Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 27.05.2022

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scale; Squama

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A skin flake is a circumscribed collection of loosely connected horny lamellae. In a normal skin condition, skin scales occur as imperceptible (not visible) physiological exfoliation of horny cells (desquamatio insensibilis).

In a pathological skin condition, increased desquamation or pathological scaling may occur. The scales are then recognizable as visible accumulations of horny lamellae of the skin (desquamatio sensibilis).

Scaling has a high diagnostic value because it represents an underlying pathogenic process. The type of scaling allows conclusions to be drawn about the type, duration, acuity and floor 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.

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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


Last updated on: 27.05.2022