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<h2 id="layer-of-skin-involved">Layer of skin involved</h2> <p class="note">Main article: <a href="/facts/Integumentary_system/vCEm01JG">Integumentary system</a></p> <p>The skin weighs an average of 4 kg (8.8 lb), covers an area of about 2 m2 (22 sq ft), and is made of three distinct layers: the <a href="/facts/Epidermis_(skin)/JvRABubP">epidermis</a>, <a href="/facts/Dermis/WAm7Fd6P">dermis</a>, and <a href="/facts/Subcutaneous_tissue/EPYjXN3G">subcutaneous tissue</a>.<a class="footnote-ref" id="fnref:16" href="#fn:16"><sup>16</sup></a> The two main types of human skin are <a href="/facts/Glabrous_skin/L7vt9FL3">glabrous skin</a>, the nonhairy skin on the palms and soles (also referred to as the "palmoplantar" surfaces), and hair-bearing skin.<a class="footnote-ref" id="fnref:17" href="#fn:17"><sup>17</sup></a> Within the latter type, hairs in structures called <a href="/facts/Pilosebaceous_unit/HKMXmv1Y">pilosebaceous units</a> have a <a href="/facts/Hair_follicle/SXsAKufM">hair follicle</a>, <a href="/facts/Sebaceous_gland/HKMXmv1Y">sebaceous gland</a>, and associated <a href="/facts/Arrector_pili/HRQBLQ2E">arrector pili</a> muscle.<a class="footnote-ref" id="fnref:18" href="#fn:18"><sup>18</sup></a> <a href="/facts/Embryology/4mvpSkhC">In the embryo</a>, the epidermis, hair, and glands are from the <a href="/facts/Ectoderm/lg5p0jTL">ectoderm</a>, which is chemically influenced by the underlying <a href="/facts/Mesoderm/kf77vcNA">mesoderm</a> that forms the dermis and subcutaneous tissues.<a class="footnote-ref" id="fnref:19" href="#fn:19"><sup>19</sup></a><a class="footnote-ref" id="fnref:20" href="#fn:20"><sup>20</sup></a><a class="footnote-ref" id="fnref:21" href="#fn:21"><sup>21</sup></a> </p> <h3>Epidermis</h3> <p class="note">Main article: <a href="/facts/Epidermis_(skin)/JvRABubP">Epidermis (skin)</a></p> <p>The epidermis is the most superficial layer of skin, a <a href="/facts/Epithelium/ecKHcHC3">squamous epithelium</a> with several <a href="/facts/Stratum/w5D4VAwa">strata</a>: the <a href="/facts/Stratum_corneum/7fwl4EF2">stratum corneum</a>, <a href="/facts/Stratum_lucidum/lfEPMUD1">stratum lucidum</a>, <a href="/facts/Stratum_granulosum/fVgEs1PX">stratum granulosum</a>, <a href="/facts/Stratum_spinosum/aNUHgpPc">stratum spinosum</a>, and <a href="/facts/Stratum_germinativum/4UwmB3Qm">stratum basale</a>.<a class="footnote-ref" id="fnref:22" href="#fn:22"><sup>22</sup></a> Nourishment is provided to these layers via <a href="/facts/Diffusion/KbAxroBa">diffusion</a> from the dermis, since the epidermis is without direct blood supply.<a class="footnote-ref" id="fnref:23" href="#fn:23"><sup>23</sup></a> The epidermis contains four cell types: <a href="/facts/Keratinocyte/drqhJjuS">keratinocytes</a>, <a href="/facts/Melanocyte/z8KowoXP">melanocytes</a>, <a href="/facts/Langerhans_cell/4UoNJ8K7">Langerhans cells</a>, and <a href="/facts/Merkel_cell/o61p10YA">Merkel cells</a>. Of these, keratinocytes are the major component, constituting roughly 95% of the epidermis.<a class="footnote-ref" id="fnref:24" href="#fn:24"><sup>24</sup></a> 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.<a class="footnote-ref" id="fnref:25" href="#fn:25"><sup>25</sup></a> 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.<a class="footnote-ref" id="fnref:26" href="#fn:26"><sup>26</sup></a> </p> <h3>Dermis</h3> <p class="note">Main article: <a href="/facts/Dermis/WAm7Fd6P">Dermis</a></p> <p>The dermis is the layer of skin between the epidermis and subcutaneous tissue, and comprises two sections, the <a href="/facts/Papillary_dermis/WAm7Fd6P">papillary dermis</a> and the <a href="/facts/Reticular_dermis/WAm7Fd6P">reticular dermis</a>.<a class="footnote-ref" id="fnref:27" href="#fn:27"><sup>27</sup></a> The superficial papillary dermis interdigitates with the overlying <a href="/facts/Rete_ridge/JvRABubP">rete ridges</a> of the epidermis, between which the two layers interact through the basement membrane zone.<a class="footnote-ref" id="fnref:28" href="#fn:28"><sup>28</sup></a> Structural components of the dermis are <a href="/facts/Collagen/KsyAb72K">collagen</a>, <a href="/facts/Elastic_fiber/1pk7dL9h">elastic fibers</a>, and <a href="/facts/Ground_substance/nvpvRF9e">ground substance</a> also called extra fibrillar matrix.<a class="footnote-ref" id="fnref:29" href="#fn:29"><sup>29</sup></a> Within these components are the pilosebaceous units, arrector pili muscles, and the <a href="/facts/Eccrine_gland/QrJPP1J5">eccrine</a> and <a href="/facts/Apocrine_gland/G7BJvS7I">apocrine glands</a>.<a class="footnote-ref" id="fnref:30" href="#fn:30"><sup>30</sup></a> 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.<a class="footnote-ref" id="fnref:31" href="#fn:31"><sup>31</sup></a><a class="footnote-ref" id="fnref:32" href="#fn:32"><sup>32</sup></a> 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.