Skin Lesions - Ways to identify and treat them responsibly

A skin lesion is any modification in your skin's typical appearance. A skin lesion can appear anywhere on the body and can cover a little or huge region. Skin lesions can be single or many, localized to a single part of the body or widely dispersed. Rashes, cysts, pus-filled sacs, blisters, swelling, discolorations, lumps, hardening, or any other change in or on your skin are examples of skin lesions. Lesions on the skin can be caused by a variety of factors, ranging from something as minor as a scrape to something as dangerous as skin cancer. 

A few lesions on the skin may not be serious. But, when a new lump forms, it may be hazardous. It is critical to understand the appearance of the most frequent skin lesions so that you can detect them and avoid becoming overly concerned. If you still need help, do not hesitate in reaching out to your dermatologist. Some of the most common types of skin lesions include:

• Seborrheic Keratosis: Seborrheic keratosis, often known as senile warts, are non-cancerous lesions. The patches or lesions have a slight elevation. They have a scaly or waxy texture and are light brown, tan, or black. Except for the soles of the feet and the palms of the hands, senile warts can occur anywhere on the body. 

• Dermatosis Papulosa Nigra: Dermatosis Papulosa is a skin condition that mostly affects people with a darker complexion. It usually begins in adolescence. The papules on the skin are little and darkly pigmented blemishes. 

• Stucco Keratosis: Stucco Keratosis is another non-cancerous skin condition. Stucco keratosis lesions are usually white or grey and are quite tiny and commonly found on the feet or ankles. 

• Skin Tags: Acrochordons, often known as skin tags, are quite frequent. Skin tags are harmless skin growths. The tiny papule of the skin tag will protrude from a little bit of flesh, giving it the appearance of a tag.

• Cherry Angiomas: Cherry Angiomas develop when the capillaries near the skin's surface become clogged with blood vessels. This results in the formation of crimson papules.

• Dermatofibroma: Dermatofibroma is a skin tumour that has a round shape, is firm, and is reddish-purple or brown. It is most commonly found on the legs. 

• Solar Lentigo: Solar lentigo is a darker area of skin and is harmless. It is caused by exposure to ultraviolet (UV) light, which induces localised melanocyte proliferation and melanin build-up within skin cells (keratinocytes). Solar lentigos, also known as lentigines, are quite common in people over the age of 40.

• Sebaceous Hyperplasia: Sebaceous Hyperplasia is a condition in which the sebaceous gland of the skin gets enlarged. Small papules with a centre indent characterise this disease. The papules are usually the same or yellowish hue as the skin.

• Epidermal Inclusion Cyst: EICs are a common form of a cutaneous cyst. This cyst develops in the hair follicles rather than the oil glands. When this develops, it's frequently misdiagnosed as an infection of some sort. There is no need for therapy if the cyst is asymptomatic. Excision can be used to eliminate the cyst if desired.

• Lipoma: Lipoma is a type of skin disease that occurs when fat gathers beneath the skin. The lesion will be mild and will cease developing once it reaches a few millimetres in diameter. Lipoma is treated via elective surgery.

14 types of primary skin lesions 

Primary lesions on the skin might be present at birth or develop over the course of your life. They can be linked to a specific cause or be a response to either internal or external factors. The types of primary lesion include:

• Bulla: A vesicle packed with fluid that is larger than 0.5 centimetres (cm) or 1/5 of an inch.

• Papule: Papules are elevated lesions that frequently appear in groups. A plaque is a collection of papules or nodules. Psoriasis is characterised by plaques. Papules can appear as a result of viral illnesses like measles or mosquito bites.

• Patch: A non-palpable, flat lesion with a different hue and a diameter of more than 0.5 cm is known as a patch.

• Pustules: Pustules are pus-filled sores on the skin. Pustules include boils and abscesses, for example.

• Wheals: Wheals are swollen, elevated bumps or plaques that occur on the skin unexpectedly. An allergic reaction is the most common reason. For instance, hives (also known as urticaria), bug bites, and so forth.

• Birthmark: The most frequent type of primary skin lesion is a birthmark. Moles, port-wine stains, nevi, and other similar conditions are among them.

• Cyst: A cyst is a raised, confined region of skin that is filled with liquid or semi-solid fluid.

• Macule: Another type of skin lesion are Macules that are small, flat sores on the skin. They're tiny (less than a centimetre in diameter) and brownish or reddish. Macules are freckles and flat moles, for example. In measles, a macular rash is prevalent.

• Blisters: Blisters are small, clear-fluid-filled skin lesions that are less than half a centimetre in diameter. Small blisters are known as vesicles, whereas larger blisters are known as bullae. Burns (including sunburns), viral infections (herpes zoster), friction from shoes or clothing, bug bites, pharmacological responses, and other factors can produce blisters.

