Integumentary Disorders
o Eccrine Glands
Originate in the dermis
Controlled by the hypothalamus to regulate body
temperature through water secretion and evaporation
Diagnostic testing
o Wood’s Lamp
Exam epidermal pigmentary disorder and cutaneous
infections
Can see fungal diseases, bacterial, and pigmentary disorders
o Surface Microscopy
ABCDE
o Scraping
For nonspecific funal identification
Taken from skin or nails from active border, using #15
scalpel, placing on slide, and applying 20% KOH
Identification of hyphae and spores
Herpes
Mites
o Cultures
o Patch testing
Allergic contact dermatitis
o Biopsy
Shave skin
Punch biopsy
Excisional biopsy
Primary Lesions
o Macule: < 1 cm in diameter, flat, non-palpable, circumscribed,
discolored
o Patch: > 1 cm in diameter, flat, non-palpable, irregular shape,
discolored
o Papule: < 1 cm in diameter, raised, palpable, firm
o Nodule: > 1 cm in diameter, raised, solid
o Plaque: > 1 cm in diameter, raised, superficial, flat-topped, rough
o Tumor: large nodule
o Vesicle: < 1 cm in diameter, superficially raised, filled with serous
fluid
o Bulla: > 1 cm vesicle
o Pustule: raised, superficial, filled with cloudy, purulent fluid
, o Wheal: raised, irregular area of edema, solid, transient, variable
size
o Cyst: raised, circumscribed, encapsulated with a wall and lumen,
filled with liquid or semisolid
Secondary Lesion
o Scale: irregular formation of exfoliated, keratinized cells, irregular
shape and size
o Crust: dried serum, blood, or exudate, slightly elevated
o Lichenification: thickened epidermis with accentuated skin lines
caused by rubbing
o Scar: thin or thick fibrous tissue, following dermal injury
o Fissure: linear break in skin through epidermis and dermis
o Excoriation: hollowed-out area of all or portion of epidermis with
depressed appearance
o Erosion: localized loss of epidermis, heals without scarring
o Ulcer: loss of epidermis and dermis, variations in size
o Atrophy: depression resulting from loss of epidermis and/or dermis
Special lesion
o Burrow: narrow, elevated channel produced by a parasite
o Telangiectasia: superficial dilated blood vessel
o Petechiae: < 1 cm circumscribed deposit of blood
o Purpura: > 1 cm circumscribed deposit of blood
Benign skin lesion
o Freckles: asymptomatic, tan to brown macules ranging from 1 to 5
mm in diameter. The color is usually consistent on an individual.
o Nevi: The lesions are usually less than 0.6 cm in diameter and are
evenly pigmented. The margins are well demarcated, and the
shape is round. The patient reports that the nevus has existed for a
long period without change. The distribution is random
o Seborrheic Keratosis: usually asymptomatic. If the keratoses are
subjected to frequent trauma, by location and exposure, patients
may complain of itching, tenderness, or irritation at their site. SKs
appear as flat, light tan lesions that evolve to become raised and
have keratotic surfaces, often with increased pigmentation. The
mature lesion has a “stuck-on” appearance, and the keratotic cover
can be scraped off.
o Warts: raised lesions with no significant pigmentation, often paler
than surrounding skin. The surface is irregular and may be rough
or smooth. If the surface is scraped or pared, minute bleeding
, points appear. The most common sites include the hands and feet,
face, and genitalia. Lesions often occur in clusters. What patients
refer to as the seeds or roots of the wart are the vessels associated
with the wart.
o Actinic Keratoses: Typical sites include the face, ears, scalp,
arms, and legs, although any area of chronic sun exposure is at
risk. These scaly lesions may have margins that are irregular. The
lesions vary in color and may be hypo- or hyperpigmented. If
excess itching or pain occurs at the lesion, a biopsy should be
performed to rule out squamous cell cancer.
o Corns and Calluses: area of skin thickening at a site exposed to
repetitive force and wear and tear. Calluses represent friction over
a large patch of skin; a corn is a site of focal friction.
Unlike warts, these lesions will not reveal pinpoint black dots
and bleeding if pared or scraped.
o Epidermal Cyst: cheesy discharge with foul odor. The lesion is
sometimes tender or painful and is nodular, round, firm, and
subcutaneous; thus, it is flesh-colored but may be erythematous if
it is inflamed. The most common sites include the face, scalp, neck,
upper trunk, and extremities. However, epidermoid cysts can
involve the oral mucosa, breasts, and perineum.
Encourage the patient not to squeeze the lesions if they are
not removed.
o Molluscum Contagiosum: Molluscum contagiosum is a skin
lesion caused by the DNA poxvirus. Although they are usually
asymptomatic, patients occasionally present with the complaint of
burning or pruritus at the site of the lesion. The lesion has a
smooth surface with a central indentation. Although the lesion is
skin-colored or pink, the area immediately surrounding the lesion
may be red.
o Milia: occur in infants and are like miniature epidermal inclusion
cyst. 1- to 2-mm pearl-colored lesions scattered over a newborn
infant’s face. They may involve the oral mucosa over the palate
(Epstein’s pearls).
o Xanthomas/Xanthelasma: reflective of abnormal lipid
metabolism in the skin. They are caused by accumulation of lipid-
laden macrophages in the skin.