<a class="footnote-ref" id="fnref:33" href="#fn:33"><sup>33</sup></a><a class="footnote-ref" id="fnref:34" href="#fn:34"><sup>34</sup></a> </p> <h3>Subcutaneous tissue</h3> <p class="note">Main article: <a href="/facts/Subcutaneous_tissue/EPYjXN3G">Subcutaneous tissue</a></p> <p>The subcutaneous tissue is a layer of fat between the dermis and underlying <a href="/facts/Fascia/KnQE4bPq">fascia</a>.<a class="footnote-ref" id="fnref:35" href="#fn:35"><sup>35</sup></a> This tissue may be further divided into two components, the actual fatty layer, or <a href="/facts/Panniculus_adiposus/W8pfV8qV">panniculus adiposus</a>, and a deeper vestigial layer of muscle, the <a href="/facts/Panniculus_carnosus/W6JPPmEM">panniculus carnosus</a>.<a class="footnote-ref" id="fnref:36" href="#fn:36"><sup>36</sup></a> The main cellular component of this tissue is the <a href="/facts/Adipocyte/FuM7LlaK">adipocyte</a>, or fat cell.<a class="footnote-ref" id="fnref:37" href="#fn:37"><sup>37</sup></a> The structure of this tissue is composed of septal (i.e. linear strands) and <a href="/facts/Lobe_(anatomy)/Mc0Xa4s4">lobular</a> compartments, which differ in microscopic appearance.<a class="footnote-ref" id="fnref:38" href="#fn:38"><sup>38</sup></a> Functionally, the subcutaneous fat insulates the body, absorbs trauma, and serves as a reserve energy source.<a class="footnote-ref" id="fnref:39" href="#fn:39"><sup>39</sup></a> </p> <h2 id="diseases-of-the-skin">Diseases of the skin</h2> <p class="note">For a list, see <a href="/facts/List_of_skin_conditions/U58kszg2">List of skin conditions</a>.</p> <p>Diseases of the skin include <a href="/facts/Skin_infection/r1zDLsGz">skin infections</a> and <a href="/facts/Skin_neoplasm/r9BWEX7W">skin neoplasms</a> (including <a href="/facts/Skin_cancer/r9BWEX7W">skin cancer</a>).<a class="footnote-ref" id="fnref:40" href="#fn:40"><sup>40</sup></a> </p> <h2 id="history">History</h2> <p class="note">See also: <a href="/facts/History_of_dermatology/q0kn3XFR">History of dermatology</a></p> <p>In 1572, <a href="/facts/Geronimo_Mercuriali/MR4e5E0a">Geronimo Mercuriali</a> of <a href="/facts/Forl%C3%AC/surQJCLx">Forlì</a>, <a href="/facts/Italy/tUf0PDYF">Italy</a>, completed <i>De morbis cutaneis</i> ('On the diseases of the skin'). It is considered the first scientific work dedicated to <a href="/facts/Dermatology/YfvJ8uXn">dermatology</a>. </p> <h2 id="diagnoses">Diagnoses</h2> <p>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.<a class="footnote-ref" id="fnref:41" href="#fn:41"><sup>41</sup></a> Most of these conditions present with cutaneous surface changes termed "lesions," which have more or less distinct characteristics.<a class="footnote-ref" id="fnref:42" href="#fn:42"><sup>42</sup></a> Often proper examination will lead the physician to obtain appropriate historical information and/or laboratory tests that are able to confirm the diagnosis.<a class="footnote-ref" id="fnref:43" href="#fn:43"><sup>43</sup></a> Upon examination, the important clinical observations are the (1) morphology, (2) configuration, and (3) distribution of the lesion(s).<a class="footnote-ref" id="fnref:44" href="#fn:44"><sup>44</sup></a> 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.<a class="footnote-ref" id="fnref:45" href="#fn:45"><sup>45</sup></a> Over time, these primary lesions may continue to develop or be modified by regression or trauma, producing "secondary lesions".<a class="footnote-ref" id="fnref:46" href="#fn:46"><sup>46</sup></a> 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.<a class="footnote-ref" id="fnref:47" href="#fn:47"><sup>47</sup></a> Nevertheless, there are some commonly accepted terms used to describe the macroscopic morphology, configuration, and distribution of skin lesions, which are listed below.<a class="footnote-ref" id="fnref:48" href="#fn:48"><sup>48</sup></a> </p> <h2 id="lesions">Lesions</h2> <h3>Primary lesions</h3> <ul><li>Macule: A macule is a change in surface color, without elevation or depression, so nonpalpable, well or ill-defined,<a class="footnote-ref" id="fnref:49" href="#fn:49"><sup>49</sup></a> variously sized, but generally considered less than either 5<a class="footnote-ref" id="fnref:50" href="#fn:50"><sup>50</sup></a> or 10 mm in diameter at the widest point.<a class="footnote-ref" id="fnref:51" href="#fn:51"><sup>51</sup></a></li> <li>Patch: A patch is a large macule equal to or greater than either 5 or 10 mm across,<a class="footnote-ref" id="fnref:52" href="#fn:52"><sup>52</sup></a> depending on one's definition of a macule.<a class="footnote-ref" id="fnref:53" href="#fn:53"><sup>53</sup></a> 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.