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Table of Contents
Year : 2021  |  Volume : 7  |  Issue : 2  |  Page : 59-60

Dermatosis neglecta mimicking macular amyloidosis

Department of Dermatology, Santosh Deemed to be University, Ghaziabad, Uttar Pradesh, India

Date of Web Publication6-Dec-2021

Correspondence Address:
Anuja Yadav
Department of Dermatology, Santosh Deemed to be University, Ghaziabad, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2455-1732.331784

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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.

How to cite this article:
Yadav P, Yadav A, Agarwal S. Dermatosis neglecta mimicking macular amyloidosis. Santosh Univ J Health Sci 2021;7:59-60

How to cite this URL:
Yadav P, Yadav A, Agarwal S. Dermatosis neglecta mimicking macular amyloidosis. Santosh Univ J Health Sci [serial online] 2021 [cited 2022 Dec 8];7:59-60. Available from: http://www.sujhs.org/text.asp?2021/7/2/59/331784

  Introduction Top

Dermatitis neglecta (DN) is building up of hyperpigmented, adherent, cornflake-like scales due to inadequate frictional cleansing. It represents areas of the stratum corneum where corneocytes, sebum, sweat, and bacteria have accumulated. It sometimes poses a diagnostic challenge as a differential to various dermatosis including acanthosis nigricans, and confluent and reticulate dermatosis. Alcohol swab test serves as both diagnostic and therapeutic tool. Management includes counseling regarding the need for proper and regular cleaning and sometimes keratolytic agents.

  Case Report Top

A 54-year-old obese male presented to our outpatient department with multiple, small, asymptomatic, dark skin lesions over the upper back for 2 months. Physical examination revealed brown to black reticulate hyperpigmentation, along with hyperkeratosis and follicular prominences over the upper back in the mid-scapular region. The rest of the cutaneous and systemic examination was normal. Differential diagnoses of macular amyloidosis, hyperkeratotic malassezia dermatosis, confluent and reticulate papillomatosis, and dermatosis neglecta were considered.

Cleaning with 70% isopropyl alcohol swab revealed underlying normal skin. Hence, the diagnosis of dermatosis neglecta was established. The patient was advised to wash the area with soap and water, and the lesion disappeared completely within weeks. Psychiatric evaluation was normal.

  Discussion Top

In 1995, Poskitt et al. coined the term “dermatosis neglecta” to denote a condition in which the formation of a localized hyperpigmented lesion occurs due to lack of cleanliness of a particular body part or region, usually due to some disability.[1] Localized hyperpigmentation and scaling of the skin occurs as a consequence of poor hygiene of a particular body part and the lesion can easily be rubbed off using soap and water or an alcohol-soaked swab. It results from the accumulation of sebum, sweat, corneocytes, and bacteria in a localized area of skin, forming a compact and adherent crust of dirt.[2]

The lack of cleanliness in our patients could be attributed to the inability to access the mid scapular region during bath due probably to obesity, or self-neglect. An isopropyl alcohol swab is a cost-effective, painless diagnostic test that doubles as treatment.

Other important differentials should be considered in such cases. Macular amyloidosis presents as small 2–3-mm gray-brown or brown, pruritic (82%) or nonpruritic (18%) macules, which gradually join to form symmetric patches with a characteristic rippled/reticulate pattern involving most frequently the inter-scapular area and less frequently the upper arms, chest, and thighs. Confluent and reticulated papillomatosis has a velvety appearance and is commonly associated with Pityrosporonorbiculare. It is distributed on the central trunk and has a negative alcohol swab test.[3] Other conditions in the differential diagnosis include dermatitis artefacta which is an act of commission rather than an act of omission as is the case in dermatosis neglecta,[1] atopic dermatitis, postinflammatory hyperpigmentation, verrucous naevi, X-linked ichthyosis, acanthosis nigricans, frictional asymptomatic darkening of the extensor surfaces, and idiopathic deciduous skin.[4],[5],[6],[7] Mostly, 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. Cases have been reported at the site of pacemaker insertion, mastectomy surgery, and radiotherapy; and in dermatomyositis, hemiplegia and keloidal scars, as well as in the periareolar region. Our patient turned out to be psychiatrically normal and no underlying local or systemic pathology could be ascertained as a reason for inadequate cleansing except for improper access to the area due to obesity.

Management of dermatosis neglecta cases essentially includes counseling and encouraging the patient to maintain appropriate hygiene of the affected region despite his or her disability. Light scrubbing of the affected area daily with soap and water or alcohol is usually effective in most cases. Application of a keratolytic agent in combination with an emollient may be required for more resistant and verrucous lesions. Dermatosis neglecta is an esthetically bothersome dermatosis. A dermatologist needs to be well aware of this condition that can be diagnosed clinically and inexpensively treated and saves a lot of unnecessary diagnostic and therapeutic interventions.

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  References Top

Poskitt L, Wayte J, Wojnarowska F, Wilkinson JD. 'Dermatitis neglecta': Unwashed dermatosis. Br J Dermatol 1995;132:827-9.  Back to cited text no. 1
Ruiz-Maldonado R, Durán-McKinster C, Tamayo-Sánchez L, Orozco-Covarrubias ML. Dermatosis neglecta: Dirt crusts simulating verrucous nevi. Arch Dermatol 1999;135:728-9.  Back to cited text no. 2
Lucas JL, Brodell RT, Feldman SR. Dermatosis neglecta: A series of case reports and review of other dirty-appearing dermatoses. Dermatol Online J 2006;12:5.  Back to cited text no. 3
Freedberg JM, Eisen AZ, Wolf K, Austen KF, Goldsmith LA, Katz SI. Icthyosiform Dermatoses. Fitzpatrick's Dermatology in General Medicine 6th Edition. 2003;1:481-503.  Back to cited text no. 4
Rothe MJ, Grant-Kels JM. Atopic dermatitis: An update. J Am Acad Dermatol 1996;35:1-13.  Back to cited text no. 5
Panja SK, Sengupta S. Idiopathic deciduous skin. Int J Dermatol 1982;21:262-4.  Back to cited text no. 6
Krishnamurthy S, Sigdel S, Brodell RT. Frictional asymptomatic darkening of the extensor surfaces. Cutis 2005;75:349-55.  Back to cited text no. 7


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