Dermatosis Neglecta Research Articles

Dermatosis Neglecta: A Retrospective Study at a Tertiary Care Center in Southern India.

Dermatosis neglecta (DN) is an acquired skin condition that occurs due to unconscious neglect of self-cleaning in individuals with some underlying risk factor. The purpose of this study was to summarize the demographic, clinical characteristics, and treatment outcomes of patients with DN in a tertiary care center. We evaluated the medical records of 28 patients with DN who were diagnosed and treated in our center between August 2020 and July 2022. The retrospective data related to demographic details, duration of lesions, morphology, distribution of lesions, associated symptoms, history of cleanliness, a risk factor for the development of the condition, treatment provided, and the details of follow-up were taken into account and analyzed. Of the 28 patients, there were 19 males and nine females. The most common site in our study was the anterior trunk (n = 7) followed by the posterior trunk (n = 6). The most common site to develop DN was a recent surgical site. Soap and water cleansing resulted in the removal of lesions in the majority of the patients. Recurrence was observed in two patients. Our study indicates that the frequency of this condition is often underestimated and under-reported. To the best of our knowledge, this is the largest case series of DN in the medical literature.

Dermatosis Neglecta in Inpatients of a Tertiary Care Center

Background: Dermatosis neglecta (DN) is an underdiagnosed localized pigmentary disorder, characterized by asymptomatic hyperpigmented patches and plaques with adherent scales in an inadequately cleansed area. It is a diagnostic challenge leading to unnecessary interventions and burden to patients. Dermoscopy is a noninvasive handy diagnostic tool, though its utility in the diagnosis of DN is unexplored. Objective: To describe the various clinical and dermoscopic patterns in patients with DN. Materials and Methods: An observational study in 10 admitted patients of a tertiary hospital with DN was done, who consulted in department of dermatology in view of hyperpigmented lesions. After a thorough history and clinical examination, dermoscopy was done over the lesions. Results: In 10 patients, DN was confirmed with a resolution of part of lesion on the application of water-soaked gauze. On dermoscopy, dark-brown polygonal, cornflake-like scales are seen arranged in a mosaic pattern with intervening normal skin, sometimes over an erythematous background. On further probing, most patients gave the history of unintentional neglect of the affected part related to their primary illness. Limitations: Small sample size. Conclusions: DN is an underreported localized hyperpigmented disorder, mimicking other dermatoses. It should always be kept in mind in patients with morbidities that lead to the inability to maintain hygiene in the relevant areas, which may not be the classically described sites of DN. Dermoscopy helps to differentiate it from other hyperpigmented lesions, especially in its milder forms, avoiding the act of wiping the lesions especially in areas associated with hyperesthesia and helps in reinforcing the diagnosis. However, the criteria to diagnose DN based on dermoscopy is not definite.

Dermatosis neglecta.

Dermatosis neglecta (DN) is a frequently underdiagnosed and under-reported dermatological entity, which occurs due to unconscious neglect of self-cleaning in individuals with some underlying physical or mental pathology. The lack of cleaning leads to accumulation of scales, dirt, sweat and sebum compacted together in the skin. Owing to its asymptomatic nature, diverse background and deceptive clinical presentation, DN is often missed or misdiagnosed by physicians. Awareness and recognition of this condition is essential to avoid unnecessary diagnostic and treatment procedures. The focus of this review article is to provide insights into this condition. We also intend to develop an algorithm for practical approach to a clinical diagnosis of dirt-like dermatoses with reasonable accuracy. A few interesting cases of DN encountered in our institution are included in this article.

A Case of Dirty Dermatosis (Dermatitis Neglecta)

Dermatitis Neglecta, also known dermatosis neglecta refers to a dermatological condition that occurs from lack of hygiene. It is a condition that results from insufficient frictional cleansing leading to accumulation of corneocytes sebum and sweat eventually resulting in hyperpigmented patch or verrucous plaque. Regular bathing is very important for keeping the skin clean. Bathing and scrubbing the skin helps to remove germs, oils, and dead skin cells. Lack of bathing for a long time can also cause Dermatitis Neglecta. We are presenting a case of 22 years old boy who had itching in the scrotum for 4 years and he was being treated for scabies and tinea cruris by various practitioners. On observation we found it to be covered with dark coloured raised lesions, after we rubbed it with cotton and spirit, we found it to be Dermatitis Neglecta of scrotum. Terra firma forme dermatosis is differentiated from it by presence of sufficient hygiene, absence of corn flake-like brownish scales and successful annihilation of pigmentation with isopropyl alcohol in the former and effective clearance of lesions with soap and water in the latter. However, isopropyl alcohol is operative in both disorders.