<a class="footnote-ref" id="fnref:54" href="#fn:54"><sup>54</sup></a></li> <li><a href="/facts/Papule/2J7QwJdE">Papule</a>: A papule is a circumscribed, solid elevation of skin, varying in size from less than either 5<a class="footnote-ref" id="fnref:55" href="#fn:55"><sup>55</sup></a> or 10 mm in diameter at the widest point.<a class="footnote-ref" id="fnref:56" href="#fn:56"><sup>56</sup></a></li> <li><a href="/facts/Papule/2J7QwJdE">Plaque</a>: A plaque has been described as a broad papule, or confluence of papules equal to or greater than 10 mm,<a class="footnote-ref" id="fnref:57" href="#fn:57"><sup>57</sup></a> or alternatively as an elevated, plateau-like lesion that is greater in its diameter than in its depth.<a class="footnote-ref" id="fnref:58" href="#fn:58"><sup>58</sup></a></li> <li><a href="/facts/Nodule_(medicine)/BgCs3GNE">Nodule</a>: A nodule is morphologically similar to a papule in that it is also a palpable spherical lesion less than 10 mm in diameter. However, it is differentiated by being centered deeper in the dermis or subcutis.</li> <li><a href="/facts/Neoplasm/K0ytzmPz">Tumor</a>: Similar to a nodule, but it is larger than 10 mm in diameter.</li> <li>Vesicle: A vesicle or <a href="/facts/Bleb_(medicine)/Pt6L9V0K"><i>bleb</i></a> is a small <a href="/facts/Blister/qGhqaeQV">blister</a>,<a class="footnote-ref" id="fnref:59" href="#fn:59"><sup>59</sup></a> a circumscribed, epidermal elevation generally considered less than either 5<a class="footnote-ref" id="fnref:60" href="#fn:60"><sup>60</sup></a> or 10 mm in diameter at the widest point.<a class="footnote-ref" id="fnref:61" href="#fn:61"><sup>61</sup></a></li> <li>Bulla: A bulla is a large <a href="/facts/Blister/qGhqaeQV">blister</a>,<a class="footnote-ref" id="fnref:62" href="#fn:62"><sup>62</sup></a> a rounded or irregularly shaped blister equal to or greater than either 5<a class="footnote-ref" id="fnref:63" href="#fn:63"><sup>63</sup></a> or 10 mm,<a class="footnote-ref" id="fnref:64" href="#fn:64"><sup>64</sup></a> depending on one's definition of a vesicle.<a class="footnote-ref" id="fnref:65" href="#fn:65"><sup>65</sup></a></li></ul> <p class="note">"Pustule" redirects here; not to be confused with <a href="/facts/Boil/ykr0kfQu">Boil</a>. For the hieroglyph, see <a href="/facts/Pustule_(hieroglyph)/oQfxkpWG">Pustule (hieroglyph)</a>.</p> <ul><li>Pustule: A pustule is a small elevation of the skin usually consisting of necrotic inflammatory cells.<a class="footnote-ref" id="fnref:66" href="#fn:66"><sup>66</sup></a></li> <li><a href="/facts/Cyst/N1n2ogU9">Cyst</a>: A cyst is an epithelial-lined cavity.<a class="footnote-ref" id="fnref:67" href="#fn:67"><sup>67</sup></a></li> <li>Wheal: A wheal is a rounded or flat-topped, pale red papule or plaque that is characteristically <a href="/facts/Evanescent_(dermatology)/0R7wp9no">evanescent</a>, disappearing within 24 to 48 hours. The temporary raised skin on the site of a properly delivered intradermal (ID) <a href="/facts/Injection_(medicine)/fvkH58gk">injection</a> is also called a welt, with the ID injection process itself frequently referred to as simply "raising a wheal" in medical texts.<a class="footnote-ref" id="fnref:68" href="#fn:68"><sup>68</sup></a></li> <li><a href="/facts/Welt_(bruise)/4YTs7Aaj">Welts</a>: Welts occur as a result of blunt force being applied to the body with elongated objects without sharp edges.</li> <li><a href="/facts/Telangiectasia/72MBl6oP">Telangiectasia</a>: A telangiectasia represents an enlargement of superficial blood vessels to the point of being visible.<a class="footnote-ref" id="fnref:69" href="#fn:69"><sup>69</sup></a></li> <li>Burrow: A burrow appears as a slightly elevated, grayish, tortuous line in the skin, and is caused by burrowing organisms.<a class="footnote-ref" id="fnref:70" href="#fn:70"><sup>70</sup></a><a class="footnote-ref" id="fnref:71" href="#fn:71"><sup>71</sup></a></li></ul> <h3>Secondary lesions</h3> <ul><li>Scale: Dry or greasy laminated masses of <a href="/facts/Keratin/tBh0bY47">keratin</a>,<a class="footnote-ref" id="fnref:72" href="#fn:72"><sup>72</sup></a> they represent thickened stratum corneum.<a class="footnote-ref" id="fnref:73" href="#fn:73"><sup>73</sup></a></li> <li>Crust: Dried <a href="/facts/Sebaceous_gland/HKMXmv1Y">sebum</a> usually mixed with epithelial and sometimes bacterial debris<a class="footnote-ref" id="fnref:74" href="#fn:74"><sup>74</sup></a></li> <li><a href="/facts/Lichenification/Vkr5XpeG">Lichenification</a>: Epidermal thickening characterized by visible and palpable thickening of the skin with accentuated skin markings<a class="footnote-ref" id="fnref:75" href="#fn:75"><sup>75</sup></a></li> <li>Erosion: An erosion is a discontinuity of the skin exhibiting incomplete loss of the <a href="/facts/Epidermis_(skin)/JvRABubP">epidermis</a>,<a class="footnote-ref" id="fnref:76" href="#fn:76"><sup>76</sup></a> a lesion that is moist, circumscribed, and usually depressed.