The Info List - Lichenification

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A cutaneous condition is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, hair, nails, and related muscle and glands.[1] The major function of this system is as a barrier against the external environment.[2] Conditions of the human integumentary system constitute a broad spectrum of diseases, also known as dermatoses, as well as many nonpathologic states (like, in certain circumstances, melanonychia and racquet nails).[3][4] While only a small number of skin diseases account for most visits to the physician, thousands of skin conditions have been described.[5] Classification of these conditions often presents many nosological challenges, since underlying causes and pathogenetics are often not known.[6][7] Therefore, most current textbooks present a classification based on location (for example, conditions of the mucous membrane), morphology (chronic blistering conditions), cause (skin conditions resulting from physical factors), and so on.[8][9] Clinically, the diagnosis of any particular skin condition is made by gathering pertinent information regarding the presenting skin lesion(s), including the location (such as arms, head, legs), symptoms (pruritus, pain), duration (acute or chronic), arrangement (solitary, generalized, annular, linear), morphology (macules, papules, vesicles), and color (red, blue, brown, black, white, yellow).[10] The diagnosis of many conditions often also requires a skin biopsy which yields histologic information[11][12] that can be correlated with the clinical presentation and any laboratory data.[13][14] The introduction of cutaneous ultrasound has allowed the detection of cutaneous tumors, inflammatory processes, nail disorders and hair diseases.[15]


1 Layer of skin involved

1.1 Epidermis 1.2 Dermis 1.3 Subcutaneous tissue

2 Diseases of the skin 3 History 4 Diagnoses 5 Lesions

5.1 Primary lesions 5.2 Secondary lesions 5.3 Configuration 5.4 Distribution 5.5 Other related terms

6 Histopathology 7 References

Layer of skin involved[edit] Main article: Integumentary system

The skin weighs an average of 4 kg (8.8 lb), covers an area of 2 m2 (22 sq ft), and is made of three distinct layers: the epidermis, dermis, and subcutaneous tissue.[1] The two main types of human skin are glabrous skin, the nonhairy skin on the palms and soles (also referred to as the "palmoplantar" surfaces), and hair-bearing skin.[16] Within the latter type, hairs in structures called pilosebaceous units have a hair follicle, sebaceous gland, and associated arrector pili muscle.[17] In the embryo, the epidermis, hair, and glands are from the ectoderm, which is chemically influenced by the underlying mesoderm that forms the dermis and subcutaneous tissues.[18][19][20] Epidermis[edit] Main article: Epidermis
(skin) The epidermis is the most superficial layer of skin, a squamous epithelium with several strata: the stratum corneum, stratum lucidum, stratum granulosum, stratum spinosum, and stratum basale.[21] Nourishment is provided to these layers via diffusion from the dermis, since the epidermis is without direct blood supply.[22] The epidermis contains four cell types: keratinocytes, melanocytes, Langerhans cells, and Merkel cells. Of these, keratinocytes are the major component, constituting roughly 95% of the epidermis.[16] This stratified squamous epithelium is maintained by cell division within the stratum basale, in which differentiating cells slowly displace outwards through the stratum spinosum to the stratum corneum, where cells are continually shed from the surface.[16] In normal skin, the rate of production equals the rate of loss; about two weeks are needed for a cell to migrate from the basal cell layer to the top of the granular cell layer, and an additional two weeks to cross the stratum corneum.[23] Dermis[edit] Main article: Dermis The dermis is the layer of skin between the epidermis and subcutaneous tissue, and comprises two sections, the papillary dermis and the reticular dermis.[24] The superficial papillary dermis interdigitates with the overlying rete ridges of the epidermis, between which the two layers interact through the basement membrane zone.[24] Structural components of the dermis are collagen, elastic fibers, and ground substance also called extra fibrillar matrix.[24] Within these components are the pilosebaceous units, arrector pili muscles, and the eccrine and apocrine glands.[21] The dermis contains two vascular networks that run parallel to the skin surface—one superficial and one deep plexus—which are connected by vertical communicating vessels.[21][25] The function of blood vessels within the dermis is fourfold: to supply nutrition, to regulate temperature, to modulate inflammation, and to participate in wound healing.[26][27] Subcutaneous tissue[edit] Main article: Subcutaneous tissue The subcutaneous tissue is a layer of fat between the dermis and underlying fascia.[5] This tissue may be further divided into two components, the actual fatty layer, or panniculus adiposus, and a deeper vestigial layer of muscle, the panniculus carnosus.[16] The main cellular component of this tissue is the adipocyte, or fat cell.[5] The structure of this tissue is composed of septal (i.e. linear strands) and lobular compartments, which differ in microscopic appearance.[21] Functionally, the subcutaneous fat insulates the body, absorbs trauma, and serves as a reserve energy source.[5] Diseases of the skin[edit] For a comprehensive list, see List of cutaneous conditions.

