desquamating

Desquamating refers to the shedding or peeling of the outer layers of the skin, a process known as desquamation. In normal skin biology, desquamation is part of epidermal turnover, as keratinocytes migrate from the deeper layers to the surface and gradually slough off as corneocytes. The term is often used to describe abnormal or excessive shedding that accompanies various skin disorders or after injury.

Pathophysiology and examples

Desquamation results from alterations in epidermal adhesion, keratinocyte maturation, or inflammatory processes that accelerate shedding. Normal desquamation occurs in newborns as their skin adapts, but excessive or widespread desquamation points to pathology. Conditions associated with desquamation include toxic epidermal necrolysis and Stevens–Johnson syndrome, where extensive keratinocyte death leads to sheet-like detachment of the epidermis; staphylococcal scalded skin syndrome, in which exfoliative toxins target desmoglein-1 and disrupt cell adhesion; severe sunburn or chemical burns; exfoliative dermatitis; and various autoimmune or inflammatory dermatoses that produce widespread scaling and peeling. Psoriasis, pityriasis rubra pilaris, and certain ichthyoses can also feature prominent desquamation, though mechanisms and patterns differ.

Clinical features and diagnosis

Desquamation presents as peeling or flaking of the skin, sometimes accompanied by tenderness, fever, mucosal involvement, or a positive Nikolsky sign in severe conditions. Diagnosis relies on clinical assessment and history; supportive tests may include skin biopsy, bacterial cultures, or immunofluorescence to distinguish inflammatory, infectious, or autoimmune etiologies.

Management and prognosis

Treatment targets the underlying cause and may involve supportive skin care, wound management, and infection prevention. Mild or localized shedding often requires emollients and gentle cleansing, while severe desquamation from conditions like TEN or SSSS demands intensive medical care, often in specialized units, with multidisciplinary coordination. Prognosis varies by condition, with many forms resolving with appropriate therapy, though severe cases can be life-threatening.