Glossary: Skin and Hair

Primary skin lesions 

Anaphylaxis: Angioedema 

A life threatening allergic reaction that occurs after contact with an allergy-causing substance (allergen). It has a rapid onset and may cause death.

Most cases of anaphylaxis present with a skin rash (urticaria, itching, flushing) or involvement of mucosal tissue (angioedema). Respiratory symptoms (difficulty breathing, wheezing, stridor) and sometimes gastrointestinal symptoms (crampy abdominal pain, vomiting) can also occur.

Head lice (Pediculosis capitis)

Excoriated papules and/or nits, nymphs, lice on scalp, hair shaft, or nape of neck. They have a white to dark dandruff-like appearance, people with sensitive/itchy scalp might have excoriations or signs of severe itching. However, not everyone develops sensitivity to lice, therefore itching might not occur.

Oral herpes (Herpes labialis) 

Painful single or grouped vesicles often around the mouth. It is a viral infection caused by herpes simplex virus.

Deep or extensive mouth ulcers 

In severe cases, they are deep and extensive. If a child with measles has mouth ulcers which makes it difficult to drink or eat, they need admission/referral. 

Tinea capitis 

It is a fungal infection (scalp ringworm) that presents as circular or oval red scaling patch or plaque that may be itchy.  At later stages central clearing occurs, with spread of raised borders. Sometimes surrounded by vesicles, pustule formations. Subtle hair loss and buggy fluctuant mass (kerion) are additional clinical variants.

Tinea corporis 

Often itchy circular or oval red scaling patch or plaque. At later stages central clearing occurs, with spread of raised borders. It is sometimes surrounded by vesicles. 

Scabies

Itchy (especially at night), small, pink or dark papules or vesicles, or pustules sometimes with excoriation or burrows. Found mostly in interdigital spaces of the hands and feet, wrists, waistline, and genitals.

Urticaria  

Urticaria (hives) are slightly raised, flesh-colored patches of the skin. They occur in groups on any part of the body and can look like mosquito bites. They are often very itchy especially at night. 

Atopic eczema 

In infants: Itchy, red/pink (sometimes hypo or hyperpigmentation especially on dark skin), scaly and crusted lesions on cheeks, forehead, scalp, or extensor surfaces. Rarely in groin and axilla region.

In children: Itchy, thick (lichenified) plaques (sometimes hypo or hyperpigmentation especially on dark skin) in flexural surfaces especially elbows, knees, neck, wrist and ankles. Rarely in groin and axilla region.

Pityriasis versicolor 

It is a common superficial fungal infection, characterized by hypo/hyperpigmented patches (most often on chest, back and arms). Not itchy. Recurrences are common, especially after inadequate treatment.

Mongolian spots 

Congenital blue-gray pigmented macule (may also be green or brown). Most commonly located on the back, also seen on the buttocks, flanks, and shoulders. Diameter: typically <5 cm, may be >10 cm. It usually fades in the first or second year of life.

 

Molluscum contagiosum

Flesh-colored or pearly white, small papules with central umbilication. Sometimes associated with itching, not associated with fever.

Non-specific viral rash 

Maculopapular rash from viral infection, associated with non-specific symptoms such as fever, headache, muscle, joint or back pain.

Diaper rash 

Hyper or hypopigmented or red rash that is often itchy in the groin/buttock area due to wet diaper that has not been changed frequently. Limited to groin, buttocks, or inner thigh area.

Scarlet fever rash 

Bright red/pink or flesh or skin colored rash that blanches with pressure, with small papules giving it a sandpaper texture. Usually located on face, neck, trunk, arms and legs; cheeks may be rosy, with a pale area around the mouth.

Typically the child presents with strawberry tongue, redtonsils with exudates or petechiae. Often associatedwith sore throat, abdominal pain and emesis.

Chicken pox lesions 

It is a viral skin infection that presents with itching. Initial stage presents as macules and progress to papules and fluid filled vesicles which when burst lead to crusted papules.

Measles rash 

Pink or dark rash that starts behind the ears and on the neck and spreads to the face and rest of body. Not itchy, no vesicles nor pustules. After 4-5 days, becomes more discolored and starts to peel.

NOTE : Often associated with red eyes, runny nose or cough.

Heat rash 

Heat rash can present as:

- Miliaria rubra: Red/pink, flesh or skin coloured papules 2-4mm on a red or flesh coloured rash. Sometimes itchy.

- Miliaria crystallina : Clear, superficial vesicles 1-2mm thatlook like water droplets found most often on the head, neck and upper trunk.

Erythema toxicum 

Small, red macules and papules that progress to pustules with surrounding erythema. Located on trunkand proximal extremities (spares the palms of hands and the soles of feet). It occurs more frequently in neonates with higher birthweight and greater gestational age, It is self-limiting.

Folliculitis 

Inflammation of superficial and deep portion of hair follicles, It can be infectious and presents with Pustule or erythematous papules anywhere hair is located. Often itchy, sometimes painful. Hair shaft frequently seen.

Impetigo

Impetigo is a contagious, superficial bacterial infection. It is manifested by honey-colored crusted skin lesion. Generally located on face (mouth, nose), arms and legs.

Bullous impetigo 

Fragile, flacid bullae with yellow fluid. Generally located on trunk and arms.

Echtyma lesion 

Rare complication of impetigo. Ulcer covered with yellow crust. Sometimes ulcer with necrotic black eschar (gangrene).

Abscess 

Painful, sometimes red or darkened elevated skin lesion bump that is full of pus. Skin around the spot may be hard.

Cellulitis 

Warm to the touch, tender, swollen, pink or red. Can spread rapidly.