diseases deaths per million persons in 2012

  0–2   3–4   5–8   9–13   14–17   18–21   22–27   28–34   35–47   48–106

Diseases of the skin include skin infections and skin neoplasms (including skin cancer).[28] History[edit] In 1572, Geronimo Mercuriali
Geronimo Mercuriali
of Forlì, Italy, completed De morbis cutaneis (translated "On the diseases of the skin"). It is considered the first scientific work dedicated to dermatology. Diagnoses[edit] The physical examination of the skin and its appendages, as well as the mucous membranes, forms the cornerstone of an accurate diagnosis of cutaneous conditions.[29] Most of these conditions present with cutaneous surface changes termed "lesions," which have more or less distinct characteristics.[30] Often proper examination will lead the physician to obtain appropriate historical information and/or laboratory tests that are able to confirm the diagnosis.[29] Upon examination, the important clinical observations are the (1) morphology, (2) configuration, and (3) distribution of the lesion(s).[29] With regard to morphology, the initial lesion that characterizes a condition is known as the "primary lesion," and identification of such a lesions is the most important aspect of the cutaneous examination.[30] Over time, these primary lesions may continue to develop or be modified by regression or trauma, producing "secondary lesions."[1] However, with that being stated, the lack of standardization of basic dermatologic terminology has been one of the principal barriers to successful communication among physicians in describing cutaneous findings.[21] Nevertheless, there are some commonly accepted terms used to describe the macroscopic morphology, configuration, and distribution of skin lesions, which are listed below.[30] Lesions[edit] Primary lesions[edit]

Chigger bites on human skin showing characteristic welts

Macule and patch

and plaque


Vesicles and bulla

Fissures, erosions and ulcers

A pustule on the cheek

Macule: A macule is a change in surface color, without elevation or depression and, therefore, nonpalpable, well or ill-defined,[31] variously sized, but generally considered less than either 5[31] or 10 mm in diameter at the widest point.[30] Patch: A patch is a large macule equal to or greater than either 5 or 10 mm across,[30] depending on one's definition of a macule.[1] Patches may have some subtle surface change, such as a fine scale or wrinkling, but although the consistency of the surface is changed, the lesion itself is not palpable.[29] Papule: A papule is a circumscribed, solid elevation of skin with no visible fluid, varying in size from a pinhead to less than either 5[31] or 10 mm in diameter at the widest point.[30] Plaque: A plaque has been described as a broad papule, or confluence of papules equal to or greater than 1 cm,[30] or alternatively as an elevated, plateau-like lesion that is greater in its diameter than in its depth.[29] Nodule: A nodule is morphologically similar to a papule in that it is also a palpaple spherical lesion less than 1 cm in diameter. However, it is differentiated by being centered deeper in the dermis or subcutis. Tumour: Similar to a nodule but larger than 1 cm in diameter. Vesicle: A vesicle is small blister,[32] a circumscribed, fluid-containing, epidermal elevation generally considered less than either 5[31] or 10 mm in diameter at the widest point.[30] The fluid is clear serous fluid. Bulla: A bulla is a large blister,[32] a rounded or irregularly shaped blister containing serous or seropurulent fluid, equal to or greater than either 5[31] or 10 mm,[30] depending on one's definition of a vesicle.[1]

