Necrotizing fasciitis

Primary and Secondary Skin Lesions

Bryn A. Boslett, MD
Division of Infectious Diseases
University of California, San Francisco

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 Learning Objectives
Describe the components of the integumentary system
Define the following primary skin morphologies: macule,
patch, plaque, papule, vesicle, bulla, pustule and wheal
Define the following secondary skin morphologies: scale,
crust, lichenification, erosion, ulcer, fissure

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Integumentary System
Epidermis
Keratinocytes, melanocytes,
Langerhans cells, Merkel cells
Dermis
Connective tissue, vessels, hair
follicles, glands, nerve endings
Hypodermis
Vascular supply, adipose

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 Primary skin lesions
Skin lesion that originates from previously normal skin
Directly associated with a disease process
Rarely specific to a single disease

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 Primary skin lesions
Macule: a change in skin color
Patch: a macule >1 cm at its widest aspect
Papule: solid raised lesion that has distinct
borders and is less than 1 cm in diameter
Plaque: solid raised flat-topped lesion >1
cm in diameter
Nodule: solid raised non-flat-topped lesion
>1 cm in diameter

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 Primary skin lesions
Wheal: evanescent papule or plaque, often
with erythematous borders and pale center
Vesicle: raised lesion up to 1cm in diameter,
filled with clear fluid
Bulla: raised lesion > 1 cm in diameter, filled
with clear fluid
Pustule: raised lesion filled with pus

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Macule or Patch Nodule Bullae

Papule Vesicles Pustules

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 Secondary skin lesions
Secondary lesions typically result from evolution of primary
lesions
May be initiated by external forces (scratching, infection) or
the healing process

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 Secondary skin lesions
Scale: visible fragments of the stratum
corneum as it is shed from the skin
Crust: liquid debris (serum or pus) that has
dried on the surface of the skin
Lichenification: thickening of epidermis,
with resulting accentuation of skin lines,
often as a result of scratching

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 Secondary skin lesions
Fissure: sharply-defined, linear or wedge-
shaped tears in the epidermis
Erosion: Loss of superficial layers of upper
epidermis by friction or pressure
Ulcer: epidermis and some dermis have
been lost

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Credits: Primary and Secondary Skin Lesions
Slide 4: https://en.wikipedia.org/wiki/File:Skin_layers.png
Slide 6: http://commons.wikimedia.org/wiki/File:Macule_and_Patch.svg
http://commons.wikimedia.org/wiki/File:Papule_and_Plaque.svg
http://commons.wikimedia.org/wiki/File:Nodules.svg
Slide 7: http://commons.wikimedia.org/wiki/File:Hives2010.JPG
Slide 8: http://missinglink.ucsf.edu/lm/dermatologyglossary/primarylesions1a.html
Slide 10: http://missinglink.ucsf.edu/lm/dermatologyglossary/secondarylesions1a.html
Slide 11: http://commons.wikimedia.org/wiki/File:Ulcers,_fissures,_and_erosions.svg
http://missinglink.ucsf.edu/lm/dermatologyglossary/secondarylesions1a.html

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