LESI KULIT

Yunita Hapsari

Bagian IK Kulit & Kelamin

FK UNRAM/RSU Propinsi NTB
2014
Learning Objective

 Mampu mengenal tipe lesi kulit

 Mampu mendefinisikan setiap lesi kulit
 Mampu mendeskripsikan lesi kulit
 Mampu melakukan pendekatan dalam diagnosis
dermatologi
 Anamnesis
 pemeriksaan fisik kulit & laboratorium
sederhana pada dermatologi
 Lesi kulit

Lesi Lesi Lesi

primer sekunder spesial
Lesi kulit primer
lesi yang pertama kali
Lesi yang termasuk dalam perubahan kulit
yang pertama

 Makula, patch
 Papul, plak, nodul, tumor
 Urtika
 Vesikel
 Bula
 Pustul
Lesi kulit sekunder
• Lesi primer yang berkembang atau modifikasi
lesi primer (regresi, trauma, faktor ekstrakutan)

 Skuama  Skar (atrofi,

 Ekskoriasi & abrasi hipertrofi)
 Fisura  Keloid
 Krusta  Kista
 Erosi  Likenifikasi
 Ulkus
Lesi kulit spesial

 Lesi kulit yang terbentuk akibat

kondisi spesial pada sistem tubuh

• Eritema (Eritema • Ekimosis

multiforme,
eritema • Vibices
nodosum) • Hematoma
• Telangiektasi • Eritroderma
• Purpura (eksfoliatif
• Peteki dermatitis)
RAISED
 PAPULE
 Solid, elevated lesion < 0.5 cm in size in which
a significant portion projects above the plane
of the surrounding skin.
 Papules with scale : papulosquamous
 Sessile, pedunculated, dome-shaped,
flattopped, rough, smooth, filiform,
mammillated, acuminate, umbilicated
 PAPULE

• A superficial, elevated solid lesion up to 0.5 cm in

diameter
• Well or ill-defined
• Dome-shaped, cone-shaped, flat-topped, vegetation
• May become confluent and form plaque
 PAPULE
• COLOUR

WHITE (M. contagiosum)

VIOLACEOUS (L. Planus)
YELLOWISH (Xanthomatosis)
FLESH COLOURED (A. sebaceum)
BLUISH-BLACK (Malignant Melanoma)
 PLAQUE
 Solid plateau-like elevation
 Relatively large surface area vs with its height
above the normal skin level
 Diameter > 0.5 cm
 Well-defined
 Lichenification is less well-defined, large
plaque where the skin marking are
accentuated
PLAQUE
 Differential diagnosis of plaques
Acanthosis nigricans Lymphoma (cutaneous T cell)
Psoriasis
Candidiasis
Morphea
Cellulitis Sarcoidosis
Myxedema
Deep fungal infections
Seborrheic dermatitis
Dermatomyositis Necrobiosis lipoidica diabeticorum

Diaper dermatitis Sweet's syndrome

Paget's disease
Eczematous dermatitis
Syphilis
Pityriasis rosea
Erythrasma

Tinea infections Lichen sclerosus Tinea versicolor

Granuloma annulare
Lupus erythematosus Vasculitis
Ichthyosis
Lyme disease Xanthelasma
Lichen planus
 NODULE
 Solid, round/ellipsoidal, palpable, diameter > 0.5 cm & depth of
involvement and/or substantive palpability
 Types:
 (1) epidermal
 (2) epidermal–dermal
 (3) dermal
 (4) dermal–subdermal
 (5) subcutaneous
 Additional features :
 warm, hard, soft, fluctuant, movable, fixed, or painful.
 surfaces of nodules : smooth, keratotic, ulcerated, or
fungating
NODULE
 NODULE

• Epidermal (Nodular BCC/ Keratoacanthoma)

• Dermal (Dermatofibroma)

• Subcutaneous (Lipoma/ Eythema Nodosum)

 Tumour

abnormal mass of tissue as a result of abnormal growth or

division of cells. Prior to abnormal growth (known as
neoplasia), cells often undergo an abnormal pattern of growth,
such as metaplasia or dysplasia
 CYST

• Encapsulated cavity or sac lined with a true epithelium that

contains fluid or semi-solid material (cells and cell products
such as keratin).
• Spherical or oval shape results from the tendency of the
contents to spread equally in all directions.
• Hard, doughy, fluctuant
CYST
CYST
 WHEAL
 Swelling of the skin that is characteristically evanescent,
disappearing within hours.
 Hives or urticaria
 Edema produced by the escape of plasma through vessel
walls in the upper portion of the dermis.
 Tiny papules or giant plaques
 Various shapes : round, oval, serpiginous, or annular
 Dermatographism
 Angioedema is a deeper, edematous reaction that occurs
in areas with very loose dermis and subcutaneous tissue
such as the lip, eyelid, or scrotum.
 WHEAL

