Basic Terminologies in Dermatology

Dr. Shruti Sharma

Senior Resident,
Department of Dermatology, Pandit B.D. Sharma Postgraduate Institute of
Medical Sciences, Rohtak
• Harmonized and clear nomenclature- crucial for communication among
dermatologists and dermatopathologists.

• The International League of Dermatological Societies (ILDS) first published a

‘Glossary of basic dermatology lesions’ in 1987– Revised in 2016.

Nast A, Griffiths CE, Hay R, Sterry W, Bolognia JL. The 2016

International League of Dermatological Societies' revised glossary for
the description of cutaneous lesions. Br J Dermatol. 2016
Jun;174(6):1351-8. doi: 10.1111/bjd.14419.
Epub 2016 Apr 3. PubMed PMID: 26801523. PubMed. Journal.
Describing skin conditions

• Lesion - Any single area of altered skin; solitary or multiple.

• Rash - Widespread eruption of lesions.

• Dermatosis - Generic term for a disease of the skin.

When examining the skin, a dermatologist assesses distribution, morphology and

arrangement of skin lesions, number, size, and colour, which sites are involved, their
symmetry, shape, and arrangement.
❑ Basic terms for cutaneous lesions (13)

❑ Additional terms for cutaneous lesions based on-

▪ Morphology
▪ Surface changes MAIN
▪ Side profile/ Form DISCUSSION
▪ Shape and topography
▪ Distribution POINTS
▪ Arrangement
▪ Unique appearances
▪ Color
▪ Palpation
Basic descriptive terms for
cutaneous lesions

Macule Papule Plaque Nodule Weal Vesicle Bulla

Pustule Crust Scale Excoriation Erosion Ulcer

1.

Macule
A flat, circumscribed, non-palpable lesion that differs in color from the surrounding skin;
any color or shape.

Café-au-lait macule Vitiligo

In North America: macule (≤ 1 cm), patch (> 1 cm).

2.
Papule
An elevated, solid, palpable lesion, ≤ 1 cm in diameter.

Fibrous papule of nose Skin tags Cherry angiomas

3.
Plaque

• A circumscribed, palpable lesion > 1 cm in diameter

• Most plaques are elevated*
• May result from a coalescence of papules.

Psoriasis Eczema * Depressed plaque- Morphea

4.
Nodule
• An elevated, solid, palpable lesion > 1 cm usually located primarily in the dermis and/
or subcutis.
• The greatest portion of the lesion may be exophytic or beneath the skin surface

Rheumatoid nodule Plexiform Neurofibroma

5.
Weal
• A transient elevation of
the skin due to dermal
oedema--pale centrally
with an erythematous rim.

• There are no surface

changes.

Urticaria
6. 7. 8.
Vesicle Bulla Pustule

A circumscribed lesion ≤ 1 cm in A circumscribed lesion > 1 cm in A circumscribed lesion that

diameter that contains liquid diameter that contains liquid contains pus
(clear, serous or haemorrhagic). (clear, serous or haemorrhagic)

‘Small blister’ ‘Large blister’

Eczema
Epidermolysis bullosa Folliculitis
9. 10.
Crust Scale
Dried serum, blood or pus on the surface of the A visible accumulation of keratin, forming a flat
skin plate or flake (of stratum corneum)

P. Rosea
Impetigo

Eczema
11. 12. 13.
Excoriation Erosion Ulcer

• Loss of the epidermis and • Loss of either a portion of or • Loss of full-thickness of

a portion of the dermis the entire epidermis epidermis plus at least a
due to scratching or an • May arise following detachment portion of the dermis.
exogenous injury, of the roof of a blister • May extend into the
• linear or punctate subcutaneous tissue

Generalised pruritus Pemphigus vulgaris Pyoderma gangrenosum

Additional descriptive terms
A. Based on Morphology
Purpura: Haemorrhage into the skin due to pathological processes- Senile purpura, vasculitis, topical steroid overuse

Petechia (1-2 mm) Ecchymosis (bruise) (> 2 mm) Hematoma

• Tiny pinpoint hemorrhage • Hemorrhage into the skin • Circumscribed, usually palpable
into the dermis • trauma, use of anticoagulant hemorrhage into the skin or soft
• Capillaritis (pigmented medications, postoperative, clotting tissues
purpura), thrombocytopenia abnormality • Trauma, including surgery; use of
anticoagulant medications

Small vessel vasculitis Trauma induced echhymosis Subungual hematoma

S/C hematoma
Comedo
• Plugged follicular orifice
• Acne vulgaris, comedones of sun-damaged facial skin (Favre–Racouchot syndrome), chloracne

