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Pressure ulcer stages, primary, secondary, & vascular skin lesions.

Stage I Pressure Ulcer

Skin is unbroken but appears red; no blanching when pressed.

Stage II Pressure Ulcer

Skin is broken, and there is superficial skin loss involving the epidermis alone or also the dermis. The lesion resembles a vesicle, erosion, or blister.

Stage III Pressure Ulcer

Pressure are involves epidermis, dermis, and subcutaneous tissue. The ulcer resembles a crater. Hidden areas of damage may extend through the subcutaneous tissue beyond the borders of the external lesion but not through the underlying fascia.

Stage IV Pressure Ulcer

Pressure are involves epidermis, dermis, subcutaneous tissue, bone, and other support tissue. The ulcer resembles a massive crater with hidden areas of damage in adjacent tissue.

Macule

Flat, non-palpable skin color change. Circumscribed border. This particular lesion is LESS than 1 cm. (ie: freckles, flat moles)

Patch

Flat, non-palpable skin color change. Irregular border. This particular lesion is GREATER than 1 cm. (ie: port wine stains, ecchymosis)

Papule

Elevated, palpable, solid mass; circumscribed border. This particular lesion is LESS than 0.5 cm. (ie: warts)

Plaque

Elevated, palpable, solid mass; circumscribed border. This particular lesion is GREATER than 0.5 cm. (may be coalesced papule with flat top) {ie: psoriasis}

Nodule

Elevated, solid, palpable mass; extends deeper into dermis than papule. This particular lesion is 0.5-2 cm; circumscribed. (ie: squamous cell carcinoma)

Tumor

Elevated, solid, palpable mass; extends deeper into dermis than papule. This particular lesion is GREATER than 1-2 cm; does not always have sharp borders. (carcinoma)

Vesicle

Circumscribed elevated, palpable mass containing serous fluid. This particular lesion is LESS than 0.5 cm. (ie: herpes zoster, varicella, poison ivy)

Bulla

Circumscribed elevated, palpable mass containing serous fluid. This particular lesion is GREATER than 0.5 cm. (ie: contact dermatitis, large burn blisters)

Wheal

Elevated mass with transient borders, often irregular. Size and color vary. Caused by movement of serous fluid into the dermis; does NOT contain free fluid in a cavity. (ie: hives, insect bites)

Pustule

Pus-filled vesicle or bulla. (ie: acne, impetigo, carbuncles, furuncles)

Cyst

Encapsulated fluid-filled or semi-solid mass; located in the subcutaneous tissue or dermis.

Erosion

Loss of superficial epidermis, but does not extend to dermis. Depressed moist area. (ie: ruptured vesicles, scratches)

Ulcer

Skin loss extending past epidermis, necrotic tissue loss, bleeding & scarring possible. (ie: pressure ulcer)

Scar

Skin mark left after healing of wound or lesion, represents replacement by connective tissue, can be young- red or purple, or mature- white or glistening (ie: healed wound)

Fissure

Linear crack in the skin, may extend to the dermis. (ie: chapped lips)

Scales

Flakes secondary to desquamated, dead epithelium, may adhere to skin surface. (ie: dandruff, psoriasis)

Crust

Dried residue of serum, blood, or pus on skin surface, large one maybe a scab. (ie: residue left after ruptured vesicle)

Keloid

Hypertrophied scar tissue, secondary to excessive collagen formation during healing, greater incidence in African Americans. (ie: after ear piercing)

Atrophy

Thin, dry, transparent appearance of epidermis, loss of surface markings, underlying vessels may be visible. (ie: aged skin)

Lichenification

Thickening & roughening of the skin, accentuated skin markings, may be secondary to repeated rubbing, irritation, or scratching. (ie: contact dermatitis)

Petechia

Round red or purple macule, associated with bleeding tendencies or emboli to skin.

Ecchymosis

Larger than petechia, this lesion is a round or irregular macule with varying color, and is associated with trauma & bleeding tendencies.

Hematoma

A localized collection of blood creating elevated ecchymosis, associated with trauma.

Cherry Angioma

Papular and round, red or purple, may blanch with pressure, normal age-related skin alteration, usually not clinically significant.

Spider Angioma

Red, arteriole lesion, central body with radiating branches, associated with liver disease, pregnancy, and Vitamin B deficiency.

Telangiectasis

Spider-like or linear, bluish or red in color, does not blanch, associated with increased venous pressure states.

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