Primary and Secondary Lesions PDF

Primary Lesions The term “primary” is used to describe a lesion as it first appears Secondary Lesions Is one which results from an alteration of the 1ry lesion either as a natural course of the disease or because of manipulation. Erosion, ulcer, sinus, scar, desquamation Types of primary lesions:...

Primary Lesions The term “primary” is used to describe a lesion as it first appears Secondary Lesions Is one which results from an alteration of the 1ry lesion either as a natural course of the disease or because of manipulation. Erosion, ulcer, sinus, scar, desquamation Types of primary lesions: 1- Macule. 2- Patch. 3- Papule 4- Plaque. 5- Nodule. 6- Tumor. 7- Vesicle. 8- Bulla. 9- Pustule. 10- Cyst. 11- Wheals. 12- Keratosis. Types of secondary lesions: 1- Erosion. 2-Ulcer. 3- Fissure 4- Sinus 5- Fistula 6- Scar 7- Crust 8- Desquamation.  Primary lesions Macule Well circumscribed flat lesions that are noticeable with color change Skin or Mucosa, less than 1cm in diameter hyperpigmented, or darker, relative to the skin) or vitiligo lesions (which are hypopigmented or depigmented, or lighter, relative to the skin). Macule Red- Inflammation Pigmented- Melanin, Haemosiderin, foreign material. Ex: Melanotic Macule Patch Circumscribed area larger than the macule and differentiated from the surrounding epidermis by color, texture or both. It is neither elevated nor depressed. It may be of any size. Amalgam tattoo  Freckles melanosis Small brown spots on your skin, often in areas that get sun exposure. freckles are harmless. They form as a result of overproduction of melanin, which is responsible for skin and hair colour (pigmentation).  Addison’s disease A primary adrenal insufficiency or hypoadrenalism, is a rare disorder of the adrenal glands. The adrenal glands are 2 small glands that sit on top of the kidneys. They produce 2 essential hormones: cortisol and aldosterone. Snuff dipper’s patch. Smokeless tobacco keratosis is a condition that causes thick white patches. They form where smokeless tobacco is held in inner cheek between teeth and gums. Chewing tobacco, snuff, and dipping tobacco (dip) can all cause this condition. Petechiae and Ecchymosis Petechiae: sharply circumscribed deposit of blood or blood pigments up to 1cm in diameter. Ecchymosis: sharply circumscribed deposit of blood pigments more than 1cm in diameter. Papule and Plaque Papule Well circumscribed solid flat-topped lesions raised above the skin or mucosal surface up to1 cm in Diameter. Papular acne of skin  Papules Ex: Erythematous papules, lichen planus Erythematous papules  Plaque Well circumscribed solid raised lesions more than 1cm in diameter. Also defined as an elevated, plateau- like lesion that is greater in its diameter than in its depth.  Plaque A flat (broad), raised area Larger than 1 cm in diameter. Plaques may extend deeper into the dermis than papules. Squamous cell carcinoma Leukoplakia Nodule and Tumor Nodule Well circumscribed solid, rounded projection up to 1 cm in diameter. They are deeply seated. They might sometimes protrude above the skin or oral mucosa. A single, firm movable lump beneath normal-looking skin or under the lining (mucosa) of the inside of the mouth. Less than 1 cm in diameter but extend deeper into the dermis. Can be asymptomatic or painful. Usually slowly growing. fibroma  Nodule E.g. Fibroepithelial polyp, fibrous epulis. Lipoma. Tumor: Well circumscribed solid rounded projection more than 1 cm in diameter. It also represents a neoplasm Deeply seated. It is usually raised, with rounded, or ulcerated dome. It is either benign or malignant.  Pleomorphic adenoma of palate Kaposi’s Sarcoma (HHV8) Squamous cell carcinoma Vesicles and Bullae Vesicles Sharply circumscribed fluid – filled blisters less than 1 cm in diameter (on skin or mucous membrane). Chicken Pox Circumscribed. Fluid filled elevations in the skin/mucous membrane. Less than 1 cm in diameter. Fluid may consist of lymph, blood or serum. These lesions often give rise to secondary lesions e.g.: Crusts, ulcers Herpes zoster Herpes simplex  Bullae Sharply circumscribed fluid filled blisters, containing clear fluid greater than 1 cm in Diameter. Or A rounded or irregularly shaped blister containing serous or seropurulent fluid, equal to or greater than 1 cm in Diameter Bullous pemphigoid When a vesicle has a diameter larger than 1 cm, it is termed a bulla Thin-walled bullae: Pemphigus vulgaris. Thick –walled bulla: Mucous membrane Pemphigoid.  