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Let's get back to the basics. A #dermtwitter #tweetorial on:
THE PRIMARY LESION!
My plan is to make a #Derm101 series on #morphology and the #skin exam, so this will be the first in that series of #medthreads.
#MedEd #FOAMEd #medtwitter #medstudenttwitter pc:@dermnetnz
Let's get back to the basics. A #dermtwitter #tweetorial on:
THE PRIMARY LESION!
My plan is to make a #Derm101 series on #morphology and the #skin exam, so this will be the first in that series of #medthreads.
#MedEd #FOAMEd #medtwitter #medstudenttwitter pc:@dermnetnz
2/
Why are #dermatologists so obsessed with description?
Well, for us, morphology is everything. We start with the exam and take the history afterward based on the possible differential we've come up with!
So let's start simple. What was that lesion in the prior tweet?
Why are #dermatologists so obsessed with description?
Well, for us, morphology is everything. We start with the exam and take the history afterward based on the possible differential we've come up with!
So let's start simple. What was that lesion in the prior tweet?
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That was a PATCH of vitiligo.
PATCHES are flat lesions >1 cm wide, whereas MACULES are flat lesions <1 cm wide! Check out photo #1 of perioral vitiligo where macules are coalescing into patches!
In #2, you can see both macules and patches in these Cafe au lait lesions.
That was a PATCH of vitiligo.
PATCHES are flat lesions >1 cm wide, whereas MACULES are flat lesions <1 cm wide! Check out photo #1 of perioral vitiligo where macules are coalescing into patches!
In #2, you can see both macules and patches in these Cafe au lait lesions.
4/
If lesions are raised, they are called PAPULES (<1 cm wide) or PLAQUES (>1 cm wide).
In #1, there's a brown plaque (seborrheic keratosis), & red papules (cherry angiomas).
#2/#3 are examples of papules/plaques of psoriasis in light & dark skin!
pc: healthline.com/health/psorias…
If lesions are raised, they are called PAPULES (<1 cm wide) or PLAQUES (>1 cm wide).
In #1, there's a brown plaque (seborrheic keratosis), & red papules (cherry angiomas).
#2/#3 are examples of papules/plaques of psoriasis in light & dark skin!
pc: healthline.com/health/psorias…
5/
Let's throw in a bit of nuance.
Did you know that papules and plaques actually don't have to be raised? We call things that are atrophic, papules and plaques too!
ANY change in skin elevation is a papule or plaque. Check out this linear atrophic plaque of morphea!
Let's throw in a bit of nuance.
Did you know that papules and plaques actually don't have to be raised? We call things that are atrophic, papules and plaques too!
ANY change in skin elevation is a papule or plaque. Check out this linear atrophic plaque of morphea!
6/
Next up, nodules and tumors. They are deeper seated than plaques; it's honestly sometimes a judgement call. Some people say nodules are >1 cm in depth (but it's almost impossible to measure).
I'd call this a NODULE (of sweets syndrome) and TUMOR stage mycosis fungoides.
Next up, nodules and tumors. They are deeper seated than plaques; it's honestly sometimes a judgement call. Some people say nodules are >1 cm in depth (but it's almost impossible to measure).
I'd call this a NODULE (of sweets syndrome) and TUMOR stage mycosis fungoides.
7/
VESICLES AND BULLAE -
Vesicles are fluid filled lesions <1 cm wide, and Bullae are fluid filled and >1 cm wide!
#1 and #2 are zoster in light and dark skin, where we see vesicles.
#3 is bullous pemphigoid, where we see tense bullae!
pc for #2: ejdv.eg.net/viewimage.asp?…
VESICLES AND BULLAE -
Vesicles are fluid filled lesions <1 cm wide, and Bullae are fluid filled and >1 cm wide!
#1 and #2 are zoster in light and dark skin, where we see vesicles.
#3 is bullous pemphigoid, where we see tense bullae!
pc for #2: ejdv.eg.net/viewimage.asp?…
8/
A PUSTULE is anything filled with pus! See the pic of pustular psoriasis!
BTW, the adjective for this is "purulent," not... you know....
Nb: any vesicle or bulla that is left alone long enough will fill with pus, so it's important to ask how long a lesion has been present!
A PUSTULE is anything filled with pus! See the pic of pustular psoriasis!
BTW, the adjective for this is "purulent," not... you know....
Nb: any vesicle or bulla that is left alone long enough will fill with pus, so it's important to ask how long a lesion has been present!
9/
While we're talking about pustules, I want to emphasize that patients with darker skin have a different exam; erythema is harder to see.
Check out both these photos of miliaria (aka sweaty back rash) that is pustular. The pink in #2 is still there, just less obvious.
While we're talking about pustules, I want to emphasize that patients with darker skin have a different exam; erythema is harder to see.
Check out both these photos of miliaria (aka sweaty back rash) that is pustular. The pink in #2 is still there, just less obvious.
10/
Okay, last one - WHEALS. These are funny, because we use this to mean hive-like.
But really, they are just papules and plaques that are edematous when you look at them. For that reason, usually we don't see scale since there isn't any epidermal action!
Okay, last one - WHEALS. These are funny, because we use this to mean hive-like.
But really, they are just papules and plaques that are edematous when you look at them. For that reason, usually we don't see scale since there isn't any epidermal action!
11/
RECAP: THE PRIMARY LESION
✅Flat: macules (<1 cm), patches (>1 cm)
✅Raised/depressed: papules (<1 cm), plaques (>1 cm)
✅Deeper seated: nodules and tumors
✅Fluid filled: vesicles (<1 cm), bullae (>1 cm)
✅Pustule: pus filled
✅Wheals: hive-like
✅Exam first, history 2nd
RECAP: THE PRIMARY LESION
✅Flat: macules (<1 cm), patches (>1 cm)
✅Raised/depressed: papules (<1 cm), plaques (>1 cm)
✅Deeper seated: nodules and tumors
✅Fluid filled: vesicles (<1 cm), bullae (>1 cm)
✅Pustule: pus filled
✅Wheals: hive-like
✅Exam first, history 2nd
12/12
Thanks for joining! I know other folks on #dermtwitter have put out similar threads in the past (@HarkerDavid); I couldn't find it, so why not have another!
Also, if you like to learn in video format:
Join me for another #Derm101 #tweetorial soon!
Thanks for joining! I know other folks on #dermtwitter have put out similar threads in the past (@HarkerDavid); I couldn't find it, so why not have another!
Also, if you like to learn in video format:
Join me for another #Derm101 #tweetorial soon!
