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Le Lesioni Elementari

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Le Lesioni Elementari Derm atologia pediatrica: le lesioni e le m e n ta ri Dott. Angelo Milazzo Pediatra di Fam iglia Responsabile della Rete di Derm atologia Pediatrica della Regione Sicilia Società Europea di Derm atologia Pediatrica Docente di Pediatria di Fam iglia all’Università di Catania Primary lesions • There are no universally agreed upon definitions of term s or, in particular, dim ensions of prim ary lesions. • - circum scribed area of skin, up to 1.0 cm , with a changeM acule from norm al skin color, which is neither raised above nor depressed below the surrounding skin. Many use the term for lesions much greater than 1.0 cm . Term does not include . purpura • - a flat, circum scribed, discoloration of skin or mucous mPatch em brane greater than 1.0 cm in diam eter. • - discrete solid area of skin that is elevated by palpationPapule above the surrounding skin less than 1 cm in diam eter. Variations include accum inate,and keratotic, flat- topped, follicular, um bilicated, pedunculated, necrotitic and o th e rs . • - sim ilar to a papule but greater that 1.0 cm in diamPlaque eter. Often form ed by the confluence or coalescence of papules. Secondary features may include, am ong others, atrophy, lichenification or hyperkeratosis. Vesicles • - a circum scribed fluid-filled lesion less than 1Vesicle .0 cm in diam eter that is usually elevated above the surrounding skin. May be described as solitary, grouped, um bilicated, dyshidrotic, spongiotic, multi- locular or uni-locular. • - a circum scribed fluid-filled lesion greater than 1Bulla .0 cm in diam eter that is usually elevated above the surrounding skin. May attain diam eters of several cm s and are described as tense, or flacid. • - descrete elevated vesicle or bulla of skin, usuallyPustule small, containing purulent exudate composed of inflam m atory leukocytes (pus), with or without cellular debris. May be superficial, deep-seated, follicular, grouped, etc. and may arise secondarily from a vesicle. Nodules – Tumors • - descrete, solid, palpable, round or ovalNodule (elipsoidal) lesion of the skin measuring up to 1.0 cm in diam eter (or long axis). Applies to processes involving any or all levels of the skin, and is a general term for any mass, benign or malignant. • - a term used by som e for a "nodule" greaterTumor than 1.0 cm in diam eter. Applies to processes involving any or all levels of the skin, and is a general term for any mass, benign or malignant. U rtic a ria - an evanescent, round or irregular, • Wheal often flat-topped elevation of skin with a pale red color, arising from edem a in the superficial derm is. May vary from 2-3 mm to 10 or more cm in diam eter, with round or arcuate configurations. Should be distinguished from , a massive angioedema edem a involving the entire derm is and subcutaneous tissues. Secondary lesions • - a hard plaque of dense fibrotic tissue covered by a thin epidermScar is. A mark of injury from any sort of process (physical or pathologic). • - Atrophy usually refers to thinning of the epiderm is leavingAtrophy an easily wrinkled and/or shiny surface. Atrophy may also apply to derm al and/or subcutaneous tissue, with or without changes in the epiderm is. • - loss of skin tissue or substance from the surface downward,Ulcer leaving an uncovered or denuded wound that is slow to heal. • - a superficial denudation of the skin, usually im plying theErosion loss of the epiderm is. - a vertical splitting or separation of the skin. • Fissure • - dried surface fluid, often serous (inspissated serum ) in nature,Crust with or without tissue debris. For purposes of this docum ent this includes the term "scab". Secondary lesions • - a scratch m ark, often with denudation of the skin toExcoriation form a sm all ulcer. Exposure of the corium by mechanical rem oval of the epiderm is. • - a thin flake of epithelium (mostly com posed of corneoctyes)Scale which is separated from the underlying intact skin proper. • - a thickening of the skin surface an increaseLichenification of skin markings, usually seen with chronicand coalescence of papular lesions, especially atopic eczem a. • - a lushly grow ing, proliferating, process, usually withVegetating elevated or exophytic features. • - technically secondary features, but includedLinear / Figurate here solely out of convenience.not These are that skin lesions may assum e, which aid in theirconfigurations diagnostic identification. Figurate includes geom etrical shapes (e.g. annular, arciform , cyclic, etc.). M acular Lesions • Brown • Grey Slate Blue • Black • White • Pink - Red • Yellow • Scale Brown M acular Lesions • · Ephilides • · Neurofibromatosis • · Albright's disease • · Peutz Jeghers syndrome • · Xeroderm pigmentosum • · Acropigmentation • · Seborrheic keratosis • · Neurocutaneous melanosis • · Nieman-Pick disease • · M elasma (Chloasma) • · Kwashiokor • · Photochemical reactions • · Berlock dermatitis • · Ultraviolet light (sun tan) • · Thermal radiation - Erythema ab igne • · Becker's nevus • · Hemochromatosis Brown M acular Lesions • · Trauma • · Post-inflammatory hyperpigmentation • · M alignant melanoma • · Lentigo melanoma • · M astocytosis (urticaria pigmentosa) • · Encephalitis (chronic) • · Cronkhite - Canada syndrome • · Tatoo • · Reticular acropigmentation of Kitamura • · Dermatopathia pigmentosa reticularis • · Fanconi's syndrome • · Riehl's melanosis • · Periorbital melanosis • · Franceschetti - Jadassohn syndrome • · Gaucher's disease • · Dyskeratosis congenita • · Addison's disease Grey Slate Blue M acular Lesions • Oculodermal melanocytosis (Nevus of Ota) • Dermal melanocytosis (M ongolian spot) • Blue melanocytic nevus • Incontinentia pigmenti • Franceschetti - Jadassohn syndrome • Hemochromotosis • Chronic nutritional insufficiency • Fixed drug eruption • Pinta • Erythema dyschromicum perstans • M alignant melanoma • Tatoo • M aculae cerulae • Ochronosis • M etastatic melanoma Black and white M acular • Black M acular Lesions Lesions • M elanocytic nevus • M alignant melanoma • Ecchymosis (blue-black) • White and Hypomelanotic M acular Lesions • Vitiligo • Albinism • Piebaldism • Vogt-Koyanagi-Harada syndrome • Tuberous sclerosis • Waardenburg's syndrome • Hyperthyroidism • Hypoparathyroidism • Addison's disease • Hypopituitarism • Pernicious anemia • Halo nevus (Leukoderma acquisitum centrifugum - Hyde and Sutton) • Nevus depigmentosus • Leprosy - tuberculoid • Pityriasis alba • Chediak-Higashi syndrome • Post-inflammatory depigmentation • Phenylketonuria (pigment dilution) • Alezzandrini's sundrome • Idiopathic guttate hypomelanosis • Syphilitic leukoderma (L2) • Scleroderma / morphea Pink – red - yellow M acular Lesions • Exanthems • Drug eruptions • Telangiectasia • Nevus flammeus (Port wine stain - salmon patch) • Jaundice • Xanthomata (plantar - plantar) • Xanthelasma (sometimes paplable) • Carotenemia • Pseudoxanthoma elasticum • Necrobiosis lipoidica diabeticorum • Amyloidosis (primary) • Fordyce condition • Solar elastosis M acules with Scale • Tinea versicolor • Seborrheic keratosis • Pityriasis alba Papular Lesions • With Scale • Koebner Phenomenon • Facial Papule(s) Papulo-squamous differential • Pityriasis rosea • Psoriasis • Lichen planus • Pityriasis rubra pilaris • Parapsoriasis • Secondary syphilis • Tinea versicolor • Tinea corporis • Seborrheic dermatitis • Drug reaction - lichenoid (e.g. atabrine, gold, isoniazid) Koebner Phenomenon • Lichen planus • Eczema (active) • Psoriasis • Auto-inoculation: Verruca, M olluscum contagiosum, etc.) Flesh Colored Papules • Adenoma sebaceum of Pringle • Basal cell carcinoma • Intraepidermal nevus • Acrochordon • Dermatofibroma • Verruca vulgaris / plana • M olluscum contagiosum • Syringoma • Acne cyst • Hidrocystoma – Apocrine – Eccrine • Epithelioid inclusion cyst ("Sebaceous" cyst) • Epithelioma adenoides cystica / Trichoepithelioma • Neurofibroma • Nevus lipomatous superficialis • Nodular elastoidosis (with cysts and comedones) / (Favre - Racouchot syndrome) • Lichen amyloidosis • Lipoid proteinosis • Trichofolliculoma • M ilia • Colloid milium • M etastatic lesions Nodular Lesions • Nodules on Legs • Nodules around Joints Nodules on the Legs • Erythema nodosum • Subacute nodular migratory panniculitis • Weber-Christian disease (relapsing febrile nodular panniculitis) • Superficial migratory thrombophlebitis • Acute pancreatitis with nodular subcutaneous fat necrosis • Polyarteritis nodosa • Insect bites • Sarcoidosis • Erythema induratum (Bazin) • Erythema nodosum leprosum • Trichophyton rubrum granuloma (M ajocchi) • Zirconium and Silicon granuloma • Deep fingal infection • Actinomycosis, blastomycosis, sporotrichosis, coccidioidmycosis • M eningococcal or pneumococcical septicemia • Kaposi's sarcoma - other neoplasm • Rheumatoid nodules • Sweet's syndrome - usually tender plaque(s) • Behcet's disease • Parasites (leishmaniasis, echinococcosis, cysticercosis, shistosomiasis, onchocerciasis, myiasis) • Rothman-M akai syndrome Nodules around Joints • Arthritis – Rheumatoid arthritis – Gouty tophi (Tophaceous gout) • Infectious disease – Papulonecrotic tuberculid - elbows, fingers • M etabolic disease – Xanthoma tuberosum – Calcinosis cutis • Neoplasms – M yxoid cyst • M iscellaneous – Erythema elevatum diutinum – Reticulohistiocytoma Tumor Lesions - Differential by Color • Brown • Black - Grey • Blue • Pink - Red - Purple • Skin Colored - Yellow - Fawn – Orange • Painful Dermal Tumors Brown • M alignant melanoma • Spitz nevus • M elanocytic nevus • Pyogenic granuloma (brown to red) • Seborrheic keratosis • Comedone • Basal
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