Although many skin disorders are easily recognized by simple inspection, the history and physical examination are often necessary for accurate assessment. The entire body surface, mucous membranes, conjunctiva, hair, and nails should always be examined thoroughly under adequate illumination. The color, turgor, texture, temperature, and moisture of the skin and the growth, texture, caliber, and luster of the hair and nails should be noted. Skin lesions should be palpated, inspected, and classified on the bases of morphology, size, color, texture, firmness, configuration, location, and distribution. One must also decide whether the changes are those of the primary lesion itself or whether the clinical pattern has been altered by a secondary factor such as infection, trauma, or therapy.
Primary lesions are classified as macules, papules, patches, plaques, nodules, tumors, vesicles, bullae, pustules, wheals, and cysts.
A macule represents an alteration in skin color but cannot be felt.
When the lesion is >1 cm, the term patch is used.
Papules are palpable solid lesions <0.5–1 cm, whereas nodules are larger in diameter.
Tumors are usually larger than nodules and vary considerably in mobility and consistency. Vesicles are raised, fluid-filled lesions <0.5 cm in diameter; when larger, they are called bullae. Pustules contain purulent material.
Wheals are flat-topped, palpable lesions of variable size, duration, and configuration that