Chapter 2 Morphology of primary and secondary skin lesions
1. Why do dermatologists use words that no one else understands?
The language of dermatology is unique. It encompasses terms that rarely, if ever, are used in other medical specialties. The use of these correct dermatologic terms is important to accurately describe skin lesions to dermatologists during telephone calls and during rounds and teaching. A good description of a skin lesion enables the listener to formulate a series of differential diagnoses, whereas a poor one does not.
2. But why are the descriptions so long?
Use of appropriate terminology and important clues, such as configuration and skin distribution, effectively paints an accurate picture for the listener. Use of vague terms—spot, bump, rash, and lesion—is not helpful. Such vocabulary is counterproductive to formulating an accurate differential diagnoses. “Grouped vesicles on an erythematous base” immediately suggests herpes simplex, and “brown, friable ‘stuck-on’ papules” accurately describes seborrheic keratoses. “Well-demarcated, erythematous plaques with micaceous, silvery scales located on extensor surfaces” is suggestive of psoriasis. “Violaceous, polygonal papules with Wickham’s striae located on flexural surfaces” is consistent with lichen planus. On the other hand, “red, scaly rash on the foot” describes an enormous, nebulous group of disorders.
3. How can I possibly learn the language of dermatology?
4. What is a primary skin lesion?
7. How does a primary lesion differ from a secondary lesion?
Secondary skin lesions are created by scratching, scrubbing, or infection. They may also develop normally with time. For example, the primary lesion in a sunburn is a macular erythema (although it could also be a blister), but with resolution, scale and increased pigmentation become prominent. Examples of secondary lesions include:
11. What are telangiectasias?
Telangiectasias (Fig. 2-1) are small, dilated, superficial blood vessels (capillaries, arterioles, or venules) that blanch (disappear) with pressure.
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