Dermatosis neglecta

A 35-year-old male of Pakistani origin, with multiple fractures, neurological deficit and immobility sustained in a fall, leading to the development of dermatosis neglecta of the left hand. Upper image: Dorsum of hand (at presentation). Lower image: Dorsum of hand (after two weeks).

Dermatosis neglecta is a skin condition in which accumulation of sebum, keratin, sweat, dirt and debris leads to a localized patch of skin discoloration or a wart-like plaque. It is caused by inadequate hygiene of a certain body part, usually due to some form of disability or a condition that is associated with pain or increased sensitivity to touch (hyperesthesia) or immobility.^[1]

Dermatosis neglecta typically develops several months after a disability or other affliction leads to improper cleaning. Patients may deny that negligence is the cause of the lesion, even though it completely resolves with vigorous rubbing with alcohol swaps or water and soap (which is both a form of diagnosis and treatment). Recognizing the diagnosis avoids unnecessary skin biopsies.

Examples of case reports from the literature include a man who avoided washing the skin area surrounding an artificial pacemaker out of fear it might be damaged, a woman who didn't clean the right side of her chest due to hyperesthesia following an amputation for breast cancer (mastectomy), a girl who was afraid to wash the area around an abdominal scar, or a man with multiple fractures, shoulder dislocation and radial nerve palsy.^[2][3][1]

Differential diagnosis

Many other conditions can lead to localized scaling or hyperpigmentation.

This condition should firmly be distinguished from dermatitis artifacta which is the factitious creation of a skin lesion, whereas dermatosis neglecta results from unconscious avoidance of cleaning due to pain or immobility.

Other skin conditions that should not be mistaken for dermatosis neglecta include terra firma-forme dermatosis^[4] (in which there is no history of inadequate cleaning), confluent and reticulated papillomatosis of Gougerot and Carteaud, several forms of ichtyosis, acanthosis nigricans and Vagabond's disease.

History

The term was first coined by Poskitt and coworkers in 1995.^[5]

Footnotes

1. ^ ^{a b} Ruiz-Maldonado R, Durán-McKinster C, Tamayo-Sánchez L, Orozco-Covarrubias ML (June 1999). "Dermatosis neglecta: dirt crusts simulating verrucous nevi". Arch Dermatol 135 (6): 728–9. doi:10.1001/archderm.135.6.728. PMID 10376717. http://archderm.ama-assn.org/cgi/pmidlookup?view=long&pmid=10376717. 
2. ^ Qadir SN, Ejaz A, Raza N (2008). "Dermatosis neglecta in a case of multiple fractures, shoulder dislocation and radial nerve palsy in a 35-year-old man: a case report". J Med Case Reports 2 (1): 347. doi:10.1186/1752-1947-2-347. PMC 2596164. PMID 19014627. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2596164. 
3. ^ Lucas JL, Brodell RT, Feldman SR (2006). "Dermatosis neglecta: a series of case reports and review of other dirty-appearing dermatoses". Dermatol. Online J. 12 (7): 5. PMID 17459291. 
4. ^ Browning J, Rosen T (2005). "Terra firma-forme dermatosis revisited". Dermatol. Online J. 11 (2): 15. PMID 16150223. http://dermatology.cdlib.org/112/case_reports/dirtydermatoses/rosen.html. 
5. ^ Poskitt L, Wayte J, Wojnarowska F, Wilkinson JD (May 1995). "'Dermatitis neglecta': unwashed dermatosis". Br. J. Dermatol. 132 (5): 827–9. PMID 7772495.