Configuration and distribution of skin lesions

Where these points sit in the description

A skin lesion is described under eight points, in this order: primary skin lesion vs secondary skin lesion; color; shape and border; size; configuration; location / distribution; surface / texture; and blanchable or not.

Configuration is the fifth and location / distribution the sixth, and shape and border is the third. A full description walks the list rather than reaching for a diagnosis.

Configuration

Configuration is how lesions are arranged or related to others - it describes the group, not the single lesion.

The named configurations are: grouped, linear, arcuate, serpiginous, nummular, annular, and reticular.

Distribution

Distribution is the anatomic distribution pattern of the skin lesions, and it is read as a set of pairs:

• Disseminated vs localized vs solitary
• Unilateral vs bilateral
• Symmetric vs asymmetric
• Sun-exposed sites vs sun-protected sites
• Flexural vs extensor surfaces
• Intertriginous, that is large body folds
• Acral, that is hands, feet, ears and nose
• Palmoplantar
• Seborrheic regions
• Periorificial
• Mucosal, that is mouth and anogenital