Overview

A skin lesion is an unusual growth or appearance of the skin compared to the skin around it.

Skin lesions could be something you're born with or something you pick up along the way. They might be benign or severe, symmetrical or asymmetrical, all over the body or just in some spots.

Skin lesions are relatively frequent, and they usually arise as a result of localized skin irritation, such as sunburns or contact dermatitis. On the other hand, others can be symptoms of underlying conditions, such as infections, diabetes, or autoimmune or genetic disorders. 

The classification of Skin Lesions ICD 10, used to indicate a diagnosis has the code L98.9 “for Disorder of the skin and subcutaneous tissue, unspecified”.

Types of Skin Lesions

Skin lesions are divided into two main categories: primary and secondary, as described in the following sections. 

Primary Lesions

Primary Skin Lesions could exist at birth, but they could also occur at a later stage of your life. These could be related either to a specific cause or to various internal or external factors and they can be split into three categories:

1. Vesicles and pustules are skin lesions caused by fluid within the skin layers.
2. Solid, palpable masses on the skin, such as nodules or tumors.
3. Patches and macules that are flat are non-palpable skin lesions.

The following list illustrates examples of primary lesions you could notice on your skin:

• Bulla: A fluid-filled cyst whose dimensions are significantly over 0.5 centimeters (cm).
• Cyst: A raised, confined skin region filled with either liquid or semi-solid fluid.
• Macule: A non-palpable, flat lesion with a different color and a size of less than 0.5cm.
• Papule (also called maculopapular): A minor bump on the skin. A confined and hard raised solid lesion up to 0.5 cm in size. It comes in a variety of colors.
• Patch: A non-palpable, leveled lesion with a different color and more than 0.5 cm in diameter.
• Plaque: A firm, rough, and flat-topped plaque greater than 1-2 cm in diameter and elevated like a pimple.
• Vesicle: A small, fluid-filled blister smaller than 0.5 cm in diameter.
• Pustule: Similar to a vesicle but filled with pus instead of fluid
• Nodule: a solid, circular lump bigger than 0.5 cm in diameter.
• Telangiectasia: It is characterized by clusters of spider veins, which are tiny blood vessels resulting in red stripes on the skin's surface.
• Tumor: A tumor that expands more than 0.5 cm in diameter but looks like a nodule. Tumors can be either benign or malignant.
• Wheal: A temporary, irregularly shaped, solid, raised region that can change color.
• Moles: Darkened areas of skin that are round or oblong. These are the three primary types of moles.

1. Congenital: This form of a mole is present at birth and can be of any size or location on the body. Common: Most individuals have 10–40 of these mostly harmless growths, which tend to occur above the waist and in places exposed to the sun.
2. Atypical: Atypical moles are more extensive than 6 millimeters in diameter, not round, and have more than one color. Atypical moles could stimulate the occurrence of melanoma, which is another skin cancer that appears in the proximity of moles.

All of the above mentioned skin lesions are specific to different conditions of the skin, such as:

• Acne

Whiteheads, blackheads, pimples, and cysts are all signs of acne. Depending on its severity, for some it may be harmless, but for others, it may result in scarring or a loss of self-esteem.

Acne occurs when the skin's pores become blocked with dead skin cells and sebum, the skin's natural oil. Bacteria can also enter the plugged pore, causing the sores to get inflamed.

Over-the-counter (OTC) medications containing benzoyl peroxide or salicylic acid may be helpful for people with mild acne. In most cases, these products generate benefits in 4–8 weeks. A good skincare routine, patience and frequent visits to dermatologists should help patients dealing with more severe forms of acne.

Acne may leave scars or discolor the skin if left untreated.

• Eczema

Eczema is a common skin condition that manifests itself as itchy, red areas of skin. These can appear on any part of the body, and it’s most common on the hands and forearms, and it looks like a burn. It is caused by a wide range of factors, from genetic to environmental. However, it is not communicable.

Although it is a chronic disorder with no specific cure, certain medications and lifestyle adjustments can help manage the symptoms.

