Terra Firma Forme Disease

Abstract

ReferencesTERRA FIRMA FORME DISEASE Terra Firma Forme Disease (TFFD), first defined by Duncan and his collegues in 1987, is also known as Duncan's Dirty Disease. It is a rare type of keratinisation disorder with fully unidentified aetiology. While lesions look black dirt, thinly papillomatous and can not be removed by cleaning and rubbing with soap and water, they disappear totally after rubbing with 70% isopropyl or ethyl alcohol. Limited number of cases has been reported since it was diagnosed.The 14-year-old female patient visited our polyclinic with complaints of asymptomatic thinly papillomatous brown lesions on abdomen and back for 1 year. Medical and family history of the patient was examined and no significant pathology was detected. The patient stated that the problem still recurred despite rubbing with shampoo and soap. Dermotological examination revealed dirty, hyperkeratotic and hyperpigmented papules existed especially on the abdomen, back and shoulders. (Fig. 1) It was observed that the lesions disappeared totally after rubbing with 70% of alcohol. (Fig. 2) During histopathological examination, hyperkeratosis in the epidermis, increased pigmentation in the basal layer, oedema and mononuclear cell infiltration in papillary dermis were observed and no features were seen in periodic acid schiff coloration (Fig. 3).Lesions disappeared totally after rubbing with 70% of alcohol, and no emergence of new lesions were observed during the 8-month follow-up time.TFFD, defined by Duncan and colleagues, is a rare keratinisation disorder of unknown aetiology.1 Most of the cases reported in literature are about child and adolescent age groups (4 months minimum and as for age maximum 72) like our patient. No familial characteristic has been reported and no relationship with bathroom habits and hygiene have been observed. 2,3 The most frequent location of the disease is shoulder and back. However, some cases in which other body areas were affected have been reported. 2,4 Lesions are generally bilaterally symmetric and the most common comorbid conditions are atopic dermatitis and acne vulgaris. 5 The lesions disappearing entirely when wiped with 70% of isopropyl alcohol are Conflict of interest: None declared.

Features of Terra Firma-Forme Dermatosis

“…[1][2][3][4][5][6][7][8][9][10][11][12] Our findings were similar; during a period of 19 months, no recurrence was seen. Even so, 5 patients reported a history of recurrence, and we believe there may have been more recurrences than we evaluated.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12] In our study group, 2 patients were siblings and had xerosis. This finding suggests a genetic predisposition, but wider studies are needed to address this possibility.…”

“…It should be differentiated from dermatosis neglecta, acanthosis nigricans, neurodermatitis, ichthyosis, pityriasis versicolor, epidermal nevi, and confluent and reticulated papillomatosis. [1][2][3][4][5][6][7][8][9][10][11][12] The lesions can be mistaken for dirt, even though the patient's hygiene is good. The dirt-like lesions make patients and their parents uncomfortable; they report, "We are constantly washing these places with soap."…”

Terra Firma Forme Dermatosis – a Report of two Cases and a Review of the Literature

“…Clinically, TFFD is usually presented as asymptomatic yellowish or brownish dirt-like plaques. The changes may also have papilomatosus, verrucous or reticular appearance (3,11). In our Case 1, the changes were in the form of hyperpigmented patch lesions while in Case 2 they were papillomatous plaques.…”

“…According to literature data the duration of TFFD ranges from 3 weeks to several years (2,8,10,11,12). In case of our patients, the diagnosis of TFFD was set one and four months after the appearance of skin changes.…”