A. Upon examination, the lesions are red (erythematous), raised, hive-like or urticarial, swollen or edematous and range in size from ≤ 1 cm to > 1 cm (papules and plaques, respectively). The superficial fluid-filled lesions are vesicles (≤ 1 cm) and bulla (> 1 cm). There are erosions.
B. The lesions are described as raised, so we know that they cannot be macules and patches, which are flat and non-palpable. Although there are bulla present, we must mention that there are also vesicles.
C. Cysts refer to sacs containing fluid or semi-solid material. There is no evidence on inspection or palpation that the skin lesions are cysts.
D. Scale is an accumulation of the stratum corneum, which may manifest as excess skin flakiness. There is no evidence of scale on Ms. Granger’s physical examination. Lichenification refers to an increase in skin creases/lines due to chronic rubbing. No increase in skin lines is apparent on Ms. Granger’s physical exam.
There are 7 components to keep in mind when assessing a skin lesion, which may be helpful information for the dermatology consultant:
- Type of lesion (primary or secondary)
- Primary: lesion directly due to a pathologic process
- Secondary: lesion due to alteration of a primary lesion (includes scratching, trauma, rubbing)
- Colour
- Shape
- Size
- Texture
- Configuration
- Distribution
- Location
Based on lesion features and size, we describe the type of lesion as:
