Scaly skin conditions

Skin diseases that have excessive scale or flaking (papulosquamous disorders) are due to epidermal inflammation or proliferation. We list localised and generalised scaly skin disorders by their duration and location.

Present for < 6 weeks
Localised scaly rashGeneralised scaly rash
Dermatophyte infections With fever:
  • Scarlet fever
    • Scarlatiniform rash (redness then rough spots)
    • Strawberry tongue
    • Peeling starts after 5 days of illness
    • Evidence of streptococcal infection
  • Kawasaki syndrome
    • Child aged &lgt; 14 years
    • Starts as morbilliform or erythematous rash
    • Swelling of hands and feet
    • Oral and ocular signs
    • Lymphadenopathy
  • Exfoliative dermatitis
Without fever: Pityriasis rosea
  • Herald patch
  • Oval 2?? cm pink plaques on trunk with peripheral, trailing scale
  • Spares scalp, peripheries
Acute guttate psoriasis
  • Round 0.5?? cm red plaques with diffuse scale
  • Trunk > limbs
  • May involve all body sites
Pityriasiform or lichenoid drug eruption
  • New drug (eg hydroxychloroquine)
Present for > 6 weeks
Seborrhoeic dermatitis
  • In and around hair-bearing scalp, eyebrows, hairy chest
  • Skin folds behind ears, nasolabial fold, axilla
  • Salmon pink, flaky
  • Localised variant
  • Scalp, elbows, knees or palms and soles
Discoid lupus erythematosus
  • Face, ears, scalp > upper trunk, hands
  • Scale is due to plugged follicles
  • Leads to scarring
Pityriasis versicolor
  • Flaky rash on trunk
  • White, red, brown variants
Keratosis pilaris
  • Upper arms > thighs > cheeks
  • Hair follicles plugged with scale
Annular erythema
  • Crops of slowly enlarging erythematous annular plaques on trunk
  • Trailing scale
Palmoplantar keratoderma
  • Thickened skin of palms and soles
  • Congenital and acquired, punctate and diffuse variants
Crusted scabies
  • Scale is prominent between fingers, elbows, scalp
  • May or may not be very itchy
  • Contacts have scabies
Widespread tinea corporis
  • Irregular annular plaques
  • Peripheral scale
  • Dry skin
Chronic plaque psoriasis
  • Symmetrical well-circumscribed plaques with silvery scale
  • Generalised large or small plaques
Lichen planus
  • Bilateral but asymmetrical firm papules, plaques
  • Polygonal shape
  • Scale is variable
Pityriasis lichenoides
  • Trunk and limbs
  • Skin coloured or red flat or indurated papules/small plaques
  • Mica scale (peels off in one sheet)
Pityriasis rubra pilaris
  • Psoriasis-like symmetrical or erythrodermic scaly rash
  • Orange-red hue
  • Follicular prominence
Cutaneous T cell lymphoma
  • Slowly evolving slightly scaly annular and roundish patches, plaques and sometimes nodules
  • Various morphologies including erythroderma
  • Buttocks, breasts common initial sites

Scaly condition by body site
Solitary scaly lesionsScaly scalpScaly patches on the face
Actinic (solar) keratoses
Basal cell carcinoma (superficial)
Bowen disease (intraepidermal squamous cell carcinoma)
Squamous cell carcinoma
Pityriasis amiantacea
Cradle cap
Seborrhoeic dermatitis
Scalp psoriasis
Tinea capitis
Cutaneous lupus erythematosus
Seborrhoeic dermatitis
Seborrhoeic dermatitis
Facial psoriasis
Atopic dermatitis
Lupus erythematosus
Pityriasis alba
Scaly patches on arms and legsScaly skin foldsScaly patches on trunk
Pityriasis alba
Disseminated superficial actinic porokeratosis
Porokeratosis of Mibelli
Keratosis circumscripta
Flegel disease
Kyrle disease
Lichen striatus
Seborrhoeic dermatitis
Flexural psoriasis
Confluent and reticulated papillomatosis
Granular parakeratosis
Pityriasis rosea
Darier disease
Grover disease
Pityriasis versicolor
Scaly patches anywhere or everywhereScaly palms and soles
Dry skin
Dermatitis (Eczema)
Atopic dermatitis (eczema)
Tinea infections
Paediatric psoriasis. Psoriasis in children
Lichen planus
Ichthyosis vulgaris
Recessive X-linked ichthyosis
Netherton syndrome
Collodion baby
Chronic superficial scaly dermatosis (parapsoriasis)
Cutaneous T-cell lymphoma
Pityriasis lichenoides
Pityriasis rotunda
Pityriasis rubra pilaris
Reiter syndrome
Subcorneal pustular dermatosis (Sneddon Wilkinson disease)
Secondary syphilis
Acrodermatitis continua of Hallopeau
Cracked heels
Corns and calluses
Juvenile plantar dermatosis
Exfoliative keratolysis
Palmoplantar psoriasis
Acquired keratoderma
Diffuse hereditary keratoderma
Pachyonychia congenita
Parakeratosis pustulosa
Punctate keratoderma
Focal hereditary keratoderma
Porokeratotic eccrine ostial dermal duct naevus

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