Dermatosis Neglecta Involving Different Age Groups- A Series of Four Cases

Dermatosis neglecta is a benign cutaneous condition which is often misdiagnosed. It occurs due to poor local hygiene or inadequate washing of a part of the body resulting in progressive accumulation of sebum, sweat, keratin and other debris which form an adherent crust of dirt. It mainly occurs in individuals who are unable to take care of themselves, like those with physical disability or psychosis. It is usually asymptomatic and is characterised by localised hyperpigmented patch or verrucous papules and plaques. Rubbing the affected area with alcohol-soaked gauze results in complete clearance of the lesion which is both diagnostic and therapeutic. The present case series describes four patients of different age groups. The first patient was a 65-years-old female, who underwent amputation of the gangrenous toes of right foot. She did not wash that leg for several weeks following surgery and developed cornflakes-like scaly lesions. Later lesions were diagnosed as dermatosis neglecta. Second case was a 18-years-old male, who presented with lesions on neck, which was misdiagnosed initially as Pityriasis vesicolor. The third patient was a 20-yearsold female, who presented with lesions on neck and was earlier diagnosed and treated as acanthosis nigricans. The fourth patient was a two-year-old female who developed lesions on neck due to accumulation of dirt and debris. In all these patients, lesions resolved on rubbing with alcohol-soaked swab. Very little data is available in medical literature about this condition. Therefore this case series is being reported to bring awareness among dermatologists. This would enable prompt clinical recognition and obviate the need for expensive investigations and treatment strategies.

Dermatosis neglecta mimicking macular amyloidosis

Few cases of dermatosis neglecta have been reported in the medical literature, although the diagnosis is well-known to dermatologists. It is characterized by dirty brown-grey cutaneous patches and plaques that can simply be eradicated by rubbing with alcohol pads. In most of the cases, it is associated with a local pathology due to which the patient is afraid to clean the area or any debilitating systemic illness which makes the patient incapable of proper cleansing. Herein, we present a mentally normal, obese male with reticulate hyperpigmentation involving the mid scapular region mimicking macular amyloidosis without any underlying local pathology which turned out to be dermatosis neglecta.

Asymptomatic brown patches on the trunk

A 6-year-old otherwise healthy boy presented with a one year history of asymptomatic brown patches on the trunk. The lesions were progressively spreading despite daily cleaning of the skin with soap and hot water. The eruption had been treated with antifungal cream for one month, with no improvement. Physical examination revealed brown-reticulated scaly macular plaques on the abdomen (Fig. 1). There were no other skin lesions. What is the most likely diagnosis? (Answer on page ••) Given the appearance of the lesions, terra firma-forme dermatosis (TFFD) was suspected. This diagnosis was confirmed by using the alcohol wipe test. The lesions completely disappeared after being rubbed with a 70% isopropyl alcohol-soaked gauze. TFFD, also known as Duncan's dirty dermatosis, is an underdiagnosed benign skin disorder of unknown aetiology that affects predominantly children and young adults. The condition is characterised by asymptomatic brown to black, hyperkeratotic plaques and patches with a dirt-like appearance, typically located on the trunk and skin folds (flexures of the anterior neck, axilla, cubital fossae, inguinal region and umbilical fold). Commonly, multiple sites are involved.1 The lesions are resistant to regular washing with soap and water, but can be easily removed by rubbing with 70% isopropyl alcohol or ethyl alcohol.2 The main differential diagnosis is dermatosis neglecta, a skin condition caused by poor hygiene and characterised by brown scales that can be removed with washing with soap and water. Others differential diagnoses include dirty neck syndrome, confluent and reticulated papillomatosis of Gougerot and Carteaud, acanthosis nigricans and hyperpigmented pityriasis versicolor.3 The application of 70% isopropyl alcohol is the gold standard treatment. However, in extensive cases, mild topical keratolytics may be associated in order to avoid aggressive rubbing.2