The lesion is asymptomatic. The color ranges from flesh to
yellow. The distribution includes the area surrounding the
eyes and eyelids (xanthelasma) or the extensor areas of the
, knees and elbows (xanthomas). Regardless of the lipid level,
administration of a statin may eliminate these lesions over
time.
o Acanthosis Nigricans: may be a normal variant or associated
with insulin resistance. It is most prevalent in individuals who are
obese and of a higher Fitzpatrick skin color
There is a history of progressively growing hyperpigmented
areas that may be associated with pruritus. The lesions have
a velvety surface and are often located in the skin of the
axilla, neck, and groin.
o Café Au Lait: caused by increased melanin content and are
associated with neurofibromatosis. They vary in appearance
and size, with color ranging from tan to brown
Signs and Symptoms:There frequently is a history of a variety of
developmental and congenital conditions. The lesions are
asymptomatic. They range in size from millimeters to over 10 cm and
are usually flat macules or patches. Although the color varies, most
are coffee colored. Physical findings include signs of accompanying
conditions, such as neurofibromatosis or Fanconi anemia. Six or
more café au lait patches are a concern, and a workup is warranted.
o Congenital Nevus: usually present at birth or appear in the first
few years of life. They vary in size and have a low likelihood of
becoming malignant unless they are large congenital nevi (greater
than 20 cm). These patients should be referred to a dermatology
specialist. Small congenital nevi should be monitored; routine
excision is not recommended.
lesions are typically round or oval and have an irregular
surface. Giant pigmented lesions may have coarse hairs in
approximately 50% of cases. There is usually a single lesion,
and the color ranges from light to dark brown. The coloring
may be speckled. The surface may be verrucous, smooth, or
nodular. Typically, the lesion grows proportionally with the
child. Biopsy if the lesions change
o Angiomas: arise from dilated capillaries. They are the result of
sun damage and genetic predisposition. The patient may describe
onset after age 30, with number and size increasing over time. The
lesions are asymptomatic. The color is typically bright red, though
they may be darker, including purple to black in coloring. They do
not blanch.
o Eccrine Glands
Originate in the dermis
Controlled by the hypothalamus to regulate body
temperature through water secretion and evaporation
Diagnostic testing
o Wood’s Lamp
Exam epidermal pigmentary disorder and cutaneous
infections
Can see fungal diseases, bacterial, and pigmentary disorders
o Surface Microscopy
ABCDE
o Scraping
For nonspecific funal identification
Taken from skin or nails from active border, using #15
scalpel, placing on slide, and applying 20% KOH
Identification of hyphae and spores
Herpes
Mites
o Cultures
o Patch testing
Allergic contact dermatitis
o Biopsy
Shave skin
Punch biopsy
Excisional biopsy
Primary Lesions
o Macule: < 1 cm in diameter, flat, non-palpable, circumscribed,
discolored
o Patch: > 1 cm in diameter, flat, non-palpable, irregular shape,
discolored
o Papule: < 1 cm in diameter, raised, palpable, firm
o Nodule: > 1 cm in diameter, raised, solid
o Plaque: > 1 cm in diameter, raised, superficial, flat-topped, rough
o Tumor: large nodule
o Vesicle: < 1 cm in diameter, superficially raised, filled with serous
fluid
o Bulla: > 1 cm vesicle
o Pustule: raised, superficial, filled with cloudy, purulent fluid
, o Wheal: raised, irregular area of edema, solid, transient, variable
size
o Cyst: raised, circumscribed, encapsulated with a wall and lumen,
filled with liquid or semisolid
Secondary Lesion
o Scale: irregular formation of exfoliated, keratinized cells, irregular
shape and size
o Crust: dried serum, blood, or exudate, slightly elevated
o Lichenification: thickened epidermis with accentuated skin lines
caused by rubbing
o Scar: thin or thick fibrous tissue, following dermal injury
o Fissure: linear break in skin through epidermis and dermis
o Excoriation: hollowed-out area of all or portion of epidermis with
depressed appearance
o Erosion: localized loss of epidermis, heals without scarring
o Ulcer: loss of epidermis and dermis, variations in size
o Atrophy: depression resulting from loss of epidermis and/or dermis
Special lesion
o Burrow: narrow, elevated channel produced by a parasite
o Telangiectasia: superficial dilated blood vessel
o Petechiae: < 1 cm circumscribed deposit of blood
o Purpura: > 1 cm circumscribed deposit of blood
Benign skin lesion
o Freckles: asymptomatic, tan to brown macules ranging from 1 to 5
mm in diameter. The color is usually consistent on an individual.
o Nevi: The lesions are usually less than 0.6 cm in diameter and are
evenly pigmented. The margins are well demarcated, and the
shape is round. The patient reports that the nevus has existed for a
long period without change. The distribution is random
o Seborrheic Keratosis: usually asymptomatic. If the keratoses are
subjected to frequent trauma, by location and exposure, patients
may complain of itching, tenderness, or irritation at their site. SKs
appear as flat, light tan lesions that evolve to become raised and
have keratotic surfaces, often with increased pigmentation. The
mature lesion has a “stuck-on” appearance, and the keratotic cover
can be scraped off.
o Warts: raised lesions with no significant pigmentation, often paler
than surrounding skin. The surface is irregular and may be rough
or smooth. If the surface is scraped or pared, minute bleeding
, points appear. The most common sites include the hands and feet,
face, and genitalia. Lesions often occur in clusters. What patients
refer to as the seeds or roots of the wart are the vessels associated
with the wart.
o Actinic Keratoses: Typical sites include the face, ears, scalp,
arms, and legs, although any area of chronic sun exposure is at
risk. These scaly lesions may have margins that are irregular. The
lesions vary in color and may be hypo- or hyperpigmented. If
excess itching or pain occurs at the lesion, a biopsy should be
performed to rule out squamous cell cancer.
o Corns and Calluses: area of skin thickening at a site exposed to
repetitive force and wear and tear. Calluses represent friction over
a large patch of skin; a corn is a site of focal friction.
Unlike warts, these lesions will not reveal pinpoint black dots
and bleeding if pared or scraped.
o Epidermal Cyst: cheesy discharge with foul odor. The lesion is
sometimes tender or painful and is nodular, round, firm, and
subcutaneous; thus, it is flesh-colored but may be erythematous if
it is inflamed. The most common sites include the face, scalp, neck,
upper trunk, and extremities. However, epidermoid cysts can
involve the oral mucosa, breasts, and perineum.
Encourage the patient not to squeeze the lesions if they are
not removed.
o Molluscum Contagiosum: Molluscum contagiosum is a skin
lesion caused by the DNA poxvirus. Although they are usually
asymptomatic, patients occasionally present with the complaint of
burning or pruritus at the site of the lesion. The lesion has a
smooth surface with a central indentation. Although the lesion is
skin-colored or pink, the area immediately surrounding the lesion
may be red.
o Milia: occur in infants and are like miniature epidermal inclusion
cyst. 1- to 2-mm pearl-colored lesions scattered over a newborn
infant’s face. They may involve the oral mucosa over the palate
(Epstein’s pearls).
o Xanthomas/Xanthelasma: reflective of abnormal lipid
metabolism in the skin. They are caused by accumulation of lipid-
laden macrophages in the skin.
The lesion is asymptomatic. The color ranges from flesh to
yellow. The distribution includes the area surrounding the
eyes and eyelids (xanthelasma) or the extensor areas of the
, knees and elbows (xanthomas). Regardless of the lipid level,
administration of a statin may eliminate these lesions over
time.
o Acanthosis Nigricans: may be a normal variant or associated
with insulin resistance. It is most prevalent in individuals who are
obese and of a higher Fitzpatrick skin color
There is a history of progressively growing hyperpigmented
areas that may be associated with pruritus. The lesions have
a velvety surface and are often located in the skin of the
axilla, neck, and groin.
o Café Au Lait: caused by increased melanin content and are
associated with neurofibromatosis. They vary in appearance
and size, with color ranging from tan to brown
Signs and Symptoms:There frequently is a history of a variety of
developmental and congenital conditions. The lesions are
asymptomatic. They range in size from millimeters to over 10 cm and
are usually flat macules or patches. Although the color varies, most
are coffee colored. Physical findings include signs of accompanying
conditions, such as neurofibromatosis or Fanconi anemia. Six or
more café au lait patches are a concern, and a workup is warranted.
o Congenital Nevus: usually present at birth or appear in the first
few years of life. They vary in size and have a low likelihood of
becoming malignant unless they are large congenital nevi (greater
than 20 cm). These patients should be referred to a dermatology
specialist. Small congenital nevi should be monitored; routine
excision is not recommended.
lesions are typically round or oval and have an irregular
surface. Giant pigmented lesions may have coarse hairs in
approximately 50% of cases. There is usually a single lesion,
and the color ranges from light to dark brown. The coloring
may be speckled. The surface may be verrucous, smooth, or
nodular. Typically, the lesion grows proportionally with the
child. Biopsy if the lesions change
o Angiomas: arise from dilated capillaries. They are the result of
sun damage and genetic predisposition. The patient may describe
onset after age 30, with number and size increasing over time. The
lesions are asymptomatic. The color is typically bright red, though
they may be darker, including purple to black in coloring. They do
not blanch.