• A rounded or flat-topped pale red papule or plaque,

evanescent, disappearing within 24-48 hours
• Due to edema of the papillary dermis
• May be round, gyrate, or irregular with pseudopods
 WHEAL

Transient Vascular Reaction in Dermis


Vasodilation / Increased Capillary permeability

Extravasation of fluid from Capillaries

Edema
WHEAL
DERMOGRAPHISM
ANGIOEDEMA
 SCAR
 Proliferation of fibrous tissue (previously normal
collagen) after a wound/ulceration breaches the
reticular dermis.
 Early scars : deeper pink to red color
 Later : hypo- or hyperpigmented
 Epidermis is thinned & imparts a wrinkled appearance
at the surface.
 Absent adnexal structures
 Hypertrophic scars typically take the form of firm
papules, plaques, or nodules.
 Keloid scars are also elevated, exceed, with web-like
extensions, the area of initial wounding.
 Atrophic scars are thin depressed plaques.
SCAR
KELOID
 COMEDO
 Dilated & plugged of hair follicle infundibulum by
keratin and lipids.
 Open comedo : the pilosebaceous unit is open to the
surface of the skin with a visible keratinaceous plug
 Closed comedo : A closed infundibulum in which the
follicular opening is unapparent accumulates whitish
keratin.
 The black color of the comedo is due to the oxidized
sebaceous content of the infundibulum
(“blackhead”).
Comedo
 Horn
 Hyperkeratotic
conical mass of
cornified cells
arising over an
abnormally
differentiating
epidermis.
 A clinical example
is verruca vulgaris
 CALCINOSIS
 Deposits of calcium in the
dermis or subcutaneous tissue
may be appreciated as hard,
whitish nodules or plaques,
with or without visible
alteration of the skin’s surface.
 A clinical example is cutaneous
calcinosis in dermatomyositis
DEPRESSED
 EROSION

 A moist, circumscribed, depressed lesion that results

from loss of a portion or all of the viable epidermal or
mucosal epithelium.
 pinpoint bleeding : defect extending to the most
superficial part of the dermis
 Trauma, detachment of epidermal layers with
maceration, rupture of vesicles or bullae, or epidermal
necrosis.
 Unless they become secondarily infected, erosions do
not scar.
 EROSION

• A focal loss of epidermis, erosions do not penetrate

below the dermoepidermal junction, heal without
scarring
 ULCER
 Defect in which the epidermis & at least the upper
(papillary) dermis.
 Breach of the dermis and destruction of adnexal
structures impede reepithelialization, and the defect
heals with scarring.
 Borders : rolled, undermined, punched out, jagged, or
 angular.
 Base : clean, ragged, or necrotic.
 Discharge : purulent, granular, or malodorous.
 Surrounding skin : red, purple, pigmented, reticulated,
indurated, sclerotic, or infarcted.
 ULCER

• A focal loss the skin that extend to the dermis or

deeper, heal with scarring
EXCORIATION

An erosion caused by scratching, often linear

FISSURE

A linear loss of epidermis and dermis with sharply

defined,nearly vertical walls
 ATROPHY
 Diminution in the size of a cell, tissue, organ, or part of
the body.
 Glossy, almost transparent, paper thin and wrinkled,
and may not retain normal skin lines.
 Atrophy of the papillary or reticular dermal connective
tissue manifests as a depression of the skin.
ATROPHIC

• A diminution of some or all layers of the skin

 POIKILODERMA
 Combination of atrophy, telangiectasia, and varied
pigmentary changes (hyper- and hypo-) over an area of
skin.
 This combination of features may give rise to a dappled
appearance to the skin.
 A clinical example is chronic radiodermatitis
 Poikiloderma

skin condition that consists of areas

of hypopigmentation, hyperpigmentation, telangiectasias and
atrophy
 SINUS
 Tract connecting
deep suppurative
cavities to each
other or to the
surface of the skin.
 A clinical example is
hidradenitis
suppurativa
 STRIAE
 Linear depressions of
the skin that usually
measure several
centimeters in length
and result from
changes to the
reticular collagen that
occur with rapid
stretching of the skin.
 A clinical example is
striae distensae
BURROW

A narrow, elevated, turtous channel produced by

parasite
 BURROW
 Wavy, threadlike
tunnel through
the outer portion
of the epidermis
excavated by a
parasite.
 A clinical example
is scabetic burrow
 SCLEROSIS
 A circumscribed or diffuse
hardening or induration of
the skin that results from
dermal fibrosis. It is
detected more easily by
palpation, on which the
skin may feel board-like,
immobile, and difficult to
pick up.
 A clinical example is
morphea
FLAT & MACULAR LESIONS
 MACULE & PATCH

