NURSING STANDARD VOLUME 13 NUMBER 46 1999

Q U I C K R E F E R E N C E G U I D E 7

A monthly series of quick reference guides to tear out

and keep. Whether you are a student nurse, need to
update your skills or are teaching others the guides will
be a useful aid to your practice

Dermatological conditions
Identifying and classifying common skin lesions are important skills in
nursing assessment. This guide should allow you to describe them
using appropriate nursing/medical terminology.

1. NURSING ASSESSMENT and influence management, and identify

aggravating or improving factors)
Much of the language in dermatology is Latin in ■ Current drug therapy (both for skin disorder and
origin creating problems with comprehension and other conditions).
communication, and for nursing assessment. Also,
nurses must rely on visual and tactile assessment to
guide diagnosis, management and nursing care. 2. PRIMARY AND SECONDARY
Both factors mean that a detailed dermatological
history must be taken systematically. Six main
LESIONS
headings should be used: ‘Primary lesion’ applies to the original lesion
■ General health to identify exacerbating presenting, which can change over time into a
conditions or problems (eg. asthma or hayfever, secondary lesion (eg. a blister developing into an
which are strongly associated with atopic erosion and becoming encrusted in herpes
eczema) infections).
■ History of present skin condition including time
of onset, site of onset and details of spread, Primary and secondary lesions can be described in
distribution and appearance (eg. size, shape, terms of five features:
colour, dry or wet) of rash or lesions associated ■ Size
symptoms (eg. pruritus) ■ Shape (eg. nummular [coin-shaped], annular
■ Past history of skin disorders/medical conditions [ring-like], oval, discoid [disc-like])
■ Family history of skin conditions ■ Contours
■ Social and occupational history (information ■ Colour
about hobbies, work and travel can aid diagnosis ■ Characteristics.

Primary lesions and related terminology

Epidermis
Macule (<0.5cm) Large macule patch
(>0.5cm)

Dermis

Papule Plaque

Vesicle Bulla

Erosion
Fissure Ulcer
NURSING STANDARD VOLUME 13 NUMBER 46 1999

Q U I C K R E F E R E N C E G U I D E 7

Dermatological conditions
Examples of primary lesions and their features Macule Comedones of acne
include:
■ Macule – completely flat – change in skin
colour/texture are distinguishing features
■ Papule – solid, raised lesion, < 0.5cm in diameter
(eg. comedones, or blackheads, of acne)
– erythematous, flesh coloured, pigmented or
showing loss of pigmentation
■ Plaque – superficial, solid raised lesion, > 2cm in
diameter (eg. large red, raised, scaly lesions in
plaque psoriasis)
■ Pustule – pus-filled, yellow- or white-topped
lesion
– raised and erythematous
■ Vesicles – fluid-filled blisters, < 0.5cm in diameter
■ Bullae – fluid-filled blisters, > 0.5cm in diameter
Discoid eczema Pustules
■ Nodule – small mass or tumour, < 0.5cm in
diameter
– can be benign or malignant, therefore,
should be described as a nodule until diagnosis of
malignant tumour made
– major signs of malignant melanoma are
change of shape, size and colour, and other
signs are itch, erythema, crusting and bleeding
– most benign pigmented lesions are of
uniform size, shape and colour
■ Weal – oedematous reaction in dermis (eg.
urticaria, hives or nettle rash reaction)
– often erythematous (weal and flare reaction)
– urticarial weals can be intensely itchy Vesicles on foot Acne nodule/cyst
■ Angioedema – diffuse, widespread reaction with
oedema extending to subcutaneous tissue
– associated with urticarial-type reactions
■ Haemorrhagic lesions – described according to
shape and size of lesion
– petechiae are tiny, usually flat, pinhead-size
lesions (macules)
– purpura describes slightly larger haemorrhagic
lesions (macules or papules)
– ecchymosis is more widespread bleeding
– haematomas result from gross bleeding into
skin, with pain and swelling
– telangiectasis are tiny, spider-like
capillaries visible on the skin. Herpes zoster Sarcoma
Primary and secondary lesions can be present
simultaneously as in herpes zoster. Some of the
more common secondary lesions and their features,
include:
■ Erosion – total or partial loss of epidermis
– does not leave scarring on healing
■ Ulcer – complete loss of epidermis and partial
loss of dermis
– scarring can occur on healing
■ Excoriation – caused by scratching
– can result in erosions or ulcers
■ Fissures – slits in skin which can extend into
dermis
■ Scale – flake of skin on the primary lesion
– scaling is a diagnostic factor in psoriasis
■ Atrophy – follows loss or thinning of epidermis,
dermis or subcutaneous tissues
– skin appears white, papery and translucent with
loss of surface markings
Further reading
■ Striae – linear lesions Ashton R, Leppard B (1993) Differential Diagnosis in Dermatology.
– can appear atrophic, deep purple or pink Second edition. Oxford, Radcliffe Medical Press.
– result of changes in connective tissue DeWitt S (1990) Nursing assessment of the skin and dermatologic
– often from misuse of topical steroid therapy lesions. Nursing Clinics of North America. 25, 1, 235-245.
■ Pigmentation – hypo- or hyperpigmentation can Hunter JAA et al (1989) Clinical Dermatology. Oxford, Blackwell
occur after healing of primary lesion. Scientific.