Skin Lesion Nomenclature: Bruises, Birthmarks & Burns

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  • 0:05 Skin Lesions
  • 1:10 Bruises
  • 3:29 Burns
  • 6:02 Types of Birthmarks
  • 8:59 Lesson Summary
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Lesson Transcript
Instructor: Rachel Torrens

Rachel is a Nurse Practitioner with experience working as a high school teacher, skin surgery center, and as a family NP.

In this lesson, you'll learn the terminology to describe bruises, burns, and birthmarks. We've all run into something, touched an item that was too hot, and been born, so you'll be able to relate to some, if not all, the terms we're about to cover!

Skin Lesions

Our skin is an amazingly resilient organ. It is able to heal itself following almost any type of injury, but sometimes there is evidence of that injury or of the healing process. Any abnormality on the skin that differs from the surrounding skin is termed a skin lesion. Today, we will examine two categories of skin lesions that occur following injuries: one category covers injuries to the blood vessels under the skin, or bruising, and the other relates to damage of the skin tissue itself by heat or chemicals, or burns.

Then we will examine a category of skin lesions which actually is not caused by any outside force, but rather is part of a person's genetic make-up, or birthmarks. We tend to think of babies as pristine and perfect, but in reality they are quite messy when they arrive and come out with their own distinctive skin features. Most birthmarks are benign, and their only significance is to tell the parents of their baby's unique stay inside the womb.


So, to begin, we will cover all the terminology used to describe hemorrhaging under the skin. Hemorrhaging is the leaking of blood out of the blood vessels and into surrounding tissue. Purpura is red or purplish spots, each measuring greater than three millimeters in diameter, noted when hemorrhaging under the surface of the skin occurs. Patients with platelet disorders can often present with purpuric rash, like the patient in this image:


Now, when hemorrhaging presents as a pinpoint sized, perfectly round, red-purplish spot under the skin, then it is described as petechia. The patient in this image has strep throat, and the resulting petechiae in the back of the throat are a common finding on physical exam:


Note how these lesions are significantly smaller than those in the first image.

When hemorrhaging produces a larger, roundish, or irregular blue-purplish patch, it is described as ecchymosis. The patient in this image had acute pancreatitis, and the resulting hemorrhagic patches or ecchymoses along her flank is a tell-tale sign of this condition:


Purpura, petechiae and ecchymoses are flat, so if you were to run your finger over the tops of them, you would not be able to feel any difference from the surrounding tissue. Furthermore, these types of hemorrhagic skin lesions are usually the result of disease processes.

However, sometimes hemorrhaging occurs not due to a disease but due to an injury. When trauma occurs resulting in injury to an area with the rupturing of blood vessels but without a break in the skin, it is termed a contusion. This is known commonly as a 'bruise.' Bruises range in color from red, blue, and purple to yellowish-green, all depending on what stage of healing is occurring. A hematoma is a collection of clotted blood under the skin due to a break in a blood vessel. An example of a hematoma is when a toddler trips, bumps his head on the coffee table, and five minutes later has a large 'goose egg' on his forehead.


Next, we are going to talk about another type of injury sustained by the skin: burns. Burns are currently undergoing a term renovation. Previously, burns were defined by degrees, first through third, with first being the least severe. Now, practitioners prefer to label burns according to the depth of injury. Since both sets of terms are still in use, it is important to be familiar with each.

And before we go any further, let's quickly review the layers of the skin, as this is critical information in understanding the new depth-based classification of burns. The top most layer is the epidermis (numbers one and two), followed by the dermis (number three), and finally the subcutaneous tissue (number four). Alright, now that we've refreshed that information, let's move on!

Layers of the Skin

So, a first-degree burn, or a superficial burn, is a burn affecting only the epidermis. The area is usually red, dry, and painful to the touch. An example of a first degree burn would be a non-blistering sunburn. Usually, first degree burns heal without scarring, in about three to five days.

The category of second-degree burn has been divided into two new terms: superficial partial thickness burn and deep partial thickness burn. A superficial partial thickness burn is a burn affecting the entire epidermis and the upper layer of the dermis. A deep partial thickness burn is a burn resulting in complete destruction of epidermis and the majority of the dermis. These types of burns tend to be pink or red and appear moist. Blisters are usually present, and the area is very painful. The deeper the partial thickness burn, the more likely scarring will result. Superficial partial thickness burns usually heal in 7 to 21 days, whereas deep partial thickness burns take even longer to resolve.

Finally, a third degree burn, or a full thickness burn, is a burn affecting the entire epidermis, dermis, and some of the subcutaneous tissue. These burns are white, gray, or black in color. They appear leathery and dry but tend to not be painful, as the nerve endings have been destroyed. Full thickness burns will result in significant scarring and need grafting in order to be repaired.

Types of Birthmarks

Now, you may think of all spots or lesions on the skin are the result of something affecting the skin, like in the case of hematomas or burns that we just discussed. However, the next topic we are going to cover addresses those lesions which occur while the skin is still protected from outside forces. To what am I referring? Birthmarks, of course!

There are many types of birthmarks, or congenital skin lesions. Let's take a closer look at some of the most common ones.

A café au lait spot is a flat patch of skin, ranging in color from light tan to dark brown. The term café au lait comes from the French phrase 'coffee with milk,' and that is an excellent description of how these birthmarks appear.

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