Understanding and Describing Skin Lesions and Rashes

Understanding and Describing Skin Lesions and Rashes

May 23, 2019

Dyshidrotic Dermatitis On Hands

With the very high number of skin health and skin disease conditions, it is particularly useful to be able to understand and systematically describe the different features and observable patterns of the underlying skin lesion or rash. Documenting the appearance of a lesion or rash can be challenging given their pattern of distribution and the sublety of their surface features. As such, it is necessary to gain familiarity with the typical types of lesions seen and rash patterns; these are introduced below.

What are Rashes

A rash is a change in the colour or texture of the skin and as such reflects the nature and pattern of a collection of individual lesions.

Owing to the wide-ranging nature of lesions, it is helpful to understand their different types. A useful distinction is also made of primary and secondary lesions. Primary lesions are caused directly by the skin disease process; this includes macules, papules, nodules, plaques, wheals, vesicles, bulla, pustules and cysts. Secondary lesions refer to the consequences of the skin disease process; these include scale, crust, fissures, lichenification, erosion, ulcers, excoriation, scar and atrophy.

Guidance on describing skin lesions.

1. Look first to identify:

a. Sites involved: specify body area
b. Number of lesions: single, multiple
c. Distribution: includes symmetrical or not, localisedor generalised
d. Arrangement: includes discrete, coalescing,disseminated, linear, annular

2. Feel the lesions by:

a. Surface palpation: with finger tips – smooth,uneven, rough
b. Deep palpation: by squeezing between finger and thumb – soft, firm, hard

3. Describe a typical lesion using the following headings:

a. Type of lesion
b. Surface features
c. Colour, including erythematous or non-erythematous
d. Border of rash/lesion: well/poorly defined or an accentuated edge
e. Size and shape of individual lesion: includes round, irregular, serpiginous

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