Pustule: A pustule is a small elevation of the skin containing cloudy[29] or purulent material (pus) usually consisting of necrotic inflammatory cells.[30] These can be either white or red. Cyst: A cyst is an epithelial-lined cavity containing liquid, semi-solid, or solid material.[31] Erosion: An erosion is a discontinuity of the skin exhibiting incomplete loss of the epidermis,[33] a lesion that is moist, circumscribed, and usually depressed.[21] Ulcer: An ulcer is a discontinuity of the skin exhibiting complete loss of the epidermis and often portions of the dermis and even subcutaneous fat.[33] Fissure: A fissure is a crack in the skin that is usually narrow but deep.[29] Weal: A weal is a rounded or flat-topped, pale red papule or plaque that is characteristically evanescent, disappearing within 24 to 48 hours. The temporary raised bubble of taut skin on the site of a properly-delivered intradermal injection is also called a welt, with the ID injection process itself frequently referred to as simply "raising a weal" in medical texts.[31] Telangiectasia: A telangiectasia represents an enlargement of superficial blood vessels to the point of being visible.[29] Burrow: A burrow appears as a slightly elevated, grayish, tortuous line in the skin, and is caused by burrowing organisms.[29][30]

Secondary lesions[edit]

Scale: dry or greasy laminated masses of keratin[30] that represent thickened stratum corneum.[29] Crust: dried sebum, pus, or blood usually mixed with epithelial and sometimes bacterial debris.[31] Lichenification: epidermal thickening characterized by visible and palpable thickening of the skin with accentuated skin markings.[1] Excoriation: a punctate or linear abrasion produced by mechanical means (often scratching), usually involving only the epidermis, but commonly reaching the papillary dermis.[30] Induration: dermal thickening causing the cutaneous surface to feel thicker and firmer.[29] Atrophy: refers to a loss of tissue, and can be epidermal, dermal, or subcutaneous.[30] With epidermal atrophy, the skin appears thin, translucent, and wrinkled.[29] Dermal or subcutaneous atrophy is represented by depression of the skin.[29] Maceration: softening and turning white of the skin due to being consistently wet. Umbilication: formation of a depression at the top of a papule, vesicle, or pustule.[34] Phyma: A tubercle on any external part of the body, such as in phymatous rosacea

Configuration[edit] "Configuration" refers to how lesions are locally grouped ("organized"), which contrasts with how they are distributed (see next section).

Agminate: in clusters Annular or circinate: ring-shaped Arciform or arcuate: arc-shaped Digitate: with finger-like projections Discoid or nummular: round or disc-shaped Figurate: with a particular shape Guttate: resembling drops Gyrate: coiled or spiral-shaped Herpetiform: resembling herpes Linear Mammillated: with rounded, breast-like projections Reticular or reticulated: resembling a net Serpiginous: with a wavy border Stellate: star-shaped Targetoid: resembling a bullseye Verrucous: wart-like

Distribution[edit] "Distribution" refers to how lesions are localized. They may be confined to a single area (a patch) or may exist in several places. Some distributions correlate with the means by which a given area becomes affected. For example, contact dermatitis correlates with locations where allergen has elicited an allergic immune response. Varicella zoster virus
Varicella zoster virus
is known to recur (after its initial presentation as chicken pox) as herpes zoster ("shingles"). Chicken pox appears nearly everywhere on the body, but herpes zoster tends to follow one or two dermatomes; for example, the eruptions may appear along the bra line, on either or both sides of the patient.

Generalized Symmetric: one side mirrors the other Flexural: on the front of the fingers Extensor: on the back of the fingers Intertriginous: in an area where two skin areas may touch or rub together Morbilliform: resembling measles Palmoplantar: on the palm of the hand or bottom of the foot Periorificial: around an orifice such as the mouth Periungual/subungual: around or under a fingernail or toenail Blaschkoid: following the path of Blaschko's lines
Blaschko's lines
in the skin Photodistributed: in places where sunlight reaches Zosteriform or dermatomal: associated with a particular nerve

Other related terms[edit]

Collarette Comedo Confluent Eczema
(a type of dermatitis) Evanescent (lasting less than 24 hours) Granuloma Livedo Purpura Erythema
(redness) Horn (a cell type) Poikiloderma


Hyperkeratosis Parakeratosis Hypergranulosis Acanthosis Papillomatosis Dyskeratosis Acantholysis Spongiosis Hydropic swelling Exocytosis Vacuolization Erosion Ulceration Lentiginous


^ a b c d e f Miller, Jeffrey H.; Marks, James G. (2006). Lookingbill and Marks' Principles of Dermatology. Saunders. ISBN 1-4160-3185-5.  ^ Lippens, S; Hoste, E; Vandenabeele, P; Agostinis, P; Declercq, W (April 2009). "Cell death in the skin". Apoptosis. 14 (4): 549–69. doi:10.1007/s10495-009-0324-z. PMID 19221876.  ^ King, L.S. (1954). "What Is Disease?". Philosophy of Science. 21 (3): 193–203. doi:10.1086/287343.  ^ Bluefarb, Samuel M. (1984). Dermatology. Upjohn Co. ISBN 0-89501-004-6.  ^ a b c d Lynch, Peter J. (1994). Dermatology. Williams & Wilkins. ISBN 0-683-05252-7.  ^ Tilles G, Wallach D (1989). "[The history of nosology in dermatology]". Ann Dermatol Venereol (in French). 116 (1): 9–26. PMID 2653160.  ^ Lambert WC, Everett MA (October 1981). "The nosology of parapsoriasis". J. Am. Acad. Dermatol. 5 (4): 373–95. doi:10.1016/S0190-9622(81)70100-2. PMID 7026622.  ^ Jackson R (1977). "Historical outline of attempts to classify skin diseases". Can Med Assoc J. 116 (10): 1165–68. PMC 1879511 . PMID 324589.  ^ Copeman PW (February 1995). "The creation of global dermatology". J R Soc Med. 88 (2): 78–84. PMC 1295100 . PMID 7769599.  ^ Fitzpatrick, Thomas B.; Klauss Wolff; Wolff, Klaus Dieter; Johnson, Richard R.; Suurmond, Dick; Richard Suurmond (2005). Fitzpatrick's color atlas and synopsis of clinical dermatology. McGraw-Hill Medical Pub. Division. ISBN 0-07-144019-4.  ^ Werner B (August 2009). "[ Skin
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Diseases: A Primer Ultrasound" in Medicine & Biology, Volume 41, Issue 4, Supplement, April 2015, pp. S82–S83 ^ a b c d Burns, Tony; et al. (2006) Rook's Textbook of Dermatology CD-ROM. Wiley-Blackwell. ISBN 1-4051-3130-6. ^ Paus R, Cotsarelis G (1999). "The biology of hair follicles". N Engl J Med. 341 (7): 491–97. doi:10.1056/NEJM199908123410706. PMID 10441606.  ^ Goldsmith, Lowell A. (1983). Biochemistry and physiology of the skin. Oxford University Press. ISBN 0-19-261253-0.  ^ Fuchs E (February 2007). "Scratching the surface of skin development". Nature. 445 (7130): 834–42. doi:10.1038/nature05659. PMC 2405926 . PMID 17314969.  ^ Fuchs E, Horsley V (April 2008). "More than one way to skin". Genes Dev. 22 (8): 976–85. doi:10.1101/gad.1645908. PMC 2732395 . PMID 18413712.  ^ a b c d e f Wolff, Klaus Dieter; et al. (2008). Fitzpatrick's Dermatology
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and eczema (L20–L30, 690–693,698)

Atopic dermatitis

Besnier's prurigo

Seborrheic dermatitis

Pityriasis simplex capillitii Cradle cap

Contact dermatitis (allergic, irritant)

plants: Urushiol-induced contact dermatitis African blackwood dermatitis Tulip fingers

other: Abietic acid dermatitis Diaper rash Airbag dermatitis Baboon syndrome Contact stomatitis Protein contact dermatitis


Autoimmune estrogen dermatitis Autoimmune progesterone dermatitis

Breast eczema Ear eczema Eyelid dermatitis Topical steroid addiction Hand eczema

Chronic vesiculobullous hand eczema Hyperkeratotic hand dermatitis

Autosensitization dermatitis/Id reaction

Candidid Dermatophytid Molluscum dermatitis

Circumostomy eczema Dyshidrosis Juvenile plantar dermatosis Nummular eczema Nutritional deficiency eczema Sulzberger–Garbe syndrome Xerotic eczema