• Plaque: Plaque is a firm, rough, and flat-topped plaque that is greater than 1-2 cm in diameter and elevated like a papule.

• Vesicle: A vesicle is a small, fluid-filled blister that is smaller than 0.5 cm in diameter.

• Nodules: Nodules are elevated lesions on the skin that are smaller than two millimetres in diameter and can be soft or hard. Neurofibromatosis and leprosy are two disorders that produce nodules.

• Telangiectasia: This type of skin lesion is characterised by clusters of 'spider veins,' which are small blood vessels that form red lines on the skin.

• Tumor: A tumor that is greater than 0.5 cm in diameter but looks like a nodule. They can be either benign or cancerous.

9 types of secondary skin lesions 

Secondary skin lesions form after original skin lesions or as a result of an injury and become inflamed and irritating. The following are the most common examples of secondary lesions on the skin:

• Atrophy: In this condition, the skin becomes paper-thin, translucent, and wrinkled, usually as a result of the use of a topical medication such as topical steroids.

• Crust: A crust, also known as a scab, is a type of skin lesion that develops on top of a scratched, damaged, or irritated original skin lesion. It is made up of dried secretions from the skin.

• Erosion: Erosion is the loss of the epidermis, which appears moist and shiny.

• Excoriation: Linear scratches that result in epidermal loss are known as excoriation.

• Fissure: Linear cracks in the skin that continue deeper than the epidermis into the dermis are called fissures. Excessive dryness can cause them, which can be unpleasant.

• Maceration: When skin is exposed to water or fluid for an extended period, it becomes wet, wrinkled, and lighter in color. This can happen as a result of leaking wounds caused by poor wound management.

• Scales: Scales are clumps of skin cells that pile up and break off the surface of the skin. Patches are common in psoriasis, and removing them causes bleeding.

• Ulcers: An ulcer is a break in the skin's or mucosa's continuity. Infections or trauma can create skin ulcers. Ulcers are more likely to develop if you have poor blood circulation, diabetes, smoke, or are bedridden.

• Skin atrophy: Skin atrophy develops when the skin becomes thin and wrinkled in some regions. This type of skin lesion can be caused by regular use of steroid creams, radiation therapy, or poor blood circulation.

What is the difference between a malignant skin lesion and a benign skin lesion?

Let's first define the two types of skin lesions:

What is a Malignant Skin Lesion?

By definition, a malignant skin lesion is skin cancer. Keratinocyte carcinoma and melanoma are the two most common kinds of skin cancer. Skin cancer can manifest itself in a variety of ways, including fast-growing lesions on the skin, changes in the color or size of a pre-existing lesion, or a scabbing sore that does not heal with time. 

What would be a typical appearance of a malignant skin lesion?

Basal cell carcinoma and squamous cell carcinoma are two types of keratinocyte carcinoma that emerge from skin cells called keratinocytes. Basal cell carcinoma can look like a pearly, flesh-colored skin lesion with telangiectasias (superficial blood vessels) on top. Basal cell carcinoma can appear as a scaling plaque or a non-healing sore that bleeds or forms a crust. Squamous cell carcinoma, on the other hand, is typically characterised by a thick, crusty sore with a reddish, inflammatory base that can ulcerate (look like an open sore) and bleed. Melanoma develops from melanocytes, which are skin cells.

What is a benign skin lesion?

A benign skin lesion is a noncancerous growth, tumor, or anomaly that can appear anywhere on the body. Depending on the source and tissue of origin, benign lesions can appear in a variety of ways. Most melanocytic nevi, also known as Moles, Seborrheic Keratoses, Skin Tags, Cherry Angiomas, and Lipomas are examples of benign skin lesions. Unless they create symptoms like discomfort or itching, these lesions are usually harmless and don't require treatment. Unless they create symptoms like discomfort or itching, these lesions are usually harmless and don't require treatment.

What would be a typical appearance of a malignant skin lesion?

In contrast to malignant skin lesions, benign skin lesions are usually symmetrical, well-circumscribed, uniform in appearance, and remain stable or increase slowly over time. Premalignant lesions, such as Actinic Keratosis or Lentigo Maligna, should be recognised from benign lesions since they have a higher risk of evolving into various types of skin cancer. Long-term unprotected sun exposure causes both Actinic Keratosis And Lentigo Maligna. Actinic keratosis manifests as dry, scaly patches of skin on sun-exposed areas such as the nose and forehead, whereas Lentigo Maligna manifests as localised dark-brown or black lesions on the face and trunk.

Skin lesions frequently arise as a result of bacterial or viral infections, or when your immune system reacts to an allergen.

