(1)
Hôpital Universitaire de Strasbourg, Strasbourg, France
Abstract
The analysis of certain characteristics such as shape, size, surface, and color of a lesion has enabled the identification of “primary or elementary lesions” which represent the skin’s response to various diseases and aggressions. All skin lesions are the result of the combination of one or several primary lesions, i.e., the most elementary lesions that can represent various skin diseases and may be used to describe them. In order to be classified as primary, a lesion must be easily identified from another without confusion. Primary lesions allow the description of all alterations of the skin. The combination of several of these lesions can produce actual syndromes. The primary lesions consist in an “alphabet” that the physician must learn to recognize in order to be able to describe and to diagnose a skin disease by inspecting, palpating, and folding the skin. Good lighting is essential.
The analysis of certain characteristics such as shape, size, surface, and color of a lesion has enabled the identification of “primary or elementary lesions” which represent the skin’s response to various diseases and aggressions. All skin lesions are the result of the combination of one or several primary lesions, i.e., the most elementary lesions that can represent various skin diseases and may be used to describe them. In order to be classified as primary, a lesion must be easily identified from another without confusion. Primary lesions allow the description of all alterations of the skin. The combination of several of these lesions can produce actual syndromes. The primary lesions consist in an “alphabet” that the physician must learn to recognize in order to be able to describe and to diagnose a skin disease by inspecting, palpating, and folding the skin. Good lighting is essential.
First, it must be determined whether the lesion is palpable. Most of the time, a lesion is “obviously” palpable as it is physically elevated or depressed (Fig. 2.1); however, it must sometimes be brushed with the finger in order to feel any difference of consistency compared to adjacent skin. Palpable lesions may be solid or contain fluid. In other situations, the skin must be pinched between the thumb and forefinger in order to feel deeply any palpable formation. Palpation, folding, and stretching of the skin also enable to identify changes in its consistency. The skin may lack suppleness or even be too supple or too loose. During clinical examination, other elements such as temperature and sensitivity of lesions must also be evaluated.
Skin may become palpable due to an alteration of its surface. It is very important to determine whether a lesion is itself palpable since this is almost always due to an abnormality of the dermis or of deeper structures or simply to an alteration of the skin surface resulting from epidermal lesion (Fig. 2.2). Skin can also be palpable for both reasons.
Alterations of the skin surface are discussed in detail in Chap. 7. They are briefly presented here to explain the diagnostic approach. Skin surface is altered when
Thickened, the skin, usually smooth, becomes rough (Fig. 2.3).
Thinned, it becomes too thin and transparent (Fig. 2.4).
Absent, causing oozing or bleeding (Fig. 2.5) and evolving towards a crust.
Interrupted or broken, by a depression or orifice (Fig. 2.6).
Raised due to the presence of fluid, whether clear (Fig. 2.9), cloudy, or hemorrhagic.Related posts:
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