Open: dilated hair infundibulum with oxidized (black) Closed: expansion of hair infundibulum by
keratinous debris (‘blackhead’) keratinous debris, usually with no connection to
skin surface (‘whitehead’)
Callus Clavus (hard corn) Horn

• Reactive hyperkeratosis due to • Localized thickening of the • Keratosis that resembles a

friction and/ or pressure-- stratum corneum due to horn
enhanced skin markings. pathological pressure-- smooth • Actinic keratosis, verruca
• Overlying heads of metacarpals glassy appearance
and metatarsals (palmoplantar • Overlying bony prominences,
surface) e.g. lateral fifth toe, metatarsal
heads (plantar surface)
Infarct Necrosis Gangrene
• Ischemia of tissue due to arterial • Death of tissue • Death of tissue due to ischemia,
occlusion • Septic emboli, center of cutaneous usually acral
• Cholesterol or infectious emboli, metastases, calciphylaxis • Peripheral arterial disease,
Peripheral arterial disease, intra- cholesterol emboli, frostbite
arterial injections

Peripheral arterial disease Calciphylaxis Dry gangrene

Fissure Sinus Fistula
• Abnormal congenital or acquired
• Linear disruption of stratum • Tract leading from a deeper passage from an abscess or
corneum; may extend into the focus to the skin surface hollow organ to the skin surface
dermis • Hidradenitis suppurativa, • Crohn disease, draining abscess
• Chronic hand dermatitis, pilonidal cyst, dental sinus associated with hidradenitis
angular cheilitis suppurativa

Fissure Sinus in Scrofuloderma

Atrophy Telangiectasia Poikiloderma

Loss of tissue either epidermis, • Permanently dilated capillaries • Simultaneous presence of atrophy,
dermis or subcutaneous tissue • Actinic damage, rosacea, venous telangiectasia and hypo- and
hypertension (lower extremities) hyperpigmentation
• Mycosis fungoides,
dermatomyositis, photoaging

Lipodystrophy Rosacea Poikiloderma of Civatte

Prurigo Lichenification
• Papules or nodules due to scratching or • Accentuation of skin markings + thickening of skin +
picking hyperpigmentation
• Prurigo nodularis • often due to rubbing
• Lichen simplex chronicus
Peeling (exfoliation)
Digits
• Shedding of the stratum corneum* following
• Resolving phase of a sunburn; distal digits following fever
scarlet fever, Kawasaki disease or a high fever

Exanthem
• Acute widespread eruption, usually
due to a viral infection or drug
reaction
• Rubeola, rubella, roseola infantum;
morbilliform or exanthematous
drug reaction

Viral exanthem Morbilliform Drug eruption

Erythroderma : Widespread reddening and scaling (inflammatory condition) of the skin (>90% BSA) .
• Often precedes or is associated with exfoliation ----exfoliative dermatitis

Causes:
• Dermatitis- atopic dermatitis
seborrheic dermatitis, contact
dermatitis (allergic or irritant)
• Psoriasis
• Lymphoma and leukemias
• Drug eruption (SJS/ TEN/
DRESS)
• Unknown
• Hereditary (Pityriasis rubra
pilaris, ichthyosiform
erythroderma)
• Blistering diseases including
pemphigus and bullous
pemphigoid
• Staphylococcal scalded skin
TEN syndrome
• Others: crusted scabies, LP, Psoriasis
Artefact

• Induced by exogenous injury, self-inflicted

• Dermatitis artefacta

Angioedema

• Abrupt and short-lived swelling of the skin and

mucous membranes.
• affects the subcutaneous tissue.
Stria

• Linear atrophy along tension lines

• initially can be red to purple in colour
(stria rubra).
• Striae gravidarum, potent topical
corticosteroids Striae gravidarum

Gumma
• Granulomatous nodule or plaque with sticky
(rubber-like) discharge
• Tertiary syphilis, tuberculous gumma

Tertiary syphilis
Halo
• Peripheral loss of pigment
• Halo melanocytic naevus

Anaesthesia Dysaesthesia

• Loss of sensation • Inappropriate sensations, e.g.

• Tuberculoid leprosy lesion paraesthesias
• Vulvodynia, notalgia paraesthetica, herpes
zoster
Alopecia

• Loss or decrease in density of hairs on scalp

• Androgenetic alopecia, alopecia areata, naevus sebaceus

Alopecia areata

Kerion
• Boggy plaque, due to infection, that often contains
• pustules.
• Tinea capitis due to Microsporum or Trichophyton spp.

