Sir,

Dermatosis neglecta (DN) is a skin condition that develops due to neglect of self-cleaning practices; individuals affected may have an underlying physical or mental pathology. It results from the progressive buildup of sebum, sweat, keratin, cellular debris, and exogenous impurities, leading to papules, polygonal plaques, and adherent hyperpigmented verrucous lesions. These lesions are localized and symmetrically distributed mainly on the chest, shoulders, and neck [1,2].

Its differential diagnoses include terra firma-forme dermatosis, confluent and reticulated papillomatosis, pigmented pityriasis versicolor, hyperkeratotic Malassezia dermatosis of the head and neck, dirty neck of atopic dermatitis, factitious dermatitis, verrucous epidermal nevi, and various forms of ichthyosis [3].

The diagnosis of DN is often clinical. The removal of lesions with soapy water is confirmatory and therapeutic. Dermoscopy may show well-defined, brown, waxy scales resembling cornflakes without a pigment network [1,4].

Non-judgmental counseling and proper health education on maintaining good hygiene are crucial in treating DN, often sufficient with gentle scrubbing using soap and water. Lesions may also be removed with saline solution, ethyl or isopropyl alcohol, methanol, acetone, or a mild cleanser. Topical keratolytics such as urea, salicylic acid, lactic acid, glycolic acid, or retinoids may be used for resistant or verrucous cases [5].

A sixteen-year-old healthy male patient was brought to the clinic due to the presence of whimsical, rough, blackish-brown scaly patches (Fig. 1). Dermoscopy revealed isolated, brown plaques resembling flakes (Figs. 2a and 2b).

	Figure 1: Blackish-brown, scaly plaques located on the back.
	Figure 2: (a and b) Dermoscopy reveals isolated, brown plaques resembling flakes.

The mother noticed these marks on her son’s back by chance while he was putting on a swimsuit eight days ago, prompting the visit to understand his condition. The duration of the condition was unknown, and there was no relevant personal or family medical history.

Based on these clinical findings, a diagnosis of dermatosis neglecta is established. Cleaning the affected area with alcohol resulted in the disappearance of most skin lesions (Fig. 3), confirming the clinical diagnosis.

Figure 3: After cleaning the affected area with alcohol, the disappearance of most of the blackish-brown, scaly plaques on the back was observed.

DN is an underdiagnosed condition that should be considered when evaluating any localized hyperpigmented lesion in hard-to-reach areas of the body, especially in patients with disabilities or physical limitations. Early identification of this condition may prevent unnecessary diagnostic or therapeutic procedures. The diagnosis of DN is clinical and typically straightforward, with the cleaning test often confirming it [6].

REFERENCES

1. Palaniappan V, Sadhasivamohan A, Karthikeyan K. Dermatosis neglecta. Clin Exp Dermatol. 2022;47:1265-74.

2. Sasaya EMK, Ghislandi C, Trevisan F, Ribeiro TB, Mulinari-Brenner F, Gaiewski CB. Dermatosis neglecta. An Bras Dermatol. 2015;90(3 suppl 1):59-