Scaly

Introduction Scales are one of the most common secondary skin lesions in dermatological diseases. It is produced by the epidermis of the skin and is more common in the red rash and maculopapular rash of superficial inflammatory skin diseases. In the larger, deeper, nodules, cystitis and tumors located in the deep dermis, subcutaneous tissue and fat layer, because of its deeper parts, farther from the epidermis and dermis, the scales are less common. In normal epidermis, the horn cells are keratinocytes, which are generally composed of four layers: the bottom layer is the basal cell layer, the spine layer, the granular layer, and the outermost layer are the stratum corneum.

Cause

In the thicker palm of the stratum corneum, there is a transparent layer between the granular layer and the stratum corneum. In normal conditions, the growth cycle of the keratinocytes was 12 d. In the case of inflammatory stimuli, the growth of horn cells is accelerated, such as psoriasis can be shortened to 5d. Therefore, it interferes with the law of keratin formation, keratin formation is destroyed, and therefore, keratinization is incomplete, and many keratinocytes that are not completely keratinized mature enter the human stratum corneum with the nucleus. The keratin is not dense and tough, but becomes loose and easily falls off to form scales. The scales are often white due to the loose and light-transparent refraction. Scales have different forms and characteristics in different skin diseases, so they have diagnostic value.

Not all scales are produced by inflammation-stimulated epidermis, some of which are non-inflammatory, such as congenital hereditary ichthyosis, which is non-inflammatory; squamous follicular keratosis is also non-inflammatory. Therefore, genus can be divided into two categories: inflammatory scaly and non-inflammatory scaly.

an examination

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Facial, hand, foot or whole body diffuse redness, swelling subsided in about 3 weeks, began to appear sick or leafy desquamation, hands and feet were broken gloves or broken socks, hair, nails can also fall off, the course of disease can be delayed for several months; Often have irregular fever, chills or complicated systemic lymph node swelling, toxic hepatitis, bronchial pneumonia, severe cases of secondary infections or systemic failure of the skin extensive flushing, swelling, repeated desquamation; one of the serious drug eruptions, Mostly caused by long-term medication, or continued to take medication based on the occurrence of drug eruption, the progressive progression of the disease may be exfoliative dermatitis.

First, inflammatory scales

1. Viral infectious diseases: viral infectious rash diseases, more common in infants and children, and more popular. The general course of disease is short, and the scales are often in the form of small batches.

(1) Measles: The rash period is only 1 week, and the rash is regressed with the rash.

(2) Rubella: only 3-4 days from rash to regression, and small debris is removed when the rash subsides.

(3) Children's acute rash: only 3 days from rash to regression, the rash subsides a little fine, or can not see the debris.

2. Cocci infection

(1) Scarlet fever: On the fifth day of onset, the rash is diffusely scarlet, and the rash lasts only 2-4 days.

(2) erysipelas: after the swelling of the erythema subsides, there are mild sputum samples and fines. If there is water sore, there is a form of ecstasy.

3. Bacterial infectious diseases

(1) Red peony: caused by Corynebacterium comatus, more common in the armpit, groin is brown-red patch, the old damage has wrinkles, and there are fine scales covering the surface, Gram staining is positive Corynebacterium.

(2) Lupus vulgaris: The course of disease can last for decades. The flat damage surface is in the form of a piece, and its surface is smooth, showing a small amount of scales.

(3) Tuberculosis-type leprosy: It is a large red plaque with a dry surface, a detachment of hair and a sensory disturbance, and the surface is covered with finely divided dry scales.

4. Fungal infectious diseases

(1) Head white sputum: mainly invades children's head hair and hair follicles. On the head, there are round plaques of scaly scaly white spots, which often have small patches of satellite-like scaly rounds. The boundary is clear, and the hair root has a white sleeve-shaped color sheath, which is characterized by a fracture of 0.5 cm. Hair microscopy revealed hairy and endogenous fungal spores. Woodlight darkroom illumination has green fluorescence.

(2) Hand, foot and ankle: The papules are often ring-shaped or curved in the form of papules, and the papules on the margins have small pieces of desquamation, mainly invading the stratum corneum of the skin. The fungal hyphae can be seen by scraping the scaly microscopy.

