Facial desquamation refers to the shedding of skin fragments on the facial area, resembling fine, white, bran-like flakes or yellowish, greasy crusts, often accompanied by cutaneous pruritus.

Conditions such as "seborrheic dermatitis," "facial seborrheic dermatitis," and "eyebrow wind tinea" recorded in historical medical texts include this symptom.

Desquamation can occur on the skin of the entire body. This section only discusses facial desquamation, while scalp desquamation and generalized desquamation are discussed in separate sections.

bubble_chart Pattern Analysis

1. Blood-heat Wind-dryness︰Facial flushing, predominantly in the eyebrow arch, nasolabial folds, and areas around the ears, presents as diffuse and evenly distributed powdery white scales, with dry cutaneous pruritus. In severe cases, scratching may lead to exudation or bleeding. Dry mouth with thirst. The tongue texture is red with thin yellow coating, and the pulse is wiry. Due to constitutional yang exuberance, heat lurking in the nutrient-blood level generates wind and transforms into dryness. The characteristic facial scaling manifests as fine white scales that easily shed, with an erythematous base and burning cutaneous pruritus. The course of the disease is relatively short. This is an excess pattern, and treatment should focus on cooling blood and clearing heat to dispel wind. The recommended formula is Cooling Blood Wind-Dispersing Powder with modifications.
2. Dampness-heat of Spleen and Stomach︰The face exhibits greasy desquamation, and in severe cases, oozing and crusting with an erythematous base. Fissures are visible on both auricles. There is severe constipation and scanty dark urine. The tongue is red with a yellow, greasy coating, and the pulse is wiry-slippery or slippery-rapid. The condition is often caused by excessive consumption of spicy, rich, fried, or greasy foods, leading to internal accumulation of dampness-heat in the spleen and stomach, which fails to disperse and instead rises to the face. The characteristic facial desquamation appears as greasy crusts, with moist erythematous skin beneath, accompanied by dark urine and constipation. Key diagnostic features include a red tongue with a yellow, greasy coating and a wiry-slippery pulse. Treatment should focus on clearing heat, dispelling dampness, and removing toxins. Modified Saposhnikovia Root Tong Sheng Wan is recommended.
3. Yin Deficiency with Blood Dryness︰The facial skin is dry, covered with tightly attached fine white scales, with a dark red or dark brown base, recurring and unhealed, accompanied by incessant itching. The complexion is dull, with dry mouth and restlessness. The tongue texture is red with scant coating, and the pulse is thin. This is due to insufficiency of the liver and kidney, deficiency of yin and blood, leading to the loss of nourishment in the facial skin. Thus, it manifests as dry, thickened facial lesions with tightly attached scales, a dark-colored base, and cutaneous pruritus with persistent scratching, lingering without healing. This is a deficiency pattern, and the treatment should focus on nourishing yin and blood to moisten dryness. The recommended formula is the Angelica Decoction with modifications.

bubble_chart Documentation

Yizong Jinjian﹒Waike Xinfa Essentials: "This condition occurs on the face, initially presenting with facial swelling, itching as if insects are crawling, dry skin, and occasional white flakes. Subsequently, intense itching leads to scratching and breaking of the skin; in cases of excessive damp-heat, yellow fluid oozes out, while in cases of excessive wind-dryness, blood oozes out, causing unbearable pain. It is caused by inherent blood dryness and excessive consumption of spicy and rich foods, leading to damp-heat in the Yangming Stomach Channel being affected by wind."