Pemphigus vulgaris. Oral desquamative gingivitis in pemphigus and Pemphigoid. Pustule Sharply circumscribed pus-filled fluid elevation either a vesicle or bulla. Pustule A vesicle or bulla filled with a purulent exudate. acne Pustule Pustules are usually creamy white in color, may be yellow or green. An abscess is a much deeper localized accumulation of pus that is not visible through the surface. Cyst It is an encapsulated, fluid-filled mass in the dermis or subcutaneous tissue or submucosa. Examples: Sebaceous cyst Thyroglossal duct cyst. Periapical cyst  Wheals: A rounded or flat-topped, pale red papule or plaque that Edematous papules or plaques. Resulting form an acute extravasation of serum into the upper dermis. Pale red, pruritic and of short duration. Slightly raised, common in persons with allergies. Developed as a result of histamine release from mast cells. Insect bites. Reactions to allergens. Keratosis: Abnormal thickening of the outer layer of epithelium of skin or mucous membrane. Colour: varies from white to greyish white. may be localized or diffuse. E.g. frictional keratosis, leukoplakia, smokers keratosis Secondary lesions Erosion and Ulcer Erosion Ulcer Erosion Loss of superficial layers of epithelium. Erosions are moist and slightly depressed and often result from a broken vesicles, bullae Pemphigus vulgaris Erosions Red lesions often caused by the rupture of vesicles or Bullae or Trauma. Erosive Lichen Planus ULCERS “ Break in the continuity of the epithelium” more extensive loss of epidermis. Ulcers are deeper than erosions”.  ULCERS These are well circumscribed, often depressed lesions with an epithelial defect that is covered by a fibrin clot, causing a yellow-white appearance. Traumatic ulcer i.e.: Any ulcer is a discontinuing of surface epithelium, with a progressive destruction of the surface tissue. They may be deeper than basal layer of the epithelium and extend into the dermis. Scarring may follow healing.  Examples: Traumatic ulcers ð have ragged edges. Aphthous ulcers. Ulcers in cases of viral infections: Herpes simplex – Herpes zoster.  Ulcers due to intraepithelial vesicles ð Pemphigus vulgaris Ulcers due to subepithelial vesicles: (heal with scar) üE.g., Bullous pemphigoid. üMucous membrane pemphigoid. üEpidermolysis bullosa. Ulcer in benign mucous membrane (BMMP) heal with scar formation ® cicatricial pemphigoid, major aphthous ulcer (MAU). Fissure: A deep furrow, cleft, or slit. Are linear cracks in the skin or mucous membrane. May be painful, may be normal or abnormal linear cleft in epidermis affecting tongue, lips and perioral tissues. They can be superficial/deep/radiating. Longitudinal/transverse Fissuring of the tongue “scrotal tongue” Angular cheilitis.  Scale Localized accumulations of flakes of skin:. Psoriasis on tongue Psoriasis Crust Crusts result when blood, serum or purulent exudate dries on skin. Angular cheilitis Erythema multiforme Pseudomembrane Formation of a “false membrane” on mucosal surfaces in response to a necrotizing agent. Burns Candisiasis Scar Replacement of destroyed tissue by fibrous tissue. A scar usually defines a permanent mark or cicatrix remaining after healing. Acne scar  Scar after intraoral surgery Scar after thyroidectomy Scar formation after an injury Sinus A tract that leads from a supportive cavity, cyst or abscess to the surface of the skin/mucous membrane. A nodule of tissue hyperplasia may be found at skin or mucous membrane surface caused by repeated attempts at repair followed by break down and drainage.  Actinomycosis Sinus from dental infections Desquamation Shedding of epithelial elements in scales or sheets. Chronic desquamative gingivitis. Atrophy Thinning of the epithelium. Area looks shiny red as connective tissue, reflects its vascularity. Depapillated tongue in anemia E.g.: Atrophy of tongue papilla results in a smooth, de-papillated glossy dorsal surface.