Reference — Med-Surg
Skin Lesion Terminology Reference
Documenting skin accurately starts with the right nouns. Primary lesions arise from normal skin; secondary lesions evolve from primary ones or from trauma. Get the word right and the chart — and the next clinician — knows exactly what you saw.
Educational use only. Terminology supports documentation and communication; it does not diagnose. Pair the description with the full clinical picture. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Primary Lesions
| Term | Description (example) |
|---|---|
| Macule | Flat, <1 cm, color change only (e.g., freckle, petechiae) |
| Patch | Flat, >1 cm color change (e.g., vitiligo) |
| Papule | Raised, solid, <1 cm (e.g., wart, elevated nevus) |
| Plaque | Raised, flat-topped, >1 cm (e.g., psoriasis) |
| Nodule | Raised, solid, deeper, >1 cm (e.g., lipoma) |
| Vesicle | Fluid-filled, <1 cm (e.g., herpes, early varicella) |
| Bulla | Fluid-filled, >1 cm (e.g., large blister, burn) |
| Pustule | Pus-filled (e.g., acne, impetigo) |
| Wheal | Transient, edematous, raised (e.g., hives, allergic reaction) |
A handy split: vesicle/bulla (clear fluid) vs pustule (pus); papule/plaque/nodule (solid) by size and depth.
Secondary Lesions
| Term | Description (example) |
|---|---|
| Scale | Flakes of dead epidermis (e.g., psoriasis, dandruff) |
| Crust | Dried exudate/serum (e.g., impetigo honey crust, healing lesion) |
| Erosion | Loss of epidermis, moist, heals without scar |
| Ulcer | Loss into dermis/deeper, may scar (e.g., pressure injury) |
| Fissure | Linear crack into the dermis (e.g., cracked heels, angular cheilitis) |
| Excoriation | Scratch/abrasion from self-trauma |
| Lichenification | Thickened, leathery skin from chronic rubbing (e.g., chronic eczema) |
| Scar | Fibrous replacement of lost tissue |
Describing the Whole Picture
Configuration: linear, annular (ring), grouped/herpetiform (e.g., zoster), target/iris (erythema multiforme), serpiginous.
Distribution: localized vs generalized, symmetric vs unilateral, dermatomal (zoster), flexural (eczema) vs extensor (psoriasis), sun-exposed, acral (palms/soles).
Also document: color, size (measure), borders (well- vs ill-defined), and any change over time. In darker skin tones, erythema may appear violaceous or be subtle — palpate for warmth and induration.
NCLEX Pearls
- ✦Macule = flat color change; papule = small solid raised; plaque = large flat-topped raised; nodule = deeper solid.
- ✦Vesicle (<1 cm) and bulla (>1 cm) are clear-fluid; pustule is pus-filled; wheal is transient edema (hives).
- ✦Secondary lesions evolve: scale, crust, erosion, ulcer, fissure, lichenification, scar.
- ✦Lichenification (thick leathery skin) = chronic rubbing/scratching, classic for chronic eczema.
- ✦Document configuration + distribution + color + size + change — not just 'rash.'
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with Academy of Medical-Surgical Nurses (AMSN) · Current medical-surgical nursing standards. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →