An Unusually Severe Case of Dermatosis Neglecta: A Diagnostic Challenge

Abstract

Dermatosis neglecta is a condition secondary to lack of cleanliness, characterized by the formation of hyperkeratotic plaques located in a particular region of the body, usually due to a disability, and it is considered a diagnostic challenge because it can mimic other entities. We present the case of an 18-year-old woman with a 2-month history of progressive brown verrucous plaque in her face. Our first impression was seborrheic dermatitis and she was treated with facial cleanser soap and topic hydrocortisone 1%. One month later, she arrived with new lesions. Because of this our diagnosis changed to Darier's disease versus seborrheic pemphigus versus foliaceus pemphigus. Histopathology and immunofluorescence studies were compatible with seborrheic dermatitis. The patient complained of depression and social withdrawal and denied facial cleansing. Facial cleansing was performed during consultation presenting resolution of the lesions, which confirmed the diagnosis of dermatosis neglecta. Dermatosis neglecta is a disease that can be frequently misdiagnosed, since it has many differential diagnoses, such as hyperkeratotic syndromes. It should be recognized early and aggressive diagnostic and therapeutic methods should be avoided.

Terra firma–forme dermatosis

“…150075/-/DC1), includes conditions such as acanthosis nigricans, confluent and reticular papillomatosis, tinea versicolour and ichthyosis vulgaris. 3 Dermoscopic examination may help narrow the differential diagnosis if a "stone pavement" pattern is observed, as in our patient. Resolution of the lesions after swabbing with 70% ethyl or isopropyl alcohol confirms the diagnosis.…”

Terra-firma forme dermatosis: Report of three cases

“…However, 70% isopropyl alcohol causes effective clearance of lesions in both. Despite these differences, the distinction between DN and TFFD becomes difficult at times and it seems that there exists clinical and histological overlap between the two conditions 3,4,6,7,9,10,13 . Some authors have suggested that the difference between TFFD and DN is arbitrary and TFFD may be a milder form of DN 14 .…”

Dermatose Neglecta - Afecção de Difícil Suspeição Diagnóstica

“…4,5 Frequentemente é uma afecção subdiagnosticada 3,6 e eventos estressantes anteriores ao início do quadro podem atuar como fatores desencadeantes.…”

“…9 O estudo anatomopatológico geralmente não é necessário, mas quando realizado mostra hiperqueratose ortoceratótica, papilomatose e acantose leve sem um infiltrado inflamatório evidente. 4 Vigorosa fricção com gaze embebida em álcool ou sabão e água resulta em resolução completa do quadro. 3 Casos mais resistentes com placas verrucosas podem demandar uso de agentes ceratolíticos e emolientes para facilitar sua remoção.…”