The National Eczema Association advises eczema sufferers to avoid anything that aggravates the situation, to bathe and moisturize daily, and follow the treatment prescribed by their doctors.

• Cold sores

Herpes simplex is a contagious infection caused by the herpes simplex virus. Cold sores resembling blisters occur on or around the lips, and a person may not realize they have it until they notice them. The sores may be painful or tingling.

Cold sores tend to resurface every now and then. A flare-up of the sores can be triggered by various reasons, including stress and sun exposure, but they typically disappear after a few weeks.

Some patients use over-the-counter acyclovir lotions to relieve symptoms and hasten to heal.

OTC topical antivirals, on the other hand, are not always effective and patients taking antiviral medication prescribed by a doctor may notice better results.

• Blisters

Usually, a watery liquid called serum escapes from the surrounding tissue into the affected area when the skin is wounded. This can result in a blister, a little bubble in the skin.

Blisters are most caused by burns, friction, infections, and allergies.

These lesions usually are self-healing, and popping or bursting them raises the risk of infection.

• Hives

Hives are a red, lumpy, itchy rash that allergic responses can cause. Hives typically go away on their own within a few days.

• Impetigo

Impetigo is caused by a Staphylococcus or Streptococcus bacterial infection, also known as staph or strep.

Impetigo is a skin illness that causes red lesions surrounding them. The pus fills the sores, which turn into pimples that break open and crust over.

Impetigo is highly contagious and spreads quickly. Antibiotics are used to treat it.

• Actinic keratosis

Actinic keratosis is a kind of keratosis that develops on sun-damaged skin. Crusty lumps are flesh-colored, brown, pink, or red in appearance. Actinic keratosis patients are at a higher risk of developing cancer. As treatments, doctors may offer surgery, creams, or light therapy.

• Psoriasis

Psoriasis causes itchy or scaly patches of skin. Patches are most commonly found on the elbows, knees, and scalp, but they can arise anywhere on the body.

Scientists are still unsure what causes psoriasis. It is, however, an autoimmune disorder, meaning a malfunction with the immune system causes it.

Even if there is no cure available, there are numerous treatments available. Some people can benefit from over-the-counter lotions and ointments, while others require prescription medicine.

• Ringworm

Ringworm is a fungal illness that forms a circular rash on the skin. The inflammation can arise anywhere on the body, and it is generally accompanied by itchy, red, scaly skin and hair loss.

Ringworm on the feet is commonly referred to as athlete's foot and ringworm on the groin as jock itch.

Over-the-counter creams, lotions, and powders can treat the infection Tinea capitis is the medical term for ringworm on the scalp. It usually necessitates the use of antifungal medicine prescribed by a doctor. Treatment can take anywhere from one to three months.

Secondary Lesions

Secondary skin lesions develop when an initial skin lesion is disturbed, inflamed, or changed over time. For example, when eczema is scraped and a crust forms, this is referred to as a secondary lesion. The following is a list of examples of secondary skin lesions you could notice on your skin surface:

• Atrophy: A condition in which the skin becomes paper-thin, translucent, and wrinkled, which usually results from the usage of topical medication, mostly topical steroids.
• Crust: Dried liquids has created a rough, raised surface (which can be pus, blood, or serum)
• Erosion: The loss of the epidermis, which appears moist and shiny.
• Excoriation: Linear scratches that result in epidermal loss are known as excoriation.
• Fissures: 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.
• Lichenification: The thickening and roughening of the epidermis which occurs due to repetitive scratching or rubbing, and it highlights regular skin lines.
• Maceration: When skin is exposed to water or fluid for an extended period, it becomes wet, wrinkled, and lighter in color. This might happen due to leaking wounds caused by poor wound care.
• Phyma: In advanced rosacea, phyma is a thickening of the skin.
• Scale: A keratinized cell build-up that forms patches on the skin and subsequently flakes off.
• Ulcer: A deeper wound than the epidermis and damages the dermis; it is concave, varies in size, and graded according to depth.
• Umbilication: a depression inside a skin lesion that resembles a navel.