• Acne: Acne is most commonly shown as papules, although it can also manifest as pustules, nodules, or cysts. It's most common on the face, neck, chest, and upper back, and if left untreated, it can cause scars. When your pores become clogged with sebum (oil) or dead skin, acne develops. Overproduction of a specific type of bacteria on the skin can also cause it.

• Actinic Keratosis: Exposure to sunlight (ultraviolet radiation) causes actinic keratosis, which manifests as thick, scaly crusts on the skin. Because it is produced by years of sun exposure, it usually does not emerge until later in life (most commonly beyond the age of 40).

• Blisters: Blisters are skin blisters that are filled with fluid and can be caused by friction (for example, when walking in a shoe that rubs on your foot) or by a burn, a skin disorder, or an allergic reaction.

• Cellulitis: A skin infection caused by bacteria or fungi invading the skin is known as cellulitis. The skin becomes reddened, puffy, irritated, and prone to fluid leakage. It's hot to the touch and might give you a fever and make you feel ill.

• Chickenpox: Chickenpox, often known as varicella, is a contagious skin condition caused by a virus. It causes hot, itchy blisters with red, fluid-filled blisters all over the body. These blisters are prone to oozing pus and subsequent crusting. From two days before the rash emerges until all of the blisters have closed over, chickenpox remains contagious.

• Shingles: The varicella-zoster virus causes shingles, which is the same virus that causes chickenpox. The virus remains inactive in nerve tissue near your spinal cord and brain after you've experienced chickenpox. The virus can return as shingles years later.

• Cold Sores: Cold sores are lesions that appear on the lips and mouth. They can be red, painful, and generate blisters that are filled with fluid. Before the sore appears, there is often a tingling sensation. People with cold sores may also have flu-like symptoms since cold sores are caused by the herpes simplex virus (HSV).

• Contact Dermatitis: An allergen or substance that irritates the skin causes contact dermatitis. Symptoms are usually limited to the area where the irritant comes into contact with the skin. Redness, itching, macules, papules, fissures, blisters, swelling, and soreness to the touch are all symptoms. Plaques are common in chronic contact dermatitis.

• Eczema: Atopic dermatitis is another name for eczema. It appears as a scaly, red rash. Other signs and symptoms include skin patches that are red, grey, brown, or yellow, itching, dryness, blisters, fissures, plaques, and sensitive and painful regions. Certain factors, such as hot or cold temperatures, might exacerbate symptoms, and some skin products can aggravate.

• Freckles: Sun exposure causes freckles, which are little, flat light-brown macules on the skin. The majority of freckles are innocuous, and only a small percentage of them progress to skin cancer.

• Moles: A melanocytic nevus, or simply a nevus, is another name for a mole. They commonly appear as spherical brown/pink macules, papules, or nodules on the skin. They can appear at any age and can be found anywhere on the body.

• Keloids: Keloids come in a variety of colours, from flesh to scarlet. They are elevated scars that appear after an accident or trauma and are produced by scar tissue proliferation. They are frequently irritating and inconvenient.

• Psoriasis: Red, flaky skin, crusty areas of skin, and silvery skin scales are all symptoms of psoriasis. It also has the potential to itch and burn. The body creates skin cells too quickly in psoriasis, over days rather than weeks. Excessive skin cell development results in thick, elevated, scaly patches.

• Scabies: Scabies is caused by a mite and is characterised by severe itching. A rash may appear in the form of little red papules, welts, or scaly lesions. Scratching repeatedly can lead to excoriation. If you have a mite allergy, your symptoms may get worse. Scabies can be treated with oral and topical treatments given by your doctor, which kill the mites.

• Sebaceous Cyst: Sebaceous cysts are spherical and keratin-filled. The nodules are hard and typically have a skin-colored appearance. They might be little or large, and they usually develop on the upper torso or face. They can also rupture.

• Skin Tag: Skin tags, also known as acrochordons, are small, skin-colored growths that are soft and itchy. They become more common as people get older. They normally do not need to be removed, and they do not require medical treatment unless they are causing cosmetic problems or are in an irritating position.

• Warts: The human papillomavirus causes warts (HPV). They are contagious and tend to appear in clusters. They are flesh-colored, elevated papules with tiny black specks in the centre. They are not hazardous, but they can be painful and readily spread. Common warts, plantar warts, flat warts, filiform warts, genital warts, and periungua warts are among the various types of warts.

• Impetigo: Impetigo is a bacterial skin infection caused by one or both of the following bacteria: group A Streptococcus and Staphylococcus aureus. It is more common in young children than in later ages. Red, itchy sores that break open and exude a clear fluid or pus for a few days are symptoms.

Since skin lesion is a broad term, the causes between each kind of lesion is typically significantly different than the next.

