Urticaria

Image: “Urticaria” by Ericalens. License: CC BY 3.0


Efflorescences are changes in the skin. Primary efflorescences are skin changes that directly result from the pathological change of the skin. Examples of primary efflorescences are maculae (spots) or tumors. Secondary efflorescences can develop in the course of pathological skin changes or due to external influences. Examples for secondary efflorescences are flakes and crusts (dried-up secretion).

Note:

  • Efflorescence = skin change
  • Primary efflorescence: skin change directly resulting from the pathological process
  • Secondary efflorescence: skin change based on a primary efflorescence or via external damages

Primary and Secondary Efflorescences

Efflorescences are changes of the skin. Primary efflorescences are skin chances which directly result from the pathological change of the skin. Examples for primary efflorescences are maculae (spots) or tumors. Secondary efflorescences can develop in the course of pathological skin changes or due to external influences. Examples for secondary efflorescences are flakes and crusts (dried up secretion).

Note:

  • Efflorescence = skin change
  • Primary efflorescence: skin change directly resulting from the pathological process
  • Secondary efflorescence: skin change on the basis of a primary efflorescence or via external damages

Primary Efflorescences

Macula (spot)

macula

Image: ‘Macula’ by Madhero88. License: CC BY 3.0

A macula is a circumscribed color change in the skin level without a difference in substance, which means that no difference in level can be palpated. Examples are freckles, café au lait spots, and vitiligo (skin depigmentation). Due to the color difference of the skin, one can often conclude their genesis. Thus, white spots (depigmentation) can occur in the context of vitiligo. Red spots can develop due to increased circulation (hyperemia or erythema), and brown spots due to the overproduction of melanin. A large macular lesion > 2 cm in diameter is referred to as a Patch.

Papula (papule), nodus and plaque

Papule and Plaque

Image: ‘Papule and Plaque’ by Madhero88. License: CC BY 3.0

A papula is a small, circumscribed elevation. Its diameter is less than 0.5 cm. These nodules can develop from an increase in the substance of both the dermis and the epidermis. A nodus ranges from 0.5 cm to 5 cm.The consistency is firm and can reach into the deeper layers of the dermis.A plaque is a flat-topped, raised lesion with confluent papules.

Urticaria (Welts)

Urticaria

Image: “Urticaria” by Ericalens. License: CC BY 3.0

Urticarias(welts) are transient, slightly elevated, fuzzily limited edematous elevations of the tissueWheal is a raised, erythematous and edematous papule or plaque, and represents short-duration vasodilation and vasopermeability.

Tumor (swelling)

A tumor is a large node greater than 5 cm, which develops from an increase of tissue in the dermis or epidermis. Examples are benign and malignant neoformations like the basalioma

Vesicula (vesicle) and bulla (blister)

vesicula and bulla

Image: ‘Vesicles and Bulla’ by Madhero88. License: CC BY 3.0

Vesiculae and bullae are circumscribed cavities filled with clear fluid. They only differ from each other in size, with a difference in diameter of 5 mm.

Pustula (whelk)

A pustule (purulent blister) is an accumulation of purulence within the epidermal cavity. Depending on the composition of secretion, one distinguishes between pathogen-containing, infectious, leukocyte-rich, or sterile whelks.

Telangiectasia

Telangiectasia is a dilated, superficial blood vessel

Secondary Efflorescences

Squama (flake)

Flakes are large accumulations of cornified epithelial cells. Based on their size, they can be classified into rough, medium, and fine exfoliative.Some flakes can be easily detached from the skin,while others are more difficult.It is also crucial to consider the color of the flake.Psoriasis is a condition characterized by flake formation.

Crusta (crust)

Crustae are appositions of dried-up secretion. They can be bloody (hemorrhagic), purulent, serous, or talcous.

Erosio (erosion), ulcus (ulcer) and exkoratio (excoriation)

Ulcers fissures,and erosions

Image: ‘Ulcers fissures, and erosions’ by Madhero88. License: CC BY 3.0

Erosion, ulcer, and excoriation are different types of skin defects. Erosion is the most superficial form and only affects the epidermis. Excoriation reaches deeper and also affects the dermis. An ulcer is the chronic form and reaches into the deep dermis and heals very poorly.

Cicatrix (scar)

A scar (cicatrix) develops from defective healing of damaged skin. It contains collagen and is free of hair follicles and sweat glands. Besides surgical interventions and other traumas, scars can also form, e.g., in the event of healing of acne vulgaris.

Cyst

A skin cyst is a tissue cavity, which contains thin or thick secretion. In contrast to a pseudocyst, it is lined with epithelium (encapsulated).

Lichenification

A thickening of the skin, characterized by accentuated skinfolds.

Atrophy

It is the thinning of the skin that may appear as a depression with intact epidermis or as sites of shiny, delicate, wrinkled lesions.

Narrowing It Down – Further Steps

While the classification of the correct efflorescence forms the basis for the accurate description of the findings, there are several further characteristics, which should be considered. They include color, shape, localization and number, limitation, surface, and texture.

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