen pores. They may be used alone for mild acne or
combined with other medications for moderate-to-severe acne. They
may also be recommended for long-term use, even after the acne is
under control, to keep the skin clear.
  Topical antibiotics—Antibiotics applied to the skin, such as
clindamycin (Clindagel) and erythromycin, kill the P. acnes bacteria
that leads to inflammation.

Oral medications (taken by mouth)

 Oral antibiotics—These medications, which include tetracycline,
doxycycline (Adoxa, Doryx), and minocycline (Dynacin, Solodyn),
act systemically and can reach bacteria in the deep layers of the
dermis. They are also used for their anti-inflammatory effects.
 Oral contraceptives (Ortho Tri-Cyclen, Yaz)—For women who
experience hormonally triggered acne, birth control pills may be
prescribed to reduce sebum production.
 Anti-androgen drugs—Some drugs used for other medical
conditions are known to reduce androgen levels, such as
spironolactone (Aldactone). These may be used in some cases of
acne.
 Isotretinoin (Accutane, Sotret)—Isotretinoin remains the most
effective treatment for severe acne or acne that does not respond to
other treatments. Isotretinoin treats all causes of acne: excess
sebum, clogged pores, bacterial overgrowth, and inflammation. Most
patients take the medicine for 15-to-20-week periods that may be
repeated if necessary. Treatment requires monthly office visits,
monthly lab tests, and strict contraception. It is critical that women of
child-bearing age do not get pregnant while taking isotretinoin
because of the serious risk of birth defects. The iPledge program
was developed to reduce the likelihood of birth defects and other
side effects.

Many of these medications have side effects, such as burning, redness,

and irritation. With some medicines, such as topical retinoids, these side
effects usually decrease or go away after the medicine is used for a period
of time. If side effects are severe or don't go away, tell your doctor.

Procedures
 For persistent lesions that are inflamed or unresponsive to medications,
some doctors recommend additional methods, including extraction, light
therapy, or corticosteroid injections.

How will I choose a treatment plan?

Your doctor will recommend a treatment based on these factors:

 Severity of your acne. Mild acne may respond well to a topical

retinoid alone. Moderate acne may respond better to a combination
of topical retinoid with an antibiotic or other medication. Severe acne
with scarring may need treatment with an oral retinoid (Accutane,
Sotret).
 Results of previous treatments. Medications may be added in a
step-wise fashion, only if previous treatments are found to be
ineffective.
 Degree of scarring. More aggressive therapies may be started
earlier if acne scars have already started developing.
 Gender. Some treatments are available only for females, such as
birth control pills.

Whatever your treatment plan, it is important that you give it enough

time to work. This may mean waiting 6 to 8 weeks to see results.
While the older acne lesions are healing, the medication is hard at
work keeping new lesions from forming. Staying on your medication
is the most important step to getting acne under control.

How can I keep my acne under control?

After your acne clears, your doctor may recommend that you continue
therapy with a topical retinoid to keep it under control. It is always a good
idea to maintain good skin care and use skin care products labeled as
“non-comedogenic” (do not promote acne)

What about self care and prevention?

 For ongoing self-care and prevention of acne, follow a few simple
guidelines:

 Clean skin gently—Use a mild skin cleanser twice a day, and pat
skin dry. Harsh cleansers and astringents can actually worsen acne.
 Do not pop, squeeze, or pick at acne lesions, as this can promote
inflammation and infection. Keep hands away from your face and
other acne-prone parts of the skin.
 Limit sun exposure—Tanning only masks acne at best. At worst,
sun exposure can lead to skin damage, especially if you are using
an acne treatment that makes your skin more sensitive to sunlight
and UV rays (this includes tanning booths).
 Choose cosmetics with care—As mentioned above, choose non-
greasy skin products, and look for words like “non-comedogenic,”
“oil-free,” and “water-based." Some facial products contain active
acne-fighting ingredients, such as benzoyl peroxide or salicylic acid,
to help keep mild acne at bay.
 Be patient with your treatment—Find out how much time it should
take for your acne treatment to work (generally 6-8 weeks) and then
stick with it. Stopping treatment early may prevent you from seeing
good results or even cause a relapse of symptoms. Your skin may
look worse before it begins to improve. You may need to try more
than one type of treatment.

Where can I learn more?

For more information, visit the American Academy of Dermatology.

Images courtesy of DermAtlas, © 2001-08

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© 2008 Vivacare.
Last updated November 25th, 2008.
This information is for general educational uses only. It may not apply to
you and your specific medical needs. This information should not be used
in place of a visit, call, consultation with or the advice of your physician or
health care professional. Communicate promptly with your physician or
other health care professional with any health-related questions or
concerns.

Be sure to follow specific instructions given to you by your physician or

health care professional.

Additional Resources
Overview
Acne Handout
Medications: Topical
Retinoids: Topical
Ziana (clindamycin and tretinoin)
More Information
ACNE