• Mole (nevus) – Skin cells producing pigment (melanocytes) grow in clusters.

• Skin tags – Unknown.

• Cyst – A sac-like pocket fills with fluid or another substance due to duct blockage, disease, infection, or inflammation.

• Lipoma – It is unknown why, but fat cells overgrow into a lump under the skin.

• Angioma – It is unknown why, but blood vessels overgrow to form angiomas.

• Dermatosis papulosa nigra – Unknown, but the darker one’s skin, the more likely one would get it.

• Actinic keratoses – UV rays from sun exposure and tanning damage skin over time, and the accumulation of that damage causes abnormal skin growth.

• Seborrheic keratoses – Unknown.

The physical examination and medical history are used to diagnose skin lesions. Examining the colour, size, form, depth, and position of the lesion, as well as comparing it to other lesions is part of the physical examination. Under a magnifying glass, dermoscopy can be used to evaluate skin lesions. Under a black light, a Wood's lamp examination can be done to evaluate specific skin problems. Additionally, certain parts of the medical history, such as sun exposure, allergies, current medications, contact with irritants, past malignancy, and family history, can provide useful information in guiding the diagnosis.

Further diagnostic testing may be required for some lesions on the skin. Blood tests, allergy testing, skin or wound swabs for microbiological investigations, and imaging procedures like an X-ray or CT scan are examples of these. Finally, a biopsy can be conducted if the diagnosis is still unclear or if malignancy is suspected.

Treatment for skin lesions varies based on the type of lesion and whether or not it is malignant. Some benign lesions may not require treatment and can be monitored with regular visits to a dermatologist or medical practitioner.

• Prescribed medication: Topical medicines are frequently used as first-line therapies to reduce inflammation and protect the damaged area. Topical medication like such as retinoids, corticosteroids, or antimicrobial agents can help with mild symptom relief, such as pain, itching, or burning produced by a skin lesion. If your skin lesions are caused by a systemic infection like chickenpox or shingles, you may be given oral drugs to aid with the disease's symptoms.

• Over the Counter Medication: While some over-the-counter (OTC) drugs are effective enough to be prescribed, others have limited properties to fight the disease. They may be beneficial in mild to moderate cases, but they are rarely useful in severe cases. They may even prove useless and cause unintended negative effects if taken properly and without assistance. Chemical peel is one such example of OTC; it exfoliates the skin to enhance cell turnover and promote healthier skin, which results in growth such as actinic keratoses.

• Surgical procedures: To provide therapy and alleviation, infected skin lesions are routinely punctured and drained. Suspicious-looking moles that have changed over time may require surgical removal. Hemangioma is a type of birthmark caused by faulty blood vessels. This type of birthmark is commonly treated with laser surgery.

• Self-care at home: While home cures have become increasingly popular, there are few research that back up their usefulness. In other circumstances, their minimal usefulness vs the unknown negative effects they may have on your body may cause more harm than benefit. It's advisable to follow a dermatologist's recommendations because they know what will and won't work to treat the disease. However, if you still want to try using a home remedy, you use oatmeal bath products, oatmeal lotions, absorbent baby powder, and anti-chafe balm, to name just a few.

If you have a concerning growth, you should consult a dermatologist to determine the best course of action. If your growth is deemed harmful, it may be better to have it removed by a dermatologist and allow it to recover with minimal damage to your skin's appearance.

Once you have been given a treatment plan and prescription(s) by one of our SkyMD dermatologists, you must ensure long-term prevention of the lesion by following a skincare routine and a set of disease-prevention behaviours prescribed by our dermatologists. Here are some common preventative techniques that can be used in combination with your personalized treatment plan:

• Always apply a protective sunscreen since it lowers the chance of acquiring malignant and premalignant skin disorders.
• Before contacting the affected region, make sure your hands are clean.
• If you've had a surgical procedure for removal lesion on skin, keep the area clean and dry by cleaning it once or twice a day, and see your dermatologist at regular intervals to ensure that the wound is healing properly.

Conclusion

If you have any concerns about a skin lesion, you should consult a doctor, preferably a dermatologist, for diagnosis, assistance, and advice. Any sudden changes in a lesion should be taken seriously. Although skin lesion alterations are less likely to be caused by cancer, early detection and treatment almost always result in better outcomes. As a result, if you observe changes in your skin, consult a dermatologist.

Our dermatologists at SkyMD are available for consultation through video conference or chat. Visit our app, fill in the relevant information, and connect with one of our board-certified dermatologists. Whatever method you choose, we're here to put an end to all of your concerns about any type of skin lesion. 

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• Dry Skin Patches
• Bullae
• Seborrheic Keratosis
• Actinic Keratosis
• Facial lesions