• A circumscribed, area of change in skin color

without elevation or depression (not palpable)
• Well or ill-defined
• White, brown, blue, red, grey
 Differential diagnosis of Hyperpigmented
macules macules
Nevi
Erythematous macules Photodistributed
Fixed drug eruption
Drug eruption macules
Postinflammatory
Viral exanthem Drugs
Ephelis (freckle)
Secondary syphilis Dermatomyositis
Lentigo
Rheumatic fever Lupus erythematosus
Schamberg's purpura
Hypopigmented macules Porphyria cutanea tarda Nevus
Postinflammatory Polymorphous light Mongolian spot
eruption
Tinea versicolor Purpura
Vitiligo Stasis dermatitis
Halo nevus Melasma
Sarcoidosis Melanoma
Tuberous sclerosis Ochronosis
Cutaneous T cell lymphoma Mastocytosis
Leprosy Café au lait spot
Erythroderma
SURFACE CHANGE
 SCALES

• Flakes of stratum corneum

• Large (like membrane), tiny (like dust), pityriasiform,
adherent, loose
 Scales

Scales: psoriasiform (psoriasis), pitiriasiform/powdery

(pitiriasis versicolor),
Collarette (breakdown vesicles)
 CRUST

• A collection of dried serum, blood or purulent exudate

on the skin surface
• Yellow (serum), green or yellow-green (purulent
exudate), brown, dark red or black (blood)
LICHENIFICATION

An area of thickened skin with accentuated skin

Keratoderma

 Yellowish thickening of skin on the

soles (ex. Inherited keratoderma)
FLUID-FILLED LESIONS
 VESICLE & BULLAE

• A circumscribed elevated, superficial cavity

containing fluid.
• Vesicles are dome-shaped, umbilicated, flaccid
• Containing serum (yellowish), blood (red to black),
 VESICLE/ BULLA
• Levels

Stratum Corneum - Impetigo Contagiosum

- Pemphigus Foliaceus

Stratum Spongiosum - Contact Dermatitis

- Pompholyx

Stratum basale - Pemphigus Vulgaris

Dermo-Epidermal Junction - Bullos Pemphigid

- Dermatitis Herpetiformis
 Intraepidermal vesicle
• Cytolysis
– Epidermolysis bullosa : rupture of basal cells due to
trauma
• Spongiosis
– Loss of cohesion between epidermal cells due to the
influx of tissue fluid into the epidermis and leucocytes
• Acantholysis
– Disappearance of desmosomes due to autoantibodies.
The cells are intact but no longer attached
– Suprabasal, mid epidermal, subcorneal
– Primary : pemphigus group & staphylococcal exotoxin
VESICLE/ BULLA
 PUSTULE

• A circumscribed, superficial cavity of the skin that

contain purulen exudate
• May be white, yellow, greenish-yellow, hemorrhagic
• Usually dome-shaped, conical (follicular pustule &
containing hair in the center)
PUSTULE
PUSTULE
PUSTULE
Abcess

• Localized accumulation of purulent materials

so deep in the dermis or subcutaneous tissue
that the pus is usually not visible from the
surface of the skin
PURPURA/VASCULAR
LESIONS
PURPURA

A circumscribed deposit of blood > 0.5cm

TELANGIECTASIA

small dilated blood vessels near the surface of the

skin or mucous membrane
Approach to Dermatologic Diagnosis
Deskripsi Lesi Kulit

Type Color Number

Shape Consistency Margin

Arrangement Distribution
 Color : uniform or variegated
 Number : single or multiple
 Margination : well or ill defined
 Palpation
1. Consistency : soft, firm, hard, fluctuant,
boardlike
2. Deviation in temperature
3. Mobility
 Shape or configuration
 round/nummular, polycyclic, annular (ring
shaped), iris/targetoid, arcuate, serpiginous,
linier, reticuler, whorled
 Arrangement
1. grouped : herpetiform
2. disseminated : scaterred discrete lesion
 Distribution
 1. dermatomal/zosteriform
 2. blashckoid
 3. lymphangitic
 4. sun exposed/sun protected
 5. acral, truncal
 6. flexor, extensor
 7. intertriginous
 8. localized, generalized
 9. Bilateral symmetric
 10. universal
PEMERIKSAAN
LABORATORIUM
Pemeriksaan Laboratorium
 Jamur
 Bakteri
 Parasit
 Bullous disease & Viral
Fungal
T. rubrum Candida albicans
Fungal

PVC Spagheti meat balls

Bacterial

Positive Rods Negative rods

Bacterial

Positive cocci Negative cocci

Bacterial Vaginosis

Clue Cells
Neiserria gonorrhoea
Parasite

Clinical presentation Sarcoptes

Pediculosis
Multinucleated Giant Cells

Acantholytic Cell
Acetowhite
Condyloma