Page 124 - Journal of Special Operations Medicine - Spring 2015

associated with this complaint. He denied any changes in • Comedo: retained secretions of material within the
washing detergents, soaps, or use of lotions, and denied pilosebaceous follicle.
any known exposure to plants or animals in the area • Pustule: a circumscribed elevation containing pus.
prior to presentation. Physical examination was unre­ • Cyst: a circumscribed, thick walled, slightly elevated
markable with the exception of the skin findings on the lesion extending into the deep dermis and subcutane­
posterior aspect of his left knee. The patient was able to ous fat.
bear weight without difficulty, had a normal knee joint • Wheal or hive: a distinctive white to pink or pale red,
examination, and no lymphadenopathy noted. He was edematous, solid elevation formed by local, superfi­
afebrile with normal vital signs. cial, transient edema. They characteristically disap­
pear, yet may reappear within a period of hours.
• Telangiectasia: blanchable (fades with fingertip pres­
Review of the Dermatologic Evaluation
sure), small, superficial, dilated capillaries.
It has been said that the eye cannot see what the mind does • Purpura: nonblanchable, purple area of the skin that
not know. It is difficult to accurately describe a dermato­ may be flat or raised.
logic abnormality without having a basic knowledge of
terminology. The following is a review of dermatologic Secondary lesions
terminology and lesion types (Figure 2) from the Special Description of secondary lesions does not offer the same
Operations Forces Medical Handbook. 1 diagnostic descriptive power as the primary lesions, but
represents the evolution of the primary lesions.
Figure 2 Lesions of the skin.
• Atrophy: thinning and wrinkling of the skin.
• Crust (scab): dried serum, blood, or pus.
• Erosion: loss of part or all of the epidermis that will
heal without scarring.
• Ulcer: loss of epidermis and at least part of the dermis
that results in scarring.
• Excoriation: linear or hollowed­out crusted area caused
by scratching, rubbing, or picking.
• Lichenification: thickening of the skin with accentua­
tion of the skin lines.
• Scale: accumulation of retained or hyperproliferative
layers of the stratum corneum.
• Scar: permanent fibrotic changes seen with healing af­
ter destruction of the dermis.

Further key aspects of description are shape and arrange­
ment (i.e., annular, arciform, herpetiform, linear, reticu­
lated, or serpiginous), color (e.g., erythematous, white),
Lesion Types
and distribution (e.g., generalized, localized, flexor or
extensor surfaces, sun­exposed areas, symmetrical). 1
Primary lesions
• Macule: a circumscribed area of change in normal Additional historical factors that are pertinent in the der­
skin color that is flat and less than 0.5cm in diameter. matologic evaluation include the patient’s age, timing of
• Patch: a circumscribed area of change in normal skin onset and progression, past medical history (dermato­
color that is flat and greater than 0.5cm in diameter. logic and general medical history), exposures (e.g., new
• Papule: a solid lesion, usually dome shaped, less than medications, soaps, creams, detergents), and other symp­
0.5cm in diameter, and elevated above the skin. toms associated with the dermatologic abnormality.
• Nodule: a solid lesion, usually dome shaped, greater
than 0.5cm in diameter, and elevated above the skin.
• Plaque: an elevation above the skin surface occupying Case Differential Diagnoses
a relatively large surface area in comparison with its Rashes, bites, sores, lesions, and other dermatologic
height. Often formed by a confluence of papules. issues are common reasons why people seek medical
• Vesicle: a circumscribed, thin walled, elevated lesion evaluation in garrison and while deployed. A detailed
2,3
less than 0.5cm in diameter, and containing fluid. history and an accurate description of the dermatologic
• Bulla: a circumscribed, thin walled, elevated lesion abnormality can put one on the right track to deter­
greater than 0.5cm in diameter, and containing fluid. mining a differential diagnosis. Using intrinsic medical

114 Journal of Special Operations Medicine Volume 15, Edition 1/Spring 2015