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Learn the 10 primary skin lesions, which include macule, papule, nodule, plaque, tumor, vesicle, pustule, bulla, wheal, and burrow.

Skin lesions are relatively common and frequently arise due to localized skin injury.

Primary skin lesions are color or texture alterations that occur at birth or develop over time. They are the first signs of a disease process.

The 10 primary skin lesions include:

1. Macule: A macule is a unique skin discoloration that may be red, brown, tan, or white, is flat with defined borders, and is less than 1 cm in diameter. It does not affect the texture or thickness of the skin. Visually, macules are noticeable.
2. Papule: A papule is a raised skin region with no apparent fluid and has a diameter of up to 1 cm. It is bordered and comes in various forms.
3. Nodule: A nodule is bigger than a papule; it is raised protrusion on the skin that is firm and easily palpable and is usually greater than 1 cm in diameter. It can appear in all skin layers, including the epidermis, dermis, and subcutaneous tissue.
4. Plaque: A plaque is a flat-topped, elevated lesion that is more than 1 cm in diameter. It is frequently red, scaly, and irritating. Plaques are more common on the scalp, elbows, and knees. They are of irregular shape, rough to touch, and have a rough texture.
5. Tumor: A tumor is a solid mass that develops on the skin or subcutaneous tissue (under the skin). It is firm and normally measures more than 2 cm in length.
6. Vesicle: A vesicle is a raised bump with a diameter of less than 1 cm that is filled with transparent liquid.
7. Pustule: A pustule is a tiny skin lump that looks like a vesicle or bulla, but it contains pus. It can become infectious although not necessarily, as in pustular psoriasis.
8. Bulla: A bulla is a fluid-filled sac that develops when fluid becomes trapped under the skin's thin layer. It is comparable to a blister and vesicle; however, it has a bigger diameter than 1 cm.
9. Wheal: A wheal is an irregularly shaped patch of edematous skin that is uneven in size or shape. It is swelling of the skin that may seem white, pink, or red and may be itchy. It generally arises due to a stimulus, such as an insect bite or food allergies. It is sometimes referred to as welts or hives.
10. Burrow: A burrow is a tunnel that grows in the skin and shows up as linear markings. It is caused by parasitic infestations of the skin such as scabies mites.

What causes primary skin lesions?

Primary skin lesions may be inherited, such as moles, freckles, or birthmarks, or acquired due to a range of disorders.

Infections are one of the most prevalent causes of skin lesions and include:

• Viruses
  • Herpes simplex
  • Human immunodeficiency virus
  • Human papillomavirus
• Bacteria
  • Staphylococcus species
  • Streptococcus species
• Fungi
  • Candida albicans

Allergic reactions such as allergic eczema or contact dermatitis occur due to a side effect to the following:

• Certain medications such as corticosteroids or chemotherapy
• Contact with irritant substances
• Unprotected sun exposure 
• Severe burns
• Insect bites

Certain conditions cause skin sensitivity, leading to lesions, which include:

• Poor circulation
• Vitamin deficiencies
• Systemic diseases
  • Autoimmune diseases such as diabetes and systemic lupus erythematosus
  • Some infectious diseases
  • Liver and kidney disease
  • Cancer

What are the risk factors for primary skin lesions?

Risk factors for primary skin lesions include:

• Genetically inherited traits that run in the family for the development of moles or freckles are born with these two lesions.
• People who are sensitive to allergens and tend to experience allergies develop skin lesions frequently.
• People with autoimmune diseases, such as those with diabetes, who have sensitive skin and psoriasis are at risk of skin lesions throughout their life.

Ringworm is caused by a fungus.
See Answer

7 ways to diagnose a skin lesion

A dermatologist makes a diagnosis of a skin lesion after a thorough physical examination and detailed medical history.

If examining your skin doesn't provide clear results, your doctor may conduct tests, such as:

1. Dermoscopy examination: Dermoscopy, also known as a dermatoscopy examination, is done using a small hand-held microscope called a dermatoscope that is used to diagnose skin lesions.
2. Wood light examination: A wood light utilizes ultraviolet light to examine the skin pigment and evaluate lesions. The skin color appears different from one condition to another.
   • Erythrasma: Coral pink
   • Pseudomonas wound infections: Blue
3. Diascopy: A microscopic slide is pressed against a skin patch to observe for changes in the skin color (blanching) when pressure is applied. This test distinguishes between a hemorrhagic and fluid-filled lesion where blanching is not seen in hemorrhagic lesions.
4. Biopsy: To make a diagnosis, a small sample of skin from the affected area is taken to perform a biopsy in which the sample is studied under a microscope.
5. Culture: A small sample of the skin is collected to test for the presence of infection-causing bacteria, viruses, or fungi.
6. Skin patch test: To check for allergic reactions, certain substances are applied on the skin and observed for hypersensitivity reactions after a period.
   • Vitiligo: White
7. Tzanck test: This test is done to examine the fluid-filled within the vesicles and detect the presence of cells. It is usually done to detect herpes simplex or herpes zoster.

What are the treatment options for primary skin lesions?

The treatment of a skin lesion depends on underlying causes. Your doctor may treat you considering various aspects, such as the type of the lesion, medical history, and previously attempted treatments.

Medical treatment

Dermal lesion treatment depends on the type and origin of the lesion. Treatment options range from local treatments using topical medications for milder cases to oral drugs for systemic infections.

• Topical medicines such as retinoids, corticosteroids, and antimicrobial agents are frequently used as first-line treatments to assist reduce inflammation and protecting the damaged region.
• Topical medicine can give modest symptom alleviation such as relief from pain, itching, or burning produced by a skin lesion.

If your skin lesions are caused by a systemic illness, such as chickenpox or shingles, you may be offered oral drugs to alleviate the disease's symptoms, including skin lesions.

Surgery

In certain circumstances, surgical excision of the lesion is necessary, which is often performed by curettage, cryotherapy, or laser treatment.

To treat and alleviate symptoms, infected skin lesions are routinely perforated and drained.