Pruritus/Itch/ Prurigo

Lichen simplex chronicus/ Prurigo nodularis

by location: Pruritus
ani Pruritus
scroti Pruritus
vulvae Scalp pruritus

Drug-induced pruritus

Hydroxyethyl starch-induced pruritus

Senile pruritus Aquagenic pruritus


Adult blaschkitis due to liver disease

Biliary pruritus Cholestatic pruritus

Prion pruritus Prurigo pigmentosa Prurigo simplex Puncta pruritica Uremic pruritus


substances taken internally: Bromoderma Fixed drug reaction

Nummular dermatitis Pityriasis alba Papuloerythroderma of Ofuji

v t e

Disorders of skin appendages (L60–L75, 703–706)


thickness: Onychogryphosis Onychauxis

color: Beau's lines Yellow nail syndrome Leukonychia Azure lunula

shape: Koilonychia Nail clubbing

behavior: Onychotillomania Onychophagia

other: Ingrown nail Anonychia

ungrouped: Paronychia

Acute Chronic

Chevron nail Congenital onychodysplasia of the index fingers Green nails Half and half nails Hangnail Hapalonychia Hook nail Ingrown nail Lichen planus
Lichen planus
of the nails Longitudinal erythronychia Malalignment of the nail plate Median nail dystrophy Mees' lines Melanonychia Muehrcke's lines Nail–patella syndrome Onychoatrophy Onycholysis Onychomadesis Onychomatricoma Onychomycosis Onychophosis Onychoptosis defluvium Onychorrhexis Onychoschizia Platonychia Pincer nails Plummer's nail Psoriatic nails Pterygium inversum unguis Pterygium unguis Purpura
of the nail bed Racquet nail Red lunulae Shell nail syndrome Splinter hemorrhage Spotted lunulae Staining of the nail plate Stippled nails Subungual hematoma Terry's nails Twenty-nail dystrophy


loss/ Baldness

noncicatricial alopecia: Alopecia

areata totalis universalis Ophiasis

Androgenic alopecia
Androgenic alopecia
(male-pattern baldness) Hypotrichosis Telogen effluvium Traction alopecia Lichen planopilaris Trichorrhexis nodosa Alopecia neoplastica Anagen effluvium Alopecia mucinosa

cicatricial alopecia: Pseudopelade of Brocq Central centrifugal cicatricial alopecia Pressure alopecia Traumatic alopecia Tumor alopecia Hot comb alopecia Perifolliculitis capitis abscedens et suffodiens Graham-Little syndrome Folliculitis

ungrouped: Triangular alopecia Frontal fibrosing alopecia Marie Unna hereditary hypotrichosis


Hirsutism Acquired

localised generalised patterned


generalised localised X-linked


Acneiform eruption


Acne vulgaris Acne conglobata Acne miliaris necrotica Tropical acne Infantile acne/Neonatal acne Excoriated acne Acne fulminans Acne medicamentosa (e.g., steroid acne) Halogen acne

Iododerma Bromoderma Chloracne

Oil acne Tar acne Acne cosmetica Occupational acne Acne aestivalis Acne keloidalis nuchae Acne mechanica Acne with facial edema Pomade acne Acne necrotica Blackhead Lupus miliaris disseminatus faciei


Perioral dermatitis

Granulomatous perioral dermatitis

Phymatous rosacea

Rhinophyma Blepharophyma Gnathophyma Metophyma Otophyma

Papulopustular rosacea Lupoid rosacea Erythrotelangiectatic rosacea Glandular rosacea Gram-negative rosacea Steroid rosacea Ocular rosacea Persistent edema of rosacea Rosacea
conglobata variants

Periorificial dermatitis Pyoderma faciale


Granulomatous facial dermatitis Idiopathic facial aseptic granuloma Periorbital dermatitis SAPHO syndrome

Follicular cysts

"Sebaceous cyst"

Epidermoid cyst Trichilemmal cyst


simplex multiplex




nares perforans Tufted folliculitis

Pseudofolliculitis barbae


Hidradenitis suppurativa Recurrent palmoplantar hidradenitis Neutrophilic eccrine hidradenitis


