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10 Questions on PASI Desquamation Scoring 1.1

Focused desquamation exercise for PASI scoring
Created 2019.
 
If you haven't already done the Interactive introduction to PASI scoring you should go and do that now.
 
[Link]
 
This exercise will give you 10 questions and should take less than 5 minutes to complete.
 
Each time you do the exercise you will get different questions, so you can keep practising.
 
When you have completed the exercise you will receive a certificate which you can download.
 
Learning objective
  • To develop competency in scoring the severity of desquamation in psoriasis plaques.
Disclaimer
This online exercise is intended to familiarise health professionals with PASI scoring. DermNet NZ does not offer any guarantee of accuracy, but if you see any errors or omissions, please let us know at http://dermnetnz.org/contactus/ so that we can correct them.
 
Author: Sam MacGill, Medical Student, University of Otago, New Zealand
Editor: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand
Images: Waikato District Health Board, New Zealand
Thank you to Prof Richard Langley for scoring advice.
Abbvie provided an educational grant towards the costs of providing this course.
Focused desquamation exercise for PASI scoring
Created 2019.
 
If you haven't already done the Interactive introduction to PASI scoring you should go and do that now.
 
[Link]
 
This exercise will give you 10 questions and should take less than 5 minutes to complete.
 
Each time you do the exercise you will get different questions, so you can keep practising.
 
When you have completed the exercise you will receive a certificate which you can download.
 
Learning objective
  • To develop competency in scoring the severity of desquamation in psoriasis plaques.
Disclaimer
This online exercise is intended to familiarise health professionals with PASI scoring. DermNet NZ does not offer any guarantee of accuracy, but if you see any errors or omissions, please let us know at http://dermnetnz.org/contactus/ so that we can correct them.
 
Author: Sam MacGill, Medical Student, University of Otago, New Zealand
Editor: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand
Images: Waikato District Health Board, New Zealand
Thank you to Prof Richard Langley for scoring advice.
Abbvie provided an educational grant towards the costs of providing this course.
Desquamation
 
Desquamation (scaling) is one of the three severity scores used when calculating a PASI score. It is scored on a scale from 0–4 as shown above.
 
For desquamation scoring:
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
 
Have a go at grading some psoriasis plaques in the next few questions.
Desquamation
 
Desquamation (scaling) is one of the three severity scores used when calculating a PASI score. It is scored on a scale from 0–4 as shown above.
 
For desquamation scoring:
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
 
Have a go at grading some psoriasis plaques in the next few questions.
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
DDesquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for these lesions?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Desquamation
 
What is the desquamation score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
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