Terra Firma-forme Dermatosis Research Articles

The histopathology of terra firma‐forme dermatosis: author's response

The histopathology of terra firma‐forme dermatosis: author's response

Acanthosis Nigricans of the Ears or Terra Firma-Forme Dermatosis?

To the editor, I read with great interest the case report by Lee et al.1 describing an obese young man with brown, dirt-like plaques on the sulci of the ears. The lesions were biopsied and diagnosed as acanthosis nigricans, which he also had on the neck, axillae, and groin. I would like to suggest a different diagnosis - terra firma-forme dermatosis. I wonder if slightly more aggressive rubbing with an alcohol swab might have significantly cleared the patient's lesions. I have often observed comparable dirt-like papules or plaques in this location in my patients who are obese and have darker skin types (Fig. 1). While these lesions may show overlapping features of (or occur in conjunction with) acanthosis nigricans, confluent and reticulated papillomatosis, and terra firma-forme dermatosis, they frequently demonstrate rapid and significant response or clearing with alcohol swabbing (Fig. 2). Finally, the lack of acanthosis in the biopsy of the patient of Lee et al.1 further puts the diagnosis of acanthosis nigricans in question. Because terra firma-forme dermatosis is rarely biopsied, the literature is lacking in histological descriptions for comparison. Fig. 1 (A, B) A 32-year-old African-American man with a many year history of bothersome, progressive, dirt-like, brown papules and plaques in the preauricular area, sulci of ear, cheeks, chest, neck, and folds on back, despite normal hygiene and many attempts ... Fig. 2 Most of the patient's lesions, including around and involving the ear, markedly improved or cleared with gentle rubbing with an alcohol swab.

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.

Terra Firma‐Forme Dermatosis: A Retrospective Review of 31 Patients

Terra firma-forme dermatosis is an idiopathic condition characterized by acquired, dirtlike plaques despite normal hygiene. A diagnosis can be reached by removing lesions with gentle alcohol swabbing. Although Terra firma-forme dermatosis was first described more than 20 years ago and is thought to be not uncommon in clinical practice, it has never been systematically studied. There are few publications about this condition, including no case series of more than six patients. In particular, little is known about the incidence, peak age groups, and most common locations of Terra firma-forme dermatosis. A retrospective review was conducted to identify cases of Terra firma-forme dermatosis in a single-provider practice consisting of 55% pediatric and 45% adult patients. Thirty-one patients with Terra firma-forme dermatosis were identified, including 10 who presented with Terra firma-forme dermatosis as their primary concern. Only two patients were older than 17 years. The median duration of lesions was 4 months. The most common lesion locations were the neck, ankles, and face. Before presenting to the dermatology clinic, three patients had undergone endocrine evaluations, and four had been prescribed topical corticosteroids. Terra firma-forme dermatosis is relatively common and most often occurs in children on the neck or posterior malleolus. This series exemplifies the importance of recognizing Terra firma-forme dermatosis so as to provide rapid relief for patients and avoid unnecessary tests and treatments.

Terra Firma‐forme Dermatosis in a 4‐Month‐Old Girl

Terra firma-forme dermatosis (TFFD) is an idiopathic condition characterized by asymptomatic, dirtlike, thinly papillomatous, hyperpigmented plaques which cannot be removed with routine cleansing, but clear with firm wiping with 70% isopropyl or ethyl alcohol. Commonly involved sites include the neck, trunk, and umbilicus. Most reports have described adolescents or young adults with a history of normal hygiene and vigorous but unsuccessful attempts at cleansing the affected areas. We describe a 4-month-old girl with TFFD, who is the youngest patient thus far reported with this condition.

Terra Firma forme dermatosis. Case series and review of the literature

Terra Firma forme dermatosis (TFFD) is an infrequently described disorder which features dirt-like lesions that clear after rubbing with alcohol. We describe a series of four patients with the disorder, discuss differential diagnostic considerations and review the literature.

Terra firma‐forme dermatosis

A 9-year-old boy was brought by his mother to our department for a follow-up visit and dermoscopy of melanocytic nevi. During the consultation, she complained of a gradually increasing, asymptomatic, cutaneous discoloration involving the trunk, arms, and lower limbs of her son which had appeared approximately at the end of the summer. The boy was healthy and was not taking any medication or nutritional supplements. Despite good hygiene, including showers and brushings with acid liquid soap at least three to four times per week, he showed no improvement of the condition. Physical examination revealed dirty-appearing skin, composed of subtle, but clear-cut, brown to blackish areas with a velvety texture, symmetrically involving the lateral sides of the trunk, umbilical, and periumbilical regions with light scaling, dorsal and volar surfaces of the arms, and posterior parts of the lower limbs (1, 2). The neck, dorsum and anterior aspects of the lower limbs were uninvolved. Figure 1Open in figure viewerPowerPoint Diffuse brown–blackish hyperpigmentation of the lateral aspect of the trunk and of the dorsal surface of the arm Figure 2Open in figure viewerPowerPoint Subtle pigmentation of the abdomen Partial removal of these patches by isopropyl alcohol swabbing (Fig. 3) confirmed the clinical suspicion of terra firma-forme dermatosis. The boy's mother refused our proposal of dermal scraping and 3-mm punch biopsy when reassured about the benign nature of the condition and the ease of treatment. Figure 3Open in figure viewerPowerPoint Alcohol swabbing reveals a pink linear area of normal skin. The appearance of the alcohol pad after rubbing The patient was seen 24 h later for erythema and burning of lesional areas because of excessively vigorous and extensive rubbing, but with no residual signs of the disease (Fig. 4). Figure 4Open in figure viewerPowerPoint Absence of dermatosis after cleansing at home. Notice frictional erythema of the treated areas

Terra firma-forme dermatosis revisited

Terra firma-forme dermatosis is a cutaneous discoloration resembling dirt, hence the clinical name. The dyschromia cannot be removed with routine soap and water washing, but can be eliminated by rubbing with isopropyl alcohol. Although the condition poses no serious medical threat, it is cosmetically distressing. Our experience is that this entity is much more frequent that might be expected when considering the paucity of reports in the readily available medical literature. We chronicle a series of cases to highlight occurrence in widely divergent demographic groups and long duration of remission following appropriate topical intervention. The cause remains unknown.