Symptoms of Skin Lesions

The symptoms of skin lesions could vary significantly, based on the underlying cause and a differential diagnosis is crucial for establishing the right course of action regarding treatment or lifestyle modifications. 

Firstly, it's crucial to consider whether or not:

• Single or several lesions exist.
• Specific bodily parts are afflicted (e.g., palms or soles, scalp, mucosal membranes).
• The distribution might be asymmetric or symmetric, random or patterned.
• The lesions appear on either sun-exposed or sun-protected skin.

Secondly, the texture of skin lesions could be extremely important within the diagnosis process. 

For example, the surface of verrucous lesions is uneven, pebbly, or rough. Edema, inflammation, or infiltration, including cancer, can cause induration or profound thickening of the skin. Induration could also be stimulated by panniculitis, other skin diseases, and cutaneous metastatic malignancies. The feeling of indurated skin is firm and resistant. 

Umbilicated lesions, such as molluscum contagiosum and herpes simplex, are generally viral and have a central indentation.  Xanthomas are waxy, yellowish lesions that can be idiopathic or develop in patients with lipid problems.

The color of the skin lesion could also help determine the underlying cause. A short classification of skin lesions colors is presented below: 

• Red skin lesions:

Many different inflammatory or viral disorders can cause red skin (erythema). Pink or red cutaneous tumors are common, and port-wine stains and other superficial vascular lesions might appear red.

• Orange skin lesions:

Hypercarotenemia, an ordinarily benign disorder of carotene deposition caused by excessive dietary absorption of beta-carotene, is the most common cause of orange skin.

• Yellow skin lesions:

Jaundice, xanthelasmas and xanthomas, and pseudoxanthoma elasticum give skin a yellow look.

• Green skin lesions:

Green fingernails suggest the existence of Pseudomonas aeruginosa infection.

• Violet skin lesions:

A cutaneous hemorrhage or vasculitis can cause violet skin. Kaposi sarcoma and hemangiomas are vascular lesions or tumors that can seem purple. Dermatomyositis is characterized by a lilac hue of the eyelids or heliotrope eruption.

• Blue, silver or gray skin lesions:

The deposition of medications or metas, such as minocycline, amiodarone, and silver, can influence the color of the skin to seem blue, silver, or gray (argyria). The color of ischemic skin ranges from purple to gray, and the nevi in the deep dermis appear blue.

• Black skin lesions:

Melanocytic Skin Lesions, such as nevi and melanoma, can be black. 

Causes of Skin Lesions - Are skin lesions and cancer linked? 

There are two types of skin lesions: benign skin lesions, which are not harmful and malignant skin lesions, which can further develop into skin cancer. Physical characteristics of a skin lesion, such as color, size, texture, and location, might be needed to detect an underlying cause correctly and investigate if they are cancerous or not.

Examples of benign skin lesions are presented below:

• Skin moles are referred to as naevi in medical terms. Because they contain more pigment, they are generally darker (brown or brown-black) than the surrounding skin color. Some moles, especially those exposed to sunlight, can develop into malignant melanoma.
• Strawberry birthmarks are also known as capillary haemangiomas. As the newborn or youngster grows, some become larger or smaller. Because they are made up of expanded blood vessels, they are pink or red-purple.
• Papillomas are benign skin swellings that resemble warts.
• Seborrhoeic keratosis is also known as senile keratosis because it frequently affects the elderly. They look like raised lumps that are yellowish or brown.
• Fibromas of the skin are raised swellings that occur due to long-term damage.
• Chronic cutaneous lupus;
• Papular Sarcoidosis.

For malignant skin lesions, underlying causes could be:

• Basal cell carcinoma - a type of cancer with the most significant prevalence, mainly caused by sun exposure. These lesions are slow-growing and do not spread to other body areas. Tumors begin as transparent, pearly nodules or masses that progress to an ulcer, and it’s often referred to as a 'rodent ulcer.'
• Squamous cell carcinoma which can develop in both sun-damaged and healthy skin, and it appears as an ulcer. It usually does not migrate to other body regions, but it can extend to local lymph nodes, which can be harmful.
• Malignant melanoma -a cancer that starts in the skin's pigmented cells. They're usually brown or black, and they could spread to other areas of the body.