Dermatosis neglecta: a case report

<p>Dermatosis neglecta or dermatitis neglecta is a condition which occurs due to inadequate cleansing of a localised area of skin resulting in the accumulation of dirt, sebum, sweat, corneocytes and bacteria. These patients do not clean the area due to various reasons like pain at the site, prior surgery, physical disability, neurological deficit, or psychiatric illness. Vigorous rubbing of the lesion with alcohol soaked gauze results in removal of the lesion. We report a case of dermatosis neglecta in a 50 year old lady with carcinoma breast following mastectomy on the right side. She did not clean the area adequately as she was scared that the area of suture after mastectomy would give way, thus resulting in hyperkeratotic lesions.</p>

Dermatosis Neglecta of the Scalp Complicated with Alopecia Areata.

Dermatosis Neglecta of the Scalp Complicated with Alopecia Areata.

Extensive Dermatosis Neglecta with Severe Atopic Dermatitis: A Case that Presented as a Suicide Attempt

Extensive Dermatosis Neglecta with Severe Atopic Dermatitis: A Case that Presented as a Suicide Attempt

Dermatosis Neglecta - Report of a Case with Verrucous Plaque in a Child

Dermatosis Neglecta - Report of a Case with Verrucous Plaque in a Child

Perinevic dermatosis neglecta: clinical and dermoscopic description

Perinevic dermatosis neglecta is an underestimated skin condition usually affecting children and adolescents, characterized by the appearance of dirt-like brownish pigmentation around a preexisting nevus and often a matter of concern for parents. We describe the clinical and dermoscopic findings in a case of perinaevic dermatosis neglecta and discuss the possible etiology of this phenomenon.

Bilaterally symmetrical terra firma-forme dermatosis: a diagnostic conundrum

Terra firma-forme dermatosis or dermatosis neglecta is characterized by dirty brown plaques that can be removed by forceful rubbing or with an alcohol swab. Also known as Duncan’s Dirty Dermatosis, it is usually seen at the regions of the neck, trunk, and upper extremities in children as well as adults. Here we report a patient with complaints of multiple asymptomatic dirty brown-colored, flat-topped slightly raised lesions over the face in a young girl, and emphasize its unique expression. All the lesions completely disappeared with forceful rubbing using a spirit swab, with normal underlying skin without any recurrence till date.

A Case of Terra Firma-Forme Dermatosis Treated with Salicylic Acid Alcohol Peeling

Terra firma-forme dermatosis (TFFD) is a bizarre, acquired and idiopathic dermatosis that etiology has still not been fully defined. It is characterized by the presence of asymptomatic, brownish dirt-like lesion maybe due to disorder of keratinization. These lesions cannot be removed with ordinary cleansing. Therefore, TFFD can be differentiated from dermatosis neglecta. Patient was a 17-year-old man with brownish lesions on his face for 1 month. The patient had a history of regular washing habit with soap and water. The lesions were asymptomatic however due to cosmetic reasons, the patient wanted to treat his skin lesions. Punch biopsy revealed hyperkeratosis and fungal spore are in stratum corneum. Salicylic acid peeling with alcohol base was performed on the patient's face. The skin lesions disappeared completely on gentle swabbing with peeling. In this point, the diagnosis of TFFD could be considered. Since, this disease can be confused with dermatosis neglecta, we report this case with literature review.

A Case of Dermatosis Neglecta Caused by an Inappropriate Habit of Applying a Moisturizer.

A Case of Dermatosis Neglecta Caused by an Inappropriate Habit of Applying a Moisturizer.

Dermatosis Neglecta: An Increasingly Recognized Entity with Review of Literature.

Dermatosis Neglecta: An Increasingly Recognized Entity with Review of Literature.

A Case of Terra Firma-Forme Dermatosis: Differentiation from Other Dirty-Appearing Diseases.