Tinea capitis
B. Based on Surface changes

Present Absent
Pathological process is
Pathological process is in below the surface, either
the epidermis dermal or subcutaneous
Scaling or hyperkeratosis — An increase in the dead cells on the surface
of the skin (stratum corneum).

• Desquamation
• Psoriasiform
• Pityriasiform
• Lichenoid
• Keratotic
• Exfoliation
• Maceration
• Verrucous
Desquamation (skin coming off in scales)

Erythroderma due to psoriasis

Exfoliation (peeling skin)

Shedding of the stratum corneum*

• Sunburn;
• Thermal and chemical burns
• Frictional
• Chemical peels and topical retinoids/
BPO
• Radiation and Chemotherapy
• Miliaria rubra
• Keratolysis exfoliativa
• Contact dermatitis
• Scarlet fever
• Staphylococcal scalded skin syndrome,
TSS
• High fever
Keratolysis exfoliativa • Kawasaki disease
• Peeling skin syndrome
Psoriasiform (large white or silver flakes)

Psoriasiform dermatitis of hands

D/Ds of Psoriasiform dermatoses
Pityriasiform (branny powdery scale)

• The term Pityriasis comes from

the Greek pityron=bran

• characterized by fine branny

scales.

Causes:

• P. Rosea
• P. Versicolor
• Pityriasis alba
• P. Rosea like drug eruption
• Pityriasiform seborrhoeide
• Secondary syphilis
• Pityriasis rotunda

Pityriasiform seborrhoeide
Lichenoid (apparent scale is tightly adherent to the skin surface)

• Lichen is found growing on trees

and elsewhere in the garden or
LP forest. It is a symbiotic fungus/
alga characterised by flat-
topped organisms.

• Lichenoid skin disorders got their

name from their appearance –
also flat topped and often
somewhat scaly.
Lichenoid
keratosis
• Band like infiltrate found
on histology.
D/Ds of lichenoid
dermatoses
Keratotic (horny scale)

Focal thickening of stratum corneum

Causes:

• Actinic keratosis
• Seborrheic keratosis
• Stucco keratosis
• Keratosis pilaris
• Keratosis palmaris et plantaris
• Phrynoderma
• Lichen spinulosum
• Darier’s disease
• Oral keratosis
Actinic keratosis • Punctate keratosis
• Tobacco keratosis
Maceration (moist peeling skin)
Causes:

• Intertrigo

• Tinea pedis

• Contact Dermatitis

• Atopic dermatitis

• Hyperhidrosis

• Condyloma lata

• Staphylococcal scalded skin

syndrome

Intertrigo • Flexural Psoriasis

Verrucous (warty) Jagged, Undulating surface

Causes:

• Viral wart
• VEN
• Tuberculosis verrucosa cutis
• Epidermodysplasia
verruciformis
• Verrucous carcinoma
• Acrokeratosis verruciformis of
Hoff
• SCC
• Verrucous Hyperplasia
• Nevus Sebaceous
• Incontinentia pigmenti

Viral wart
C. Based on Form/ Side profile
Acuminate Depressed Domed
• Elevated with tapering to a • Surface below that of normal • Hemispherical form
sharp point(s) adjacent skin • Intradermal melanocytic naevus,
• Filiform wart, cutaneous • Dermal atrophy: atrophoderma fibrous papule of the nose,
horn • Lipoatrophy: antiretroviral therapy, molluscum contagiosum
corticosteroid injections

Filiform wart Lipoatrophy Molluscum

Flat-topped Papillomatous Pedunculated
• Multiple projections resembling a • Papule or nodule attached by a
• Elevated with a flat top
nipple thinner stalk
• Lichen planus, lichen
striatus, condylomata • Papillomatous intradermal • Skin tag (acrochordon)
melanocytic naevus, epidermal
lata
naevus

LP VEN Acrochordon
Raised edge Umbilicated Verruciform
• Small central depression
• Elevated peripheral rim • Multiple projections
• Varicella, herpes zoster,
• Porokeratosis resembling a wart
molluscum contagiosum
• Verrucae, TBVC

Porokeratosis of Mibelli Molluscum Viral wart

D. Based on Shape and topography
Round (discoid) Oval Polygonal
• Circular or coin-shaped • A round shape with slight
• Discoid lupus elongation, resembling that of an • A lesion whose shape resembles
erythematosus, ellipse or egg a polygon with multiple angles
nummular eczema, fixed • Pityriasis rosea • Lichen planus
drug eruption

