Integumentary system: Skin lesions

Skin lesions can include any abnormal area of the skin, so there are several terms to describe them. Let’s start with macules, which are flat lesions with a clear border up to 1 centimeter in diameter; patches are similar to a macule but are larger than 1 centimeter.

Papules are raised bumps that are up to 1 centimeter in diameter, while plaques are like papules but larger than 1 centimeter. A smooth papule or plaque that is transient, meaning that it comes and goes, is called a wheal.

Pustules are blisters filled with pus. Vesicles are clear blisters filled with fluid that are up to 1 centimeter in diameter, while bullae are fluid-filled blisters larger than 1 centimeter.

Scales are accumulations of thickened skin on the surface, which become dry and flaky and sometimes peel off. Crusts are dry exudates, which is the liquid that leaks out of blood vessels, containing cells, sebum, pus, or blood.

Now, lesions can appear in groups and form a rash, which includes any skin eruption. Rashes that are limited to one area are called localized, while rashes that occur all over the body are called systemic.

In addition, there are four categories based on how they look: maculopapular, vesicular, petechial or purpuric, and desquamating rashes. As the name suggests, a maculopapular rash has both macules and papules.

A vesicular rash has vesicles. Petechial and purpuric rashes both have flat red-brown spots that represent bleeding into the skin. If the spots are smaller than 2 mm in diameter, it’s a petechial rash; if the spots are larger than 2 mm, it’s a purpuric rash.

Finally, there are desquamating rashes, which cause peeling of the skin, like after a sunburn. Now, rashes can have many different causes, and specific care depends on which rash a client has.

Rashes may be caused by systemic infections in which the skin itself isn’t infected but develops a rash as a sign of an infection occurring somewhere inside the body.

As an example, clients with shingles, which is caused by varicella zoster virus, have a painful vesicular rash that usually forms a red, belt-like strip on the body.

Rashes can also be caused by direct skin contact with a trigger substance, causing a localized pruritic rash, called contact dermatitis. Triggers can include poison ivy; metals, like nickel; cosmetics; soaps and cleansers; bleach; and latex.

Another type of rash is atopic dermatitis, or eczema, which results from an allergy and is characterized by dryness, itching, and redness.

Atopic dermatitis can worsen in the presence of allergens, like cigarette smoke, mold, and dust mites, as well as changes in the weather and even emotional stress.

Moving on: A wound is an injury to the skin and, sometimes, its underlying tissue. Wounds can be classified as intentional or unintentional.

Intentional wounds are planned and carefully made by a healthcare professional for therapeutic purposes and interventions, such as surgical incisions or when placing medical devices, IV lines, or other tubes.

On the other hand, unintentional wounds are unplanned and are typically the result of trauma from violence or accidents or from a car crash or a fall.

Now, unintentional wounds can be further classified as closed or open. A bruise or contusion is a good example of a closed wound. It’s caused by trauma to the body where the skin over the damaged area remains intact.

On the other hand, if there is a break in the skin, the wound is open. There are different types of open wounds. Abrasions are the most superficial ones in which there’s a wearing or rubbing away of the skin due to friction.

Abrasions rarely bleed. An excoriation is similar to an abrasion but usually a bit deeper, caused by the scraping away of the skin and its underlying tissue. For this reason, excoriations tend to bleed.

Finally, a fissure is a long and narrow crack in the skin that’s often caused by extreme dryness and can present with pain and bleeding. Lacerations are deep cuts with torn tissue and jagged edges.

A skin ulcer is an unhealed sore or open wound that can appear when the tissue dies and sheds. The skin surrounding an ulcer can be red, swollen, and tender.

Some ulcers may even reach subcutaneous fat or deeper tissues. Now, skin ulcers can have many causes and types, and this is important to determine in order to give proper care.

A common type of skin ulcer is the venous stasis ulcer; these are caused by poor blood flow through the veins in the legs, which deprives the overlying skin and tissue of oxygen and nutrients, causing it to die.

Venous stasis ulcers may be associated with signs and symptoms like pain, leg edema, varicose veins, and brown discoloration.

Another type of painful ulcers are pressure ulcers, also known as bedsores or decubitus ulcers. Pressure ulcers usually appear in clients who aren’t moving about, like those on chronic bedrest or consistently in a wheelchair.