Acrokeratosis paraneoplastica of Bazex Acroosteolysis Bubble hair deformity Disseminate and recurrent infundibulofolliculitis Erosive pustular dermatitis of the scalp Erythromelanosis follicularis faciei et colli Hair
casts Hair
follicle nevus Intermittent hair–follicle dystrophy Keratosis pilaris atropicans Kinking hair Koenen's tumor Lichen planopilaris Lichen spinulosus Loose anagen syndrome Menkes kinky hair syndrome Monilethrix Parakeratosis
pustulosa Pili (Pili annulati Pili bifurcati Pili multigemini Pili pseudoannulati Pili torti) Pityriasis amiantacea Plica neuropathica Poliosis Rubinstein–Taybi syndrome Setleis syndrome Traumatic anserine folliculosis Trichomegaly Trichomycosis axillaris Trichorrhexis (Trichorrhexis invaginata Trichorrhexis nodosa) Trichostasis spinulosa Uncombable hair syndrome Wooly hair Wooly hair
Wooly hair

Sweat glands



Colloid milium Miliaria
crystalline Miliaria
profunda Miliaria
pustulosa Miliaria
rubra Occlusion miliaria Postmiliarial hypohidrosis

Granulosis rubra nasi Ross’ syndrome Anhidrosis Hyperhidrosis

Generalized Gustatory Palmoplantar


Body odor Chromhidrosis Fox–Fordyce disease


Sebaceous hyperplasia

v t e

Diseases of the skin and appendages by morphology



wart callus seborrheic keratosis acrochordon molluscum contagiosum actinic keratosis squamous-cell carcinoma basal-cell carcinoma Merkel-cell carcinoma nevus sebaceous trichoepithelioma


Freckles lentigo melasma nevus melanoma

Dermal and subcutaneous

epidermal inclusion cyst hemangioma dermatofibroma (benign fibrous histiocytoma) keloid lipoma neurofibroma xanthoma Kaposi's sarcoma infantile digital fibromatosis granular cell tumor leiomyoma lymphangioma circumscriptum myxoid cyst


With epidermal involvement


contact dermatitis atopic dermatitis seborrheic dermatitis stasis dermatitis lichen simplex chronicus Darier's disease glucagonoma syndrome langerhans cell histiocytosis lichen sclerosus pemphigus foliaceus Wiskott–Aldrich syndrome Zinc deficiency


psoriasis tinea (corporis cruris pedis manuum faciei) pityriasis rosea secondary syphilis mycosis fungoides systemic lupus erythematosus pityriasis rubra pilaris parapsoriasis ichthyosis


herpes simplex herpes zoster varicella bullous impetigo acute contact dermatitis pemphigus vulgaris bullous pemphigoid dermatitis herpetiformis porphyria cutanea tarda epidermolysis bullosa simplex


scabies insect bite reactions lichen planus miliaria keratosis pilaris lichen spinulosus transient acantholytic dermatosis lichen nitidus pityriasis lichenoides et varioliformis acuta


acne vulgaris acne rosacea folliculitis impetigo candidiasis gonococcemia dermatophyte coccidioidomycosis subcorneal pustular dermatosis


tinea versicolor vitiligo pityriasis alba postinflammatory hyperpigmentation tuberous sclerosis idiopathic guttate hypomelanosis leprosy hypopigmented mycosis fungoides

Without epidermal involvement


Blanchable Erythema


drug eruptions viral exanthems toxic erythema systemic lupus erythematosus


cellulitis abscess boil erythema nodosum carcinoid syndrome fixed drug eruption


urticaria erythema (multiforme migrans gyratum repens annulare centrifugum ab igne)

Nonblanchable Purpura


thrombocytopenic purpura actinic/solar purpura


disseminated intravascular coagulation vasculitis


scleroderma/morphea granuloma annulare lichen sclerosis et atrophicus necrobiosis lipoidica

Miscellaneous disorders



telogen effluvium androgenic alopecia alopecia areata systemic lupus erythematosus tinea capitis loose anagen syndrome lichen planopilaris folliculitis decalvans acne keloidalis nuchae


onychomycosis psoriasis paronychia ingrown nail

Mucous membrane

Aphthous stomatitis oral candidiasis lichen planus leukoplakia pemphigus vulgaris mucous membrane pemphigoid cicatricial pemphigoid herpesvirus coxsackievirus syphilis systemic histoplasmosis squam