Nummular eczema P. Rosea LP

Circumscribed Poorly circumscribed
• Indistinct demarcation between involved
• Well circumscribed Distinct demarcation
and uninvolved skin
between involved and uninvolved skin
• Atopic dermatitis
• Psoriasis, vitiligo
Digitate

• Resembles fingers

• Digitate dermatosis, a
form of parapsoriasis
(small plaque
parapsoriasis)
Annular
Arciform
• Shape of a ring
• A segment of a ring;
(clear centrally)
arch-like
• Tinea corporis,
• Urticaria, erythema
granuloma annulare,
annulare
erythema annulare
centrifugum
centrifugum

Figurate
A shape or
form with
rounded
margins
Polycyclic Serpiginous

Coalescence of • Wavy pattern,

several rings reminiscent of
Subacute cutaneous a snake
lupus erythematosus • Cutaneous
larva migrans
Geometric
Artefactual Block-like
• Lesions induced by trauma - angulated or linear edges; • Embryonic pattern resembling
• Configuration can reflect sites of exposure to irritants rectangular blocks
or allergens • Pigmentary mosaicism, chimerism
• Dermatitis artefacta
Papulo-vesicular
Papular

Polymorphic

• Variable sizes and shapes

as well as types of lesions
• Polymorphic light
eruption

Targetoid

Purpuric
Plaque
Guttate Reticulate
• Small, with a shape that often resembles a droplet • Net-like or lacy pattern
• Guttate psoriasis, idiopathic guttate • Livedo reticularis, erythema ab igne, oral
hypomelanosis; lichen planus
• often multiple similar-appearing lesions
E. Based on Distribution
Localized
Lesions confined to one or a few areas Palmar, plantar, palmoplantar

• Leiomyomas, scalp psoriasis • Lesions on the palms and/or soles

• Keratoderma, pustulosis palmaris et plantaris

Scalp psoriasis Hereditary palmoplantar keratoderma

Periorificial (e.g. periocular, Seborrhoeic regions
periorbital, perianal)
• Areas with the highest density of sebaceous glands (e.g.
• Lesions around body orifices scalp, face, upper trunk)
• Vitiligo, periorificial dermatitis • Seborrhoeic dermatitis, Darier disease

Perioral dermatitis Seborrheic dermatitis

Acral Extensoral (of extremities) Flexural
• Areas overlying muscles and tendons • Areas overlying muscle and
• Lesions of distal extremities,
involved in extension, as well as joints tendons involved in flexion of
ears, nose, penis, nipples
(e.g. extensor forearm, elbow, knee) joints or the inner aspect of joints
• Acral type of vitiligo,
• Psoriasis, keratosis pilaris, frictional (e.g. antecubital or popliteal
acrocyanosis
lichenoid dermatitis fossae)
• Atopic dermatitis

Acral vitiligo Psoriasis vulgaris Atopic dermatitis

Interdigital Intertriginous
• Area between the fingers or toes • Major body folds (axilla, submammary, inguinal
• Tinea pedis, erythrasma crease, beneath pannus, intergluteal fold)
• Inverse psoriasis, intertrigo, cutaneous candidosis
(candidiasis), Langerhans cell histiocytosis

Tinea pedis cutaneous candidiasis

Segmental

Block-like Lesions Along Blaschko lines Dermatomal

• along embryonic growth lines • Lesions along embryonic • Lesions confined to one or more
• Pigmentary mosaicism growth lines segments of skin innervated by a
• Pigmentary mosaicism, single spinal nerve (dermatomes)
incontinentia pigmenti • Herpes zoster

Segmental vitiligo Incontinentia pigmenti Herpes zoster

Follicular and perifollicular

• Lesions located within or around hair

follicles

• Folliculitis, pityriasis rubra pilaris, keratosis

pilaris

Keratosis pilaris
Exposed skin

Exposed to the environment Exposed to sunlight or other forms of

Areas exposed to external agents (chemical radiation (e.g. photodistributed)
allergens, irritants or physical agents) • Polymorphic light eruption,
• Allergic contact dermatitis to plants, • phototoxic drug eruption
• Airborne contact dermatitis • radiation dermatitis

Airborne contact dermatitis Polymorphic light eruption

Unilateral Asymmetrical Symmetrical
• Lesions confined to either the left • Lesion or distribution pattern that • Lesions or pattern with symmetry
or the right half of the body lacks symmetry along an axis (e.g. along an axis (e.g. the midline)
• Herpes zoster, CHILD syndrome, the midline) • Psoriasis, atopic dermatitis
segmental vitiligo • Acute allergic contact dermatitis,
herpes zoster, lichen striatus; in the
case of a single lesion, melanoma