Treatment of Skin Lesions

Skin lesions can appear at any age and for a number of reasons. Some may be caused by underlying medical conditions, some may be hereditary or be the result of accidents such as burns, lacerations and animal bites. Although it is important to establish the cause of any skin lesion in order to establish the best possible treatment course, not all skin lesions need treatment. 

Based on the characteristics of each type of skin lesion flare-up, your doctor will be able to prescribe you an efficient treatment. 

Benign skin lesions can be treated locally using topical drugs such as retinoids, corticosteroids, antimicrobials, laser therapy, cryotherapy, phototherapy, or surgical removal if necessary. Treatment may also address the underlying cause if the skin lesion is caused by a systemic condition. 

If over-the-counter medications do not clear up acne, eczema, or psoriasis, a person should see a doctor, who may prescribe creams, lotions, antibiotics, or pills.

For malignant skin conditions, a treatment plan will be established with a specialized healthcare professional, depending on the diagnosis. 

Home remedies

Some skin lesions are highly irritating and inconvenient. For alleviation of minor skin conditions, you might wish to try some home treatments. For example, itching and burning can be relieved with oatmeal baths or lotions. Absorbent powders or protective balms can minimize friction and prevent new skin lesions from developing if chafing is causing contact dermatitis in spots where the skin rubs against itself or a piece of clothing. Wearing loose clothing and changing your usual shower gels and soaps to non-irritant products may also help.

Skin lesions and other medical conditions

As mentioned before, skin lesions can be associated with other, more complex medical conditions, such as: 

• Skin Lesions in HIV – HIV skin spots that usually look like red, flattened portions of the skin, usually covered with small red bumps, have a prominent symptom of the rash itchiness.
• Skin Lesions Leprosy - Lesions on the skin are painless and pale or red, with no loss of sensation; lesions grow elevated as the disease advances—peripheral nerve thickening with decreased feeling and burning or tingling sensations.
• Skin lesions from Diabetes - Changes in the tiny blood arteries might occur due to diabetes. Diabetic dermopathy is a skin condition caused by these alterations, and dermopathy frequently appears as scaly, light brown spots. Skin lesions related to diabetes may appear as oval or circular patches.
• Skin lesions from Lupus - Chronic cutaneous lupus (also known as discoid lupus) is a type of lupus that creates round, disc-shaped lesions on the face and scalp. Scars or changes in skin pigmentation may result from skin lesions lupus. A red scaly rash or red ring-shaped blisters are symptoms of subacute cutaneous lupus. It commonly occurs on skin that is exposed to the sun, such as the neck and arms.
• Skin Lesions Sarcoidosis - Papular sarcoidosis is the medical term for this condition. These lumps and growths, usually painless, occur on the face or neck and frequently appear around the eyes. Lesions that are skin-colored, red, reddish-brown, violet or another color may be seen. Most bumps and growths have a rough texture when touched.

Conclusion

Any spot of the skin that differs from the surrounding skin in color, shape, size, or texture is referred to as a skin lesion. Skin lesions can be inherited, such as moles or birthmarks, or acquired as a result of allergic responses, drugs, sun exposure, and systemic disorders, such as autoimmune diseases, infectious diseases, and cancer. 

The physical examination and medical history are used to diagnose skin lesions, and some of them may require additional diagnostic procedures like blood tests, imaging, or biopsy. Treatment is determined by the type of lesion and whether or not malignancy is present. Some benign lesions may not require therapy at all, while others may require treatment only locally.

Treatment may also address the underlying cause if a systemic condition causes the skin lesion. Malignant and premalignant lesions are typically treated with surgical removal to avoid progression. Some lifestyle changes, such as avoiding irritants and wearing sunscreen all through the year can also help prevent recurrence of certain skin lesions.