Scale

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

scale; Squama

Definition
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Circumscribed accumulation of loosely connected horn lamellae. Skin scales appear in normal skin condition as imperceptible (not visible) physiological exfoliations of horny cells (desquamatio insensibilis). A pathological skin condition can lead to increased desquamation or to a pathological scale structure. The scales can then be recognised as visible accumulations of horny lamellae of the skin (desquamatio sensibilis).

Dandruff formation has a high diagnostic value because it represents an underlying pathogenic process. The type of desquamation allows statements about the type, duration, acuteity and stage of the pathogenic process.

Clinical picture
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  • A distinction is made according to size:
    • Pityriasiform scaling: bran or flour-like scales
    • Small lamellar flaking: Confetti sized flakes
    • Large-lamellar scaling.
  • By the type of scaling:
    • Exfoliative desquamation: flakes flaking like a film
    • Psoriatic scaling: Silvery white scales
    • Ichthyosiform scaling: callous-plate-like scales.

Literature
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  1. Altmeyer P (2007) Dermatological differential diagnosis. The way to clinical diagnosis. Springer Medicine Publishing House, Heidelberg
  2. Nast A, Griffiths CE, Hay R, Sterry W, Bolognia JL. The 2016 International League of Dermatological Societies' revised glossary for the description of cutaneous lesions. Br J Dermatol. 174:1351-1358.
  3. Ochsendorf F et al (2017) Examination procedure and theory of efflorescence. Dermatologist 68: 229-242

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Last updated on: 29.10.2020