Dear Editor: Terra firma-forme dermatosis (TFFD), which derives its term from the Latin phrase 'terra-firma' meaning dry land, is a rare skin disorder characterized by hyperpigmentation resembling dirt-like brown patches1,2. Only small cases have been published, but it is important to understand this disease entity because TFFD may be relatively common in clinical practice but can be easily misdiagnosed1,2. The patient was a 13-year-old girl with an asymptomatic dirt-like hyperpigmentation on her neck, which had been present for 2 months (Fig. 1). The lesion has not disappeared despite repetitive scrubbing with common detergents and water. She denied any history of eczema or incidents of trauma to the area, and did not use any cosmetics. No evidence of diabetes mellitus or excessive body weight was observed. The lesion was completely removed by hard scrubbing with alcohol sponges (Fig. 2). No recurrence was seen after 2 weeks of follow-up. TFFD has been largely ignored in the literature due to unawareness or indifference, but TFFD may in fact be common in clinical practice1,2. The etiology of TFFD remains unknown, but one hypothesis demonstrates TFFD as the result of the delayed maturation of keratinocytes with melanin retention, and the accumulation of sweat, sebum, and microorganisms. This combination may lead to buildup and retention of adhesive dirt-like scales1. TFFD is easily confused with similar diseases such as dermatosis neglecta or acanthosis nigricans3. One of the point of differentiation with other diseases is TFFD usually affects children and young adults with normal hygiene habits1,2. Additionally, TFFD mainly occurs on the face, neck, or ankles, especially posterior to the medial or lateral malleolus2. However, history of exposure to an unclean environment or underlying comorbidities causing non-washing behavior implies dermatosis neglecta, which is removable with routine detergents4. Also, TFFD can be accompanied by acanthosis nigricans in obese and diabetic patients. In these cases, TFFD can be removed by alcohol rubbing, while acanthosis nigricans remains unresolved by such measures5. Furthermore, TFFD should be distinguished from other dermatoses, including confluent and reticulated papillomatosis, pityriasis versicolor, ichthyosis, and postinflammatory hyperpigmentation1. Typical TFFD cases rarely require biopsy, but histopathological findings may aid in the diagnosis of challenging cases. Characteristic histology of TFFD demonstrates acanthosis, papillomatosis, and prominent lamellar hyperkeratosis with orthokeratotic whorls5. The recurrence of TFFD is known to be rare. Previous research has reported that more than one-fifth of patients undergo an endocrine evaluation or receive a prescription for topical corticosteroids before visiting a dermatologist2. Therefore, in typical cases of young healthy patients with a dirt-like brown appearance on the face, neck, or ankles despite normal hygiene habits, TFFD should be considered early, and alcohol scrubbing should be attempted first to prevent unnecessary diagnostic procedures and inappropriate treatments. In some cases, more aggressive efforts with alcohol were required to remove the hyperpigmentation, so vigorous force should be applied while scrubbing the lesion5. Here, we report a successfully diagnosed and treated case of TFFD. It is important for clinicians to be aware of TFFD as it is often misdiagnosed or underreported. Fig. 1 A dirt-like hyperpigmented patch lesion on the patient's anterior neck (before alcohol swabbing). Fig. 2 (A) Alcohol swabs after hard scrubbing. (B) Dirt-like hyperpigmentation removed after hard scrubbing with an alcohol swab.

Dermatosis Neglecta and Plica Polonica in Schizophrenia: Rarely Encountered or Rarely Discussed!

Dermatosis Neglecta and Plica Polonica in Schizophrenia: Rarely Encountered or Rarely Discussed!

Terra firma-forme dermatosis

Terra firma-forme dermatosis is characterized by 'dirty' brown-grey cutaneous patches and plaques that can simply be eradicated by forceful swabbing with alcohol pads. The pathogenesis has been attributed to abnormal and delayed keratinization. Although affected patients present with typical lesions, the disorder is not well-known by dermatologists. In this report, we describe two patients with terra firma-forme dermatosis in the setting of xerosis cutis and atopic dermatitis. From a clinical point of view, we lay emphasis on its unique expression and diagnosis/treatment. From a histological perspective, we highlight its resemblance to dermatosis neglecta and speculate on the role of 'neglect' in a patient with seemingly adequate hygiene. The role of urea containing emollients in the development of this disorder remains to be determined.

Dermatitis neglecta: relato de dois casos

Few cases of dermatosis neglecta have been reported in the medical literature, although the diagnosis is well-known to dermatologists. Recognizing this condition avoids unnecessary, aggressive diagnostic and therapeutic procedures. This case report discusses two cases of this condition in female patients in whom the dermatosis developed as a result of deliberate or unconscious neglect of personal hygiene.