<a class="footnote-ref" id="fnref:77" href="#fn:77"><sup>77</sup></a><a class="footnote-ref" id="fnref:78" href="#fn:78"><sup>78</sup></a></li> <li>Excoriation: A punctate or linear <a href="/facts/Abrasion_(medical)/cDrHUjy3">abrasion</a> produced by mechanical means (often scratching), usually involving only the epidermis, but commonly reaching the <a href="/facts/Papillary_dermis/WAm7Fd6P">papillary dermis</a>.<a class="footnote-ref" id="fnref:79" href="#fn:79"><sup>79</sup></a><a class="footnote-ref" id="fnref:80" href="#fn:80"><sup>80</sup></a></li> <li><a href="/facts/Ulcer_(dermatology)/ALY0IW1n">Ulcer</a>: An ulcer is a discontinuity of the skin exhibiting complete loss of the epidermis and often portions of the dermis.<a class="footnote-ref" id="fnref:81" href="#fn:81"><sup>81</sup></a><a class="footnote-ref" id="fnref:82" href="#fn:82"><sup>82</sup></a></li> <li><a href="/facts/Skin_fissure/QUJ3cagg">Fissure</a> is a lesion in the skin that is usually narrow but deep.<a class="footnote-ref" id="fnref:83" href="#fn:83"><sup>83</sup></a><a class="footnote-ref" id="fnref:84" href="#fn:84"><sup>84</sup></a></li> <li>Induration is dermal thickening causing the cutaneous surface to feel thicker and firmer.<a class="footnote-ref" id="fnref:85" href="#fn:85"><sup>85</sup></a></li> <li>Atrophy refers to a loss of skin, and can be epidermal, dermal, or subcutaneous.<a class="footnote-ref" id="fnref:86" href="#fn:86"><sup>86</sup></a> With epidermal atrophy, the skin appears thin, translucent, and wrinkled.<a class="footnote-ref" id="fnref:87" href="#fn:87"><sup>87</sup></a> Dermal or subcutaneous atrophy is represented by depression of the skin.<a class="footnote-ref" id="fnref:88" href="#fn:88"><sup>88</sup></a></li> <li><a href="/facts/Skin_maceration/6t3UAzJn">Maceration</a>: softening and turning white of the skin due to being consistently wet.</li> <li>Umbilication is formation of a depression at the top of a papule, vesicle, or pustule.<a class="footnote-ref" id="fnref:89" href="#fn:89"><sup>89</sup></a></li> <li>Phyma: A <a href="/facts/Tubercle/P2l35WpL">tubercle</a> on any external part of the body, such as in <a href="/facts/Rosacea/jxYUX2ml">phymatous rosacea</a></li></ul> <h3>Configuration</h3> <p>"Configuration" refers to how lesions are locally grouped ("organized"), which contrasts with how they are distributed (see next section). </p> <ul><li>Agminate: in clusters</li> <li>Annular or circinate: ring-shaped</li> <li>Arciform or arcuate: arc-shaped</li> <li>Digitate: with finger-like projections</li> <li>Discoid or nummular: round or disc-shaped</li> <li>Figurate: with a particular shape</li> <li>Guttate: resembling drops</li> <li>Gyrate: coiled or spiral-shaped</li> <li>Herpetiform: resembling <a href="/facts/Herpes/8AQktlTV">herpes</a></li> <li>Linear</li> <li>Mammillated: with rounded, breast-like projections</li> <li>Reticular or reticulated: resembling a net</li> <li>Serpiginous: with a wavy border</li> <li>Stellate: star-shaped</li> <li>Targetoid: resembling a <a href="/facts/Bullseye_(target)/trLujm6W">bullseye</a></li> <li>Verrucous or Verruciform: wart-like</li></ul> <h3>Distribution</h3> <p>"Distribution" refers to how lesions are localized. They may be confined to a single area (a patch) or may be 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. <a href="/facts/Varicella_zoster_virus/ebbSkn9U">Varicella zoster virus</a> is known to recur (after its initial presentation as <a href="/facts/Chicken_pox/XkGzx2GE">chicken pox</a>) as <a href="/facts/Herpes_zoster/2rEq69rr">herpes zoster</a> ("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. </p> <ul><li>Generalized</li> <li>Symmetric: one side mirrors the other</li> <li>Flexural: on the front of the fingers</li> <li>Extensor: on the back of the fingers</li> <li><a href="/facts/Intertriginous/od2707uk">Intertriginous</a>: in an area where two skin areas may touch or rub together</li> <li><a href="/facts/Morbilliform/CCcvjKME">Morbilliform</a>: resembling <a href="/facts/Measles/tepQCUIG">measles</a></li> <li>Palmoplantar: on the palm of the hand or bottom of the foot</li> <li>Periorificial: around an orifice such as the mouth</li> <li>Periungual/subungual: around or under a fingernail or toenail</li> <li>Blaschkoid: following the path of <a href="/facts/Blaschko%27s_lines/jdkzRqv1">Blaschko's lines</a> in the skin</li> <li>Photodistributed: in places where sunlight reaches</li> <li>Zosteriform or dermatomal: associated with a particular nerve</li></ul> <h3>Other related terms</h3> <ul><li>Collarette</li> <li><a href="/facts/Blackhead/aUxvzF77">Comedo</a></li> <li><a href="/facts/Confluency/gFgmxyrn">Confluent</a></li> <li><a href="/facts/Eczema/JwlyQBa2">Eczema</a> (a type of dermatitis)</li> <li><a href="/facts/Evanescent_(dermatology)/0R7wp9no">Evanescent</a> (lasting less than 24 hours)</li> <li><a href="/facts/Granuloma/mqEhHfjS">Granuloma</a></li> <li><a