What Say?

Summary and Comment |
February 22, 2016

What Say?

  1. Mark V. Dahl, MD

The International League of Dermatological Societies presents a revised glossary for the description of cutaneous lesions.

  1. Mark V. Dahl, MD

Recently, the International League of Dermatological Societies (ILDS) nominated a Committee on Nomenclature to develop a new glossary. The glossary was approved unanimously by the committee after voting by 46 national member societies and representatives from 35 countries.

The glossary contains 13 basic terms (macule, papule, plaque, nodule, wheal, vesicle, bulla, pustule, crust, scale, erosion, excoriation, and ulcer) and more than 100 descriptive terms concerning distribution, configuration, form (accuminate, depressed, domed, flat-topped, papillomatous, pedunculated, raised edge, umbilicated, verruciform), shape, and sensation on palpation (atrophy, compressible, firm, fixed, fluctuant, induration, mobile, pulsatile, rock-hard, rope-like, rough, smooth, soft, warm). Nonelevated but palpable lesions (e.g., as in morphea) are termed plaques. One centimeter is the maximum diameter for a papule rather than a plaque, and a vesicle rather than a bulla. Other primary and secondary lesions defined included callus, clavus, comedo, ecchymosis, exanthem, fissure, fistula, gangrene, gumma, halo, hematoma, horn, keratotic, infarct, keratoderma, keratosis, kerion, lichenification, necrosis, peeling, petechial, poikiloderma, prurigo, purpura, sinus, stria, swelling, telangiectasia. They even defined 13 colors.


Providers might want to study this handy reference and its tables. Space herein does not allow listings, definitions, and comments of all 100+ descriptive terms. This glossary will not settle discussions of lesion names but does provide an English glossary for precise lesion description. In this increasingly imprecise and picture-based world, good written descriptions are rare. Journal editors particularly should insist that authors provide precise dermatological descriptions.

Of note, “erythematous” is not included (pink, salmon-pink, or red were preferred), but neither are some handy, more descriptive ruddy colors, such as fire-engine red, scarlet, brick red, and rusty red. “Well-demarcated” and “poorly demarcated” appropriately receive top billing in defining shape. Nodule is defined as “a circumscribed, palpable lesion ≥1 cm usually located primarily in the dermis or subcutis,” obviating the need for the feared term “tumor.” One simply includes the nodule's diameter in the descriptive adjectives preceding the name of the primary lesion.

Editor Disclosures at Time of Publication

  • Disclosures for Mark V. Dahl, MD at time of publication Consultant / Advisory board Ulthera, Inc.; AuBio LifeSciences, LLC; Paris Therapeutics Equity Elorac, Inc.; Makucell, Inc.; Paris Therapeutics Editorial boards UpToDate Leadership positions in professional societies National Rosacea Society (Chairman, Medical Board)


Reader Comments (1)

Bernard Greenfeld Physician, Emergency Medicine

How can a Provider get an online copy of "this handy reference and its tables" to study as recommended by Dr. Dahl?

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