bubble_chart Concept

Desquamation, also known as dandruff or scale, refers to the fragments that fall off the surface of the skin. Its shapes vary, resembling chaff, scales, etc.; its colors differ, commonly seen in white, silvery white, light brown, etc.; its nature can be dry or oily. Under normal circumstances, desquamation is a natural product of skin metabolism, and a small amount of desquamation is a physiological phenomenon, which should not be confused with pathological desquamation.

Desquamation can be seen all over the body, but this article only discusses skin desquamation on the trunk and limbs, while scalp desquamation is discussed in a separate section. In addition, the origin and composition of scabs are not entirely consistent with desquamation, and are also not within the scope of this article.

bubble_chart Pattern Analysis

1. Blood-heat Wind-dryness︰The scales are dry and white, appearing incessantly, covering the red macules and papules, accompanied by irritability, thirst, dry stool, short and yellow urine, a red tongue with thin yellow coating, and a slightly rapid pulse. This condition arises from an inherent excess of yang-heat in the body, where blood-heat externally congestes the skin. The intense heat generates wind and transforms into dryness, leading to malnutrition of the skin and the onset of the disease. Amidst a series of heat symptoms (such as irritability, thirst with a preference for cold drinks, dry stool, short and yellow urine, a red tongue with yellow coating, and a slightly rapid pulse), the scaling develops rapidly, with new macules and papules continuously emerging. The macules and papules are bright red, and removing the scales reveals pinpoint bleeding. The treatment principle focuses on {|###|}cooling blood and clearing heat{|###|}, often employing Glabrous Greenbrier Pill or Keyin No. 1 Formula.
2. Blood Deficiencywind-dryness︰The scales are dry, white, small, and flake off in layers, adhering to light red patches. The skin is dry, and sometimes there is dizziness or blurred vision. The complexion is pale, the tongue texture is pale with thin coating, and the pulse is deep and thin. This is caused by prolonged illness leading to blood deficiency producing wind, which transforms into dryness, resulting in loss of skin moisture. The common feature of both syndromes is the presence of dryness in the scaling, such as dry texture, continuous shedding, and flaking in layers. The differences are: in addition to manifestations of yin-blood deficiency (such as dizziness, blurred vision, dull complexion, dry throat, thirst without desire to drink, pale tongue with little or no coating, and deep, thin pulse), the scaling has a prolonged course, develops slowly, and generally lacks new rashes. The macules and papules are light red or dull red. For treatment, the approach is to nourish blood, yin, and moisten dryness. Commonly used formulas include the Nourishing Blood and Moistening Skin Decoction or the Ke Yin No. 2 Formula.
3. Invasion of Wind-heat︰The scales are bran-like, attached to yellow round or oval macules and papules, mostly seen on the chest and back; white powdery scales may also be observed, attached to pale red round patches. There are no obvious systemic symptoms, or initial discomfort, fever, and dry throat may occur. The tongue is red with thin yellow coating, and the pulse is slightly rapid. This condition is caused by blood-heat affected by wind, leading to disharmony between nutrient and defense levels and obstruction of the muscular interstices. The clinical features include: fine, white, bran-like scales attached to pale red or yellowish-red macules and papules (oval with the long axis parallel to the skin lines). Sometimes, signs of exterior heat may accompany (such as general discomfort, grade I fever, red tongue with thin coating, and floating rapid pulse). The treatment involves dispersing wind, clearing heat, and cooling blood. The commonly used formula is Wind-Dispersing Powder with modifications.
4. Wind-dampness Infiltration︰Scales are thin, greasy, and attached to indistinct patches, commonly found on the chest, back, armpits, and groin. There are usually no obvious systemic symptoms, with normal tongue texture, thin coating, and a soggy, slow pulse. This condition arises from internal dampness accumulation, external exposure to wind, and the mutual contention of wind and dampness, which obstruct the skin. Scales often adhere to indistinct patches. Treatment focuses on dispelling wind and eliminating dampness, with the commonly used formula being the dispersing wind and dampness-resolving decoction.
5. Exuberant Toxic Heat︰The skin is flushed all over, with large patches of scaly, leaf-like desquamation, and the hands and feet appear as if shedding gloves or socks. It is often accompanied by high fever, headache, nausea, dysphoria, and a dry mouth with thirst. The tongue is red with yellow, dry coating, and the pulse is surging and rapid. This syndrome arises from excessive internal heat compounded by dermatitis medicamentosa, leading to internal accumulation of toxic heat that encroaches on the nutrient-blood and overflows to the skin. In severe cases, the toxic heat transforms into fire, scorching and damaging yin fluids, with the toxic fire invading inward to attack the zang-fu organs. This syndrome is not difficult to recognize clinically: (1) There is often a history of medication use (oral or topical), and the onset is sudden. (2) The desquamation is leaf-like, peeling off layer by layer, or even glove- or sock-like shedding on the hands and feet. In the stage of exuberant toxic heat with desquamation, where healthy qi is strong and pathogens are excessive, the skin is flushed, and desquamation is not very extensive. It is accompanied by fever, headache, thirst for cold drinks, a red tongue, and a rapid, forceful pulse. The primary focus is on treating the symptoms, with the method aimed at clearing the nutrient level to remove toxins. The commonly used formula is Plague-Clear Toxin-Vanquishing Decoction with modifications. If the condition progresses further, with yin damage and toxin sinking, extensive peeling of the skin occurs, along with high fever, unconsciousness, dysphoria, a deep red tongue with no coating, and a deep, thin pulse. In this case, the focus shifts to treating the root, with the method intended to enrich yin and increase fluids, clear heat, and remove toxins. The formula used is Fluid-Increasing Toxin-Removing Decoction.

Blood heat wind-dryness desquamation and blood deficiency wind-dryness desquamation: These two syndromes are commonly seen in psoriasis, and their disease cause and mechanism of disease are both related to wind-dryness, but they differ in blood heat and blood deficiency. The common point of the two syndromes is that the desquamation manifests as dryness, such as dry texture of the desquamation, continuous shedding, and layer-by-layer peeling.

Wind-heat external invasion desquamation and wind-dampness soaking desquamation: Both syndromes are caused by wind evil, and the main difference between them lies in the presence of dampness. Although both have symptoms of wind, the distinction between dampness-heat is obvious.

Skin desquamation should pay attention to its characteristics, such as dryness mostly belonging to wind, heat, toxin, and blood deficiency; greasiness is mostly related to dampness; bran-like, mica-like conditions are milder; large like leaves or glove-like conditions are severe.