href="/facts/Livedo/V8v86Mzb">Livedo</a></li> <li><a href="/facts/Purpura/bz0qayUG">Purpura</a></li> <li><a href="/facts/Erythema/VUsgXRlB">Erythema</a> (redness)</li> <li>Horn (a cell type)</li> <li><a href="/facts/Poikiloderma/wuh4P3hP">Poikiloderma</a></li></ul> <h2 id="histopathology">Histopathology</h2> <ul><li><a href="/facts/Hyperkeratosis/8x6CXBfM">Hyperkeratosis</a></li> <li><a href="/facts/Parakeratosis/8Flhy9Pv">Parakeratosis</a></li> <li><a href="/facts/Hypergranulosis/f1HIRKol">Hypergranulosis</a></li> <li><a href="/facts/Acanthosis/JvRABubP">Acanthosis</a></li> <li><a href="/facts/Papillomatosis/5hNDmPDG">Papillomatosis</a></li> <li><a href="/facts/Dyskeratosis/4A6Tdy9U">Dyskeratosis</a></li> <li><a href="/facts/Acantholysis/eagj6Yye">Acantholysis</a></li> <li><a href="/facts/Spongiosis/tCKAcuWI">Spongiosis</a></li> <li><a href="/facts/Hydropic_swell/GXlPACbD">Hydropic swelling</a></li> <li><a href="/facts/Exocytosis_(dermatopathology)/3hNAUktJ">Exocytosis</a></li> <li><a href="/facts/Vacuolization/BQLzVfva">Vacuolization</a></li> <li><a href="/facts/Erosion_(dermatopathology)/Vkr5XpeG">Erosion</a></li> <li><a href="/facts/Ulcer_(dermatology)/ALY0IW1n">Ulceration</a></li> <li><a href="/facts/Lentigo/h05LsMfb">Lentiginous</a></li></ul> <h2 id="see-also">See also</h2> <ul><li><a href="/facts/Wound/snv0h3Gj">Wound</a>, an injury which damages the <a href="/facts/Epidermis/JvRABubP">epidermis</a>.</li></ul> <h2 id="external-links">External links</h2> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>Miller JH, Marks JG (2006). Lookingbill and Marks' Principles of Dermatology. Saunders. ISBN 1-4160-3185-5. <a href="1-4160-3185-5" target="_blank">1-4160-3185-5</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>Lippens S, Hoste E, Vandenabeele P, Agostinis P, Declercq W (April 2009). "Cell death in the skin". Apoptosis. 14 (4): 549–569. doi:10.1007/s10495-009-0324-z. PMID 19221876. S2CID 13058619. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li> <li id="fn:3"><p>King LS (1954). "What Is Disease?". Philosophy of Science. 21 (3): 193–203. doi:10.1086/287343. S2CID 120875348. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></p></li> <li id="fn:4"><p>Bluefarb SM (1984). Dermatology. Upjohn Co. ISBN 0-89501-004-6. <a href="0-89501-004-6" target="_blank">0-89501-004-6</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></p></li> <li id="fn:5"><p>Lynch PJ (1994). Dermatology. Williams & Wilkins. ISBN 0-683-05252-7. <a href="0-683-05252-7" target="_blank">0-683-05252-7</a> <a href="#fnref:5" class="footnote-back-ref">↩</a></p></li> <li id="fn:6"><p>Tilles G, Wallach D (1989). "[The history of nosology in dermatology]". Annales de Dermatologie et de Venereologie (in French). 116 (1): 9–26. PMID 2653160. <a href="/wiki/PMID_(identifier)" target="_blank">/wiki/PMID_(identifier)</a> <a href="#fnref:6" class="footnote-back-ref">↩</a></p></li> <li id="fn:7"><p>Lambert WC, Everett MA (October 1981). "The nosology of parapsoriasis". Journal of the American Academy of Dermatology. 5 (4): 373–395. doi:10.1016/S0190-9622(81)70100-2. PMID 7026622. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:7" class="footnote-back-ref">↩</a></p></li> <li id="fn:8"><p>Jackson R (May 1977). "Historical outline of attempts to classify skin diseases". Canadian Medical Association Journal. 116 (10): 1165–1168. PMC 1879511. PMID 324589. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1879511" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1879511</a> <a href="#fnref:8" class="footnote-back-ref">↩</a></p></li> <li id="fn:9"><p>Copeman PW (February 1995). "The creation of global dermatology". Journal of the Royal Society of Medicine. 88 (2): 78–84. PMC 1295100. PMID 7769599. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1295100" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1295100</a> <a href="#fnref:9" class="footnote-back-ref">↩</a></p></li> <li id="fn:10"><p>Wolff K, Johnson RA, Suurmond R (2005). Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology (5th ed.). McGraw-Hill Medical Pub. Division. ISBN 0-07-144019-4. <a href="0-07-144019-4" target="_blank">0-07-144019-4</a> <a href="#fnref:10" class="footnote-back-ref">↩</a></p></li> <li id="fn:11"><p>Werner B (August 2009). "[Skin biopsy and its histopathologic analysis: Why? What for? How? Part I]". Anais Brasileiros de Dermatologia (in Portuguese). 84 (4): 391–395. doi:10.1590/s0365-05962009000400010. PMID 19851671. <a href="https://doi.org/10.1590%2Fs0365-05962009000400010" target="_blank">https://doi.org/10.1590%2Fs0365-05962009000400010</a> <a href="#fnref:11" class="footnote-back-ref">↩</a></p></li> <li id="fn:12"><p>Werner B (October 2009). "[Skin biopsy with histopathologic analysis: why? what for? how? part II]". Anais Brasileiros de Dermatologia (in Portuguese). 84 (5): 507–513. doi:10.1590/S0365-05962009000500010. PMID 20098854. <a href="https://doi.org/10.1590%2FS0365-05962009000500010" target="_blank">https://doi.org/10.1590%2FS0365-05962009000500010</a> <a href="#fnref:12" class="footnote-back-ref">↩</a></p></li> <li id="fn:13"><p>Xu X, Elder DA, Elenitsas R, Johnson BL, Murphy GE (2008). Lever's Histopathology of the Skin. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 978-0-7817-7363-8. <a href="978-0-7817-7363-8" target="_blank">978-0-7817-7363-8</a> <a href="#fnref:13" class="footnote-back-ref">↩</a></p></li> <li id="fn:14"><p>Weedon's Skin Pathology, 2-Volume Set: Expert Consult – Online and Print. Edinburgh: Churchill Livingstone. 2009. ISBN 978-0-7020-3941-6. <a href="978-0-7020-3941-6" target="_blank">978-0-7020-3941-6</a> <a href="#fnref:14" class="footnote-back-ref">↩</a></p></li> <li id="fn:15"><p>Alfageme F, Cerezo E, Roustan G (April 2015). "Real-Time Elastography in Inflammatory Skin Diseases: A Primer". Ultrasound in Medicine & Biology. 41 (4): S82 – S83. doi:10.1016/j.ultrasmedbio.2014.12.341. <a href="/wiki/Fernando_Alfageme" target="_blank">/wiki/Fernando_Alfageme</a> <a href="#fnref:15" class="footnote-back-ref">↩</a></p></li> <li id="fn:16"><p>Miller JH, Marks JG (2006). Lookingbill and Marks' Principles of Dermatology. Saunders. ISBN 1-4160-3185-5. <a href="1-4160-3185-5" target="_blank">1-4160-3185-5</a> <a href="#fnref:16" class="footnote-back-ref">↩</a></p></li> <li id="fn:17"><p>Burns T, Rook A (2006). Rook's Textbook of Dermatology CD-ROM. Wiley-Blackwell. ISBN 1-4051-3130-6. <a href="1-4051-3130-6" target="_blank">1-4051-3130-6</a> <a href="#fnref:17" class="footnote-back-ref">↩</a></p></li> <li id="fn:18"><p>Paus R, Cotsarelis G (August 1999). "The biology of hair follicles". The New England Journal of Medicine. 341 (7): 491–497. doi:10.1056/NEJM199908123410706. PMID 10441606. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:18" class="footnote-back-ref">↩</a></p></li> <li id="fn:19"><p>Goldsmith LA (1983). Biochemistry and physiology of the skin. Oxford University Press. ISBN 0-19-261253-0. <a href="0-19-261253-0" target="_blank">0-19-261253-0</a> <a href="#fnref:19" class="footnote-back-ref">↩</a></p></li> <li id="fn:20"><p>Fuchs E (February 2007). "Scratching the surface of skin development". Nature. 445 (7130): 834–842. Bibcode:2007Natur.445..834F. doi:10.1038/nature05659. PMC 2405926. PMID 17314969. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2405926" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2405926</a> <a href="#fnref:20" class="footnote-back-ref">↩</a></p></li> <li id="fn:21"><p>Fuchs E, Horsley V (April 2008). "More than one way to skin . ". Genes & Development. 22 (8): 976–985. doi:10.1101/gad.1645908. PMC 2732395. PMID 18413712. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732395" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732395</a> <a href="#fnref:21" class="footnote-back-ref">↩</a></p></li> <li id="fn:22"><p>Wolff KD, Goldsmith LA (2008). Fitzpatrick's Dermatology in General Medicine. Vol. 2. McGraw-Hill Medical. ISBN 978-0-07-146690-5. <a href="978-0-07-146690-5" target="_blank">978-0-07-146690-5</a> <a href="#fnref:22" class="footnote-back-ref">↩</a></p></li> <li id="fn:23"><p>Amirlak B, Shahabi L. Talavera F, Stadelmann WK, Caputy GG (eds.). "Skin Anatomy". Medscape. Retrieved 3 June 2013. <a href="http://emedicine.medscape.com/article/1294744-overview" target="_blank">http://emedicine.medscape.com/article/1294744-overview</a> <a href="#fnref:23" class="footnote-back-ref">↩</a></p></li> <li id="fn:24"><p>Burns T, Rook A (2006). Rook's Textbook of Dermatology CD-ROM. Wiley-Blackwell. ISBN 1-4051-3130-6. <a href="1-4051-3130-6" target="_blank">1-4051-3130-6</a> <a href="#fnref:24" class="footnote-back-ref">↩</a></p></li> <li id="fn:25"><p>Burns T, Rook A (2006). Rook's Textbook of Dermatology CD-ROM. Wiley-Blackwell. ISBN 1-4051-3130-6. <a href="1-4051-3130-6" target="_blank">1-4051-3130-6</a> <a href="#fnref:25" class="footnote-back-ref">↩</a></p></li> <li id="fn:26"><p>Bolognia JL, Jorizzo JL, Rapini RP (2007). Dermatology. St. Louis: Mosby. ISBN 978-1-4160-2999-1. <a href="978-1-4160-2999-1" target="_blank">978-1-4160-2999-1</a> <a href="#fnref:26" class="footnote-back-ref">↩</a></p></li> <li id="fn:27"><p>Rapini RP (2005). Practical dermatopathology. Elsevier Mosby. ISBN 0-323-01198-5. <a href="0-323-01198-5" target="_blank">0-323-01198-5</a> <a href="#fnref:27" class="footnote-back-ref">↩</a></p></li> <li id="fn:28"><p>Rapini RP (2005). Practical dermatopathology. Elsevier Mosby. ISBN 0-323-01198-5. <a href="0-323-01198-5" target="_blank">0-323-01198-5</a> <a href="#fnref:28" class="footnote-back-ref">↩</a></p></li> <li id="fn:29"><p>Rapini RP (2005). Practical dermatopathology. Elsevier Mosby. ISBN 0-323-01198-5. <a href="0-323-01198-5" target="_blank">0-323-01198-5</a> <a href="#fnref:29" class="footnote-back-ref">↩</a></p></li> <li id="fn:30"><p>Wolff KD, Goldsmith LA (2008). Fitzpatrick's Dermatology in General Medicine. Vol. 2. McGraw-Hill Medical. ISBN 978-0-07-146690-5. <a href="978-0-07-146690-5" target="_blank">978-0-07-146690-5</a> <a href="#fnref:30" class="footnote-back-ref">↩</a></p></li> <li id="fn:31"><p>Wolff KD, Goldsmith LA (2008). Fitzpatrick's Dermatology in General Medicine. Vol. 2. McGraw-Hill Medical. ISBN 978-0-07-146690-5. <a href="978-0-07-146690-5" target="_blank">978-0-07-146690-5</a> <a href="#fnref:31" class="footnote-back-ref">↩</a></p></li> <li id="fn:32"><p>Grant-Kels JM (2007). Color Atlas of Dermatopathology (Dermatology: Clinical & Basic Science). Informa Healthcare. p. 163. ISBN 978-0-8493-3794-9. <a href="978-0-8493-3794-9" target="_blank">978-0-8493-3794-9</a> <a href="#fnref:32" class="footnote-back-ref">↩</a></p></li> <li id="fn:33"><p>Ryan T (1991). "Cutaneous Circulation". In Goldsmith LA (ed.). Physiology, biochemistry, and molecular biology of the skin (2nd ed.). New York: Oxford University Press. p. 1019. ISBN 0-19-505612-4. <a href="0-19-505612-4" target="_blank">0-19-505612-4</a> <a href="#fnref:33" class="footnote-back-ref">↩</a></p></li> <li id="fn:34"><p>Swerlick RA, Lawley TJ (January 1993). "Role of microvascular endothelial cells in inflammation". The Journal of Investigative Dermatology. 100 (1): 111S – 115S. doi:10.1038/jid.1993.33. PMID 8423379. <a href="https://doi.org/10.1038%2Fjid.1993.33" target="_blank">https://doi.org/10.1038%2Fjid.1993.33</a> <a href="#fnref:34" class="footnote-back-ref">↩</a></p></li> <li id="fn:35"><p>Lynch PJ (1994). Dermatology. Williams & Wilkins. ISBN 0-683-05252-7. <a href="0-683-05252-7" target="_blank">0-683-05252-7</a> <a href="#fnref:35" class="footnote-back-ref">↩</a></p></li> <li id="fn:36"><p>Burns T, Rook A (2006). Rook's Textbook of Dermatology CD-ROM. Wiley-Blackwell. ISBN 1-4051-3130-6. <a href="1-4051-3130-6" target="_blank">1-4051-3130-6</a> <a href="#fnref:36" class="footnote-back-ref">↩</a></p></li> <li id="fn:37"><p>Lynch PJ (1994). Dermatology. Williams & Wilkins. ISBN 0-683-05252-7. <a href="0-683-05252-7" target="_blank">0-683-05252-7</a> <a href="#fnref:37" class="footnote-back-ref">↩</a></p></li> <li id="fn:38"><p>Wolff KD, Goldsmith LA (2008). Fitzpatrick's Dermatology in General Medicine. Vol. 2. McGraw-Hill Medical. ISBN 978-0-07-146690-5. <a href="978-0-07-146690-5" target="_blank">978-0-07-146690-5</a> <a href="#fnref:38" class="footnote-back-ref">↩</a></p></li> <li id="fn:39"><p>Lynch PJ (1994). Dermatology. Williams & Wilkins. ISBN 0-683-05252-7. <a href="0-683-05252-7" target="_blank">0-683-05252-7</a> <a href="#fnref:39" class="footnote-back-ref">↩</a></p></li> <li id="fn:40"><p>Rose LC (September 1998). "Recognizing neoplastic skin lesions: a photo guide". American Family Physician. 58 (4): 873–84, 887–8. PMID 9767724. Retrieved 3 June 2013. <a href="http://www.aafp.org/afp/1998/0915/p873.html" target="_blank">http://www.aafp.org/afp/1998/0915/p873.html</a> <a href="#fnref:40" class="footnote-back-ref">↩</a></p></li> <li id="fn:41"><p>Callen J (2000). Color atlas of dermatology. Philadelphia: W.B. Saunders. ISBN 0-7216-8256-1. <a href="0-7216-8256-1" target="_blank">0-7216-8256-1</a> <a href="#fnref:41" class="footnote-back-ref">↩</a></p></li> <li id="fn:42"><p>James WD, Berger TD, Elston DM, Odom RB (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0. <a href="0-7216-2921-0" target="_blank">0-7216-2921-0</a> <a href="#fnref:42" class="footnote-back-ref">↩</a></p></li> <li id="fn:43"><p>Callen J (2000). Color atlas of dermatology. Philadelphia: W.B. Saunders. ISBN 0-7216-8256-1. <a href="0-7216-8256-1" target="_blank">0-7216-8256-1</a> <a href="#fnref:43" class="footnote-back-ref">↩</a></p></li> <li id="fn:44"><p>Callen J (2000). Color atlas of dermatology. Philadelphia: W.B. Saunders. ISBN 0-7216-8256-1. <a href="0-7216-8256-1" target="_blank">0-7216-8256-1</a> <a href="#fnref:44" class="footnote-back-ref">↩</a></p></li> <li id="fn:45"><p>James WD, Berger TD, Elston DM, Odom RB (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0. <a href="0-7216-2921-0" target="_blank">0-7216-2921-0</a> <a href="#fnref:45" class="footnote-back-ref">↩</a></p></li> <li id="fn:46"><p>Miller JH, Marks JG (2006). Lookingbill and Marks' Principles of Dermatology. Saunders. ISBN 1-4160-3185-5. <a href="1-4160-3185-5" target="_blank">1-4160-3185-5</a> <a href="#fnref:46" class="footnote-back-ref">↩</a></p></li> <li id="fn:47"><p>Wolff KD, Goldsmith LA (2008). Fitzpatrick's Dermatology in General Medicine. Vol. 2. McGraw-Hill Medical. ISBN 978-0-07-146690-5. <a href="978-0-07-146690-5" target="_blank">978-0-07-146690-5</a> <a href="#fnref:47" class="footnote-back-ref">↩</a></p></li> <li id="fn:48"><p>James WD, Berger TD, Elston DM, Odom RB (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0. <a href="0-7216-2921-0" target="_blank">0-7216-2921-0</a> <a href="#fnref:48" class="footnote-back-ref">↩</a></p></li> <li id="fn:49"><p>Wolff K, Johnson RA, Suurmond R (2005). Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology (5th ed.). McGraw-Hill Medical Pub. Division. ISBN 0-07-144019-4. <a href="0-07-144019-4" target="_blank">0-07-144019-4</a> <a href="#fnref:49" class="footnote-back-ref">↩</a></p></li> <li id="fn:50"><p>Wolff K, Johnson RA, Suurmond R (2005). Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology (5th ed.). McGraw-Hill Medical Pub. Division. ISBN 0-07-144019-4. <a href="0-07-144019-4" target="_blank">0-07-144019-4</a> <a href="#fnref:50" class="footnote-back-ref">↩</a></p></li> <li id="fn:51"><p>James WD, Berger TD, Elston DM, Odom RB (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0. <a href="0-7216-2921-0" target="_blank">0-7216-2921-0</a> <a href="#fnref:51" class="footnote-back-ref">↩</a></p></li> <li id="fn:52"><p>James WD, Berger TD, Elston DM, Odom RB (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0. <a href="0-7216-2921-0" target="_blank">0-7216-2921-0</a> <a href="#fnref:52" class="footnote-back-ref">↩</a></p></li> <li id="fn:53"><p>Miller JH, Marks JG (2006). Lookingbill and Marks' Principles of Dermatology. Saunders. ISBN 1-4160-3185-5. <a href="1-4160-3185-5" target="_blank">1-4160-3185-5</a> <a href="#fnref:53" class="footnote-back-ref">↩</a></p></li> <li id="fn:54"><p>Callen J (2000). Color atlas of dermatology. Philadelphia: W.B. Saunders. ISBN 0-7216-8256-1. <a href="0-7216-8256-1" target="_blank">0-7216-8256-1</a> <a href="#fnref:54" class="footnote-back-ref">↩</a></p></li> <li id="fn:55"><p>Wolff K, Johnson RA, Suurmond R (2005). Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology (5th ed.). McGraw-Hill Medical Pub. Division. ISBN 0-07-144019-4. <a href="0-07-144019-4" target="_blank">0-07-144019-4</a> <a href="#fnref:55" class="footnote-back-ref">↩</a></p></li> <li id="fn:56"><p>James WD, Berger TD, Elston DM, Odom RB (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0. <a href="0-7216-2921-0" target="_blank">0-7216-2921-0</a> <a href="#fnref:56" class="footnote-back-ref">↩</a></p></li> <li id="fn:57"><p>James WD, Berger TD, Elston DM, Odom RB (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0. <a href="0-7216-2921-0" target="_blank">0-7216-2921-0</a> <a href="#fnref:57" class="footnote-back-ref">↩</a></p></li> <li id="fn:58"><p>Callen J (2000). Color atlas of dermatology. Philadelphia: W.B. Saunders. ISBN 0-7216-8256-1. <a href="0-7216-8256-1" target="_blank">0-7216-8256-1</a> <a href="#fnref:58" class="footnote-back-ref">↩</a></p></li> <li id="fn:59"><p>Elsevier (23 December 2020). Dorland's Illustrated Medical Dictionary (33rd ed.). Elsevier. ISBN 978-0-323-66148-5. <a href="978-0-323-66148-5" target="_blank">978-0-323-66148-5</a> <a href="#fnref:59" class="footnote-back-ref">↩</a></p></li> <li id="fn:60"><p>Wolff K, Johnson RA, Suurmond R (2005). Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology (5th ed.). McGraw-Hill Medical Pub. Division. ISBN 0-07-144019-4. <a href="0-07-144019-4" target="_blank">0-07-144019-4</a> <a href="#fnref:60" class="footnote-back-ref">↩</a></p></li> <li id="fn:61"><p>James WD, Berger TD, Elston DM, Odom RB (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0. <a href="0-7216-2921-0" target="_blank">0-7216-2921-0</a> <a href="#fnref:61" class="footnote-back-ref">↩</a></p></li> <li id="fn:62"><p>Elsevier (23 December 2020). Dorland's Illustrated Medical Dictionary (33rd ed.). Elsevier. ISBN 978-0-323-66148-5. <a href="978-0-323-66148-5" target="_blank">978-0-323-66148-5</a> <a href="#fnref:62" class="footnote-back-ref">↩</a></p></li> <li id="fn:63"><p>Wolff K, Johnson RA, Suurmond R (2005). Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology (5th ed.). McGraw-Hill Medical Pub. Division. ISBN 0-07-144019-4. <a href="0-07-144019-4" target="_blank">0-07-144019-4</a> <a href="#fnref:63" class="footnote-back-ref">↩</a></p></li> <li id="fn:64"><p>James WD, Berger TD, Elston DM, Odom RB (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. 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ISBN 0-7216-2921-0. <a href="0-7216-2921-0" target="_blank">0-7216-2921-0</a> <a href="#fnref:86" class="footnote-back-ref">↩</a></p></li> <li id="fn:87"><p>Callen J (2000). Color atlas of dermatology. Philadelphia: W.B. Saunders. ISBN 0-7216-8256-1. <a href="0-7216-8256-1" target="_blank">0-7216-8256-1</a> <a href="#fnref:87" class="footnote-back-ref">↩</a></p></li> <li id="fn:88"><p>Callen J (2000). Color atlas of dermatology. Philadelphia: W.B. Saunders. ISBN 0-7216-8256-1. <a href="0-7216-8256-1" target="_blank">0-7216-8256-1</a> <a href="#fnref:88" class="footnote-back-ref">↩</a></p></li> <li id="fn:89"><p>Benedetti J (December 2021). "Description of Skin Lesions". The Merck Manual. 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