Segmental vitiligo Lichen striatus Plantar psoriasis

Disseminated

Generalized/widespread Lesions Within an anatomical region

• Distributed randomly over most of the • (e.g. the back, an extremity)
body • Folliculitis (buttocks), Grover disease
• Varicella, disseminated zoster, (trunk)
morbilliform drug eruption, viral
exanthems

Drug eruption Folliculitis

Universal

• Involving the entire body

• Alopecia areata universalis,
congenital atrichia

Congenital atrichia
F. Based on Arrangement
Linear (linear arrangement of lesions)

Koebner phenomenon Dermatomal (zosteriform)

Lesions induced by physical stimuli (e.g. • Lesions confined to one or more segments of skin
trauma,scratching, friction, sunburn) innervated by a single spinal nerve (dermatomes)

Psoriasis, lichen planus, vitiligo • Herpes zoster, segmental neurofibromatosis

Linear (CONTD.)

Sporotrichoid Along Blaschko lines

• Lesions along lymphatic vessels • Lesions due to mosaicism

• Sporotrichosis, Mycobacterium marinum • Epidermal naevus, linear lichen planus, lichen
infection striatus

Sporotrichosis Lichen striatus

Grouped

Herpetiform Agminated Satellitosis

• Clusters of papulovesicles • Solid papules within a cluster • Smaller papules surrounding a
• Herpes simplex • Agminated melanocytic naevi, larger lesion
leiomyomas • Melanoma metastases, pyogenic
granulomas

Agminated Melanoma metastases

Herpes simplex
melanocytic naevi
G. Based on Unique appearances
Target lesion

A typical target lesion is a round

skin lesion with
three concentric color zones:

• A darker centre with a blister

or crust
• A ring around this that is paler
pink and raised due
to oedema (fluid swelling)
• A bright red outermost ring.

Characteristic of Erythema
multiforme

Atypical target lesions show just two zones and/or an indistinct border. In erythema multiforme, these lesions are raised
(papular). In SJS/ TEN, they are flat (macular).
Cocarde/ cockade/ cockarde/ Targetoid

• Targetoid appearance (2 concentric zones- NOT DUE TO EM)

• cockarde nevus, pemphigoid gestationis, urticaria, FDE, PLE
cockarde nevus

urticaria FDE
Morbilliform Scarlatiniform
• Measles • Scarlet fever
• Widespread and Maculo-papular • Widespread and confluent
H. Based on Color
Carotenoderma

• Yellow/orange skin hue

• Excessive circulating beta-carotene
(vitamin a precursor derived from
yellow/orange coloured vegetables
and fruit)
• Pronounced on palms and soles
• Does not affect the sclera.
Jaundice

Yellowing of the skin and the whites of the eye and is due to a
buildup of bile pigments in the blood; this is usually due to
biliary or liver disease.

Erythema

Red skin due to an increased blood supply; may be applied to

any red colored dermatosis.
Hyperpigmentation Hypopigmentation Leukoderma
• Darkened skin compared to normal; • Skin colour that is paler than • White skin; also known as achromia.
it can be localised or generalised. normal.

PIH P. Alba Piebaldism

Clinical examples
according to color
I. Based on Palpation
References
• Nast A, Griffiths CE, Hay R, Sterry W, Bolognia JL. The 2016 International League of
Dermatological Societies' revised glossary for the description of cutaneous lesions. Br J Dermatol.
2016 Jun;174(6):1351-8. doi: 10.1111/bjd.14419.Epub 2016 Apr 3. PubMed PMID: 26801523.
PubMed. Journal.

• Chiang NYZ, Verbov J. Dermatology: handbook for medical stu_x0002_dents & junior doctors.
Available at: http://www.bad.org.uk/library -media/documents /Dermatology
%20Handbook%20for%20 medical%20students %202nd%20Edition%202014%20 Final2%282%
29.pdf (last accessed 19 January 2016).

• Dermnet NZ

• Rooks 9th ed.

• Sehgal VN, Srivastava G, Sharma S, Sehgal S, Verma P. Lichenoid tissue reaction/interface dermatitis:
Recognition, classification, etiology, and clinicopathological overtones. Indian J Dermatol Venereol
Leprol 2011;77:418-30.

• Sehgal VN, Dogra S, Srivastava G, Aggarwal AK. Psoriasiform dermatoses. Indian J Dermatol
Venereol Leprol 2008; 74: 94-9.
Thank you