(3) Body sputum: mainly invades the stratum corneum of the skin and can cause mild inflammation. The lesions are arranged in a ring or concentric ring shape, and the edge ridges are in the shape of a bank and are composed of scaly papules. The center skin is often smooth and normal. Fungal hyphae can be found by scraping the scales.

(4) Femoral hernia: The inner side of the multi-infringed strand is fan-shaped, and the edge is raised like a dike, consisting of scaly papules. The center skin is smooth and the fungus hyphae can be found in the scales.

(5) Pedican mites: caused by round and oval round sputum, easy to invade the neck, chest, back, round brown or white rash, with tight and thin turned fines on the surface. Check the crumbs or hyphae.

(6) Dalmatia: found in tropical and subtropical regions, caused by concentric trichophyton, more common in the trunk and limbs. Parasitic to the stratum corneum of the skin, forming concentric circles, or fused into a spiral shape. The scales are characterized by one end attached to the epidermis and the other end being free and tending to the center.

5. Spiral infectious diseases

(1) Secondary syphilis rash: split trunk, limbs, palms and palms; red rose rash in the trunk, mostly round erythema in the palm of the hand and foot, and asymptomatic. The trunk rash may have fine sputum-like scum, and the circular rash on the palm of the hand and the foot is often caused by annular scales at about l-2 mm inside the outer edge of the plaque.

(2) secondary syphilis psoriasis-like scaly plaques: the damage varies in size, the color is often dark red, and the surface is covered with thick silver scales. Dark red round spots are visible on the palms of the hands and feet, and the surface is often keratinized and thick.

(3) The second stage syphilis rash is heavier, and there is a sputum-shaped syphilis rash that can occur in the face, trunk and limbs. It consists of a mixture of scales and incomprehensibility. It is hard to damage the cortical shell-like brownish black and is rare in clinical practice. Shell-shaped skin lesions can also be seen in the second phase of yaws and psoriasis.

6. Allergic skin disease

(1) Eczema and contact dermatitis: The main histopathological changes are in the epidermis and dermis, which are characterized by intraepithelial and intercellular edema, superficial edema of the dermis, small blood vessel congestion, and non-specific inflammatory cell infiltration. In the subacute phase, hyperplasia of the acanthosis, mild edema, and infiltration of inflammatory cells in the superficial dermis occur. At this time, the epidermis in the epidermis often has parakeratosis, and the scales increase, forming small pieces of scales.

(2) exfoliative dermatitis: exfoliative dermatitis is mainly caused by drug allergic reactions, followed by secondary skin diseases such as psoriasis, eczema and the like. Its clinical manifestations are diffuse flushing and hyperemia of the whole body, and the skin scales are flaky, leafy exfoliated, and the palms of the hands and feet are sleeve-like. Peel off the scales for a long time, long course of disease, repeated peeling. Often accompanied by fever, water and electrolyte imbalance, heart rhythm disorder and heart failure.

7. Connective tissue disease

(1) Chronic discoid lupus erythematosus: The erythema lesion of discoid lupus erythematosus has adhesive scales, which are flaky and hard, covering the surface of the lesion. The force is removed and the carpet nail-like horning plug is embedded in the hair follicle. It can be seen that the epidermis is atrophy, telangiectasia, and pigmentation.

(2) Systemic lupus erythematosus: butterfly erythema on the face, smooth surface, with gray-white scales.

(3) Dermatomyositis: Symmetrical edematous erythema is visible on the face, upper chest, and extremities, and the surface is covered with squamous scales. The erythema and squamous scaly papules with large joints and lateral symmetry are also one of the characteristic rashes of dermatomyositis.

8. Acute febrile skin mucosal lymph node syndrome: This disease is also known as Kawasaki disease. Occurs in infants under 5 years old. Measles-like and scarlet fever-like rashes can be seen 3-5 days after onset. It is characterized by membranous desquamation at the end of the nail at the end of the second week of the disease, followed by systemic desquamation.

9. papules scaly skin disease

(1) Psoriasis: damage to erythema scales, distribution of scalp, torso, limbs. The scales cover the surface of the lesion and appear as layers of silvery white mica. Smoothing of the scales and bleeding spots occur when the scales are scraped off.

(2) Fu Psoriasis: a bit-shaped and plaque-like form with thin scales on the surface.

(3) pityriasis rosea: a long elliptical spotted rash with a diameter of about 2-5 cm, red, and its long axis and skin texture are consistent. The scales are mostly central and have fewer margins on the edges.

(4) Hair red pityriasis: is a chronic scaly inflammatory skin disease. The disease progressed from the head to the lower limbs. The scalp often has thicker grayish white sputum scaly, which quickly affects the face, facial flushing, dry sputum, and seborrheic dermatitis. The characteristic rash is a follicular keratotic papule and scattered scaly red plaque. Especially in the first two phalanx of the finger, there is a follicular keratosis hard papule, which has diagnostic significance.

10. Ring erythematous skin disease

(1) Chuanyuan heart-shaped ring-shaped erythema: initially pale red flat papules, which later expanded into a ring shape with telecentricity, edge bulge, and the center subsided. They can be connected to each other in a map shape with scales attached to the edges.

(2) Claudication annular erythema: the performance of visceral tumor on the skin, initially a small red papule, the far heart expands into a ring shape, and the new rash is concentrically enlarged, and becomes a brain-like shape and water pattern. Singular form such as shape and pattern. The edges are raised into purple with scaly attachment.

11. Nutritional dystrophic erythroderma: Most occur in infants less than one year old, more common within 3 months after birth. The incidence of breastfeeding is high. Associated with vitamin B and vitamin H deficiency. Mainly on the scalp, face, underarms, buttocks, erythema, sputum and cloud-like desquamation. The damage is constantly expanding, causing the body to diffuse flushing, and the mica sheet is exfoliated to form exfoliative dermatitis.

12. Sebaceous gland disease

(1) Dry seborrheic: The scalp itch often has diffuse grayish white patches and falls off the shoulders when combing.

(2) Seborrheic dermatitis: occurs in areas of sebum overflow such as the scalp, behind the ears, face, sputum, upper chest, and shoulder swelling. Initially developed as a follicular red papule, it will later expand into a yellow-red patch with a clear boundary and covered with greasy scales.

Differential diagnosis

diagnosis

First, ask about the medical history.

Second, check the body. Observe the location, size, number, degree of edge rule, and color of the scale.

Third, the test. Excluding connective tissue diseases and the like.

Fourth, taking scaly pathological examination.

5. Pathogen examination. Found bacteria, viruses, fungi, spirochetes, etc.

Should be differentiated from the symptoms below

1. White pityriasis: also known as simple pityriasis, sun exposure can cause disease, more common in children, easy to develop in spring. The rash is a slightly degraded patch of pigment, with fine sputum batch fines. More common in the face, upper arms, neck, shoulders.

2. The condition of the ring is pityriasis: a mild keratotic skin disease, the cause is unknown. The lesion is a round or oval brown patch with a diameter of about 5-20 cm. The boundary is clear, it does not bulge, the surface has fine wrinkles, and it is covered with fine enamel fine particles, which are not easy to peel off close to the skin. It happens in the abdomen and waist.

3. Ordinary ichthyosis: not fully exogenous. Autosomal dominant inheritance. A few months after birth, on the back, the extremities stretched out, and the face appeared brown-black fish scales and keratinized scaly chips, which were not easily peeled off against the skin. The skin is dry, does not sweat, and is heavy in winter and light in summer. Often combined with palm and hand keratinization.

4. Asbestos-like pityriasis: the cause is unknown. It is characterized by a white tube sheath with mobility from the root of the hair, surrounding the hair shaft. The distal end of the hair has asbestos-like soft and thick white scales, forming a roof tile shape; but the hair and scalp have no damage and no inflammation.

5. Squamous follicular keratosis: the cause is unknown, and it occurs in young adults. The skin lesions are thin scaly keratinization, and the center has a black dot-like keratinization consistent with the hair follicle mouth. The crumbs are round, the edges are free, and the halo is slightly surrounded by the pigment. The central black spot still exists after the scales fall off. The skin lesions are mostly on the lateral side of the strand, the buttocks, and the flank. No symptoms, winter and summer light.

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