Terminology
Dermatology Editor: Ashley Ciosek, MD
Reviewed by: Eva Niklinska, MD
Primary Lesion |
Secondary Lesion |
|---|---|
| Flat: Macule (<5mm) versus patch (>5mm) | Excoriations: “Excavations” dug into skin secondary to scratching |
| Raised: Papule (<5mm) versus plaque (>5mm) | Lichenification: Roughing of the skin with accentuation of skin markings |
| Fluid Filled: Vesicle (<5mm) versus Bullae (>4mm) versus Pustule (pus-filled) | Scale: Flakes of stratum corneum |
| Nodule - firm, thicker, deeper, 1 and 2 cm in diameter. | Crust: Rough surface, dried serum, blood, bacteria, and cellular debris |
| Non Blanching: Petechial (<4mm) versus purpura (4-10mm) | Ulceration: Loss of epidermis and dermis, Erosion: Loss of the epidermis |
Corticosteroids: General Principles
- Main side effects ➔ skin atrophy
- Face and intertriginous areas ➔ low potency steroids ONLY
- High potency steroids should be limited to 3 weeks of use
- Optimal absorption if applied after bathing (hydration promotes steroid penetration)
- Ointments - most potent due to occlusive effect, good for thick, hyperkeratotic lesions and areas of smooth, NON-hairy skin. Avoid hairy and intertriginous areas (can cause skin maceration and folliculitis)
- Creams - more cosmetically appealing and well tolerated. Less potent than ointments
- Lotions - Useful in hairy and intertriginous areas. Less potent than creams
Corticosteroid Potencies
Low Potency |
Medium Potency |
High Potency |
Very High Potency |
|---|---|---|---|
Desonide 0.05% (cream, lotion, ointment) Triamcinolone (Kenalog) 0.025% (ointment, cream) Hydrocortisone acetate (OTC) |
Triamcinolone (Kenalog) 0.1% (ointment, cream) Hydrocortisone valerate 0.2% (ointment, cream) |
Betamethasone dipropionate 0.05% (ointment, cream, lotion) Triamcinolone (Kenalog) 0.5% (ointment, cream) |
Clobetasol 0.05% (cream, ointment, lotion, gel, foam) |