increasingly sensitive to the various causative agents, and itching will appear more
b. Pain. Pain is not seen very often in skin disorders, although there may be a
burning sensation associated with indurating lesions.
c. Edema. Edema is the collection of fluid in the tissues of the dermis. This is
usually localized at least to a particular area of the body. When individual lesions take
the form of a small area of swelling with associated pruritis, the eruption is called
urticaria. The edema may be extensive, involving either the face or part of an extremity.
When the edema involves the face, the eyes may be forced shut by the swollen tissues.
Edema is seen in numerous systemic disorders, but there are usually enough other
symptoms of the underlying disease to prevent confusion with a skin reaction to an
d. Scales. The upper layer of the epidermis may accelerate the production of
keratinized (horny) cells, and these will begin to flake off following minimal trauma.
These flakes of dry, dead tissue are called scales. Many lesions show scaling as the
disease kills additional layers of the epidermis. Occasionally the scales may take
characteristic shapes because of plugging pores in the skin.
e. Weeping. Weeping is the oozing of fluid from the surface of a lesion. This
occurs whenever sufficient layers of epidermis have been destroyed and removed so
that the capillary beds of the dermis are near the surface. Weeping is serious
because of its tendency to macerate (soften) the lesions and the surrounding skin. As
the healthy tissue breaks down, the disease spreads more easily. Weeping is
frequently seen in body creases and must be guarded against. The use of powders to
dry weeping lesions is the first step in the successful therapy of such conditions.
f. Scaling and Weeping. There may be a combination of scaling and weeping.
This will result in the formation of a crust over the lesion. Any blood, pus, or other
exudate from the lesion may add to this crust. The raw surface of the lesion will be
protected by this crust, but the fluid collecting under it will be an excellent growth
medium for bacteria, thus adding infection to the existing problems. Crusts may be a
cause of itching, and frequently they will be ripped off by the patient, either on purpose
or accidentally while scratching.
g. Fissures. Fissures are small cracks in the skin. These are very common
and occur when there is an excessive drying of the skin. The corners of the mouth are
common sites for this condition. Fissure may also be seen in areas of lichenification
(places where the tissue has become thickened from continuous irritation). Fissures are
open portals of entry for bacteria.
h. Fever. Fever is usually seen in infectious diseases, but it may also be
present in cases of allergy. This is not a common concern to the dermatologist,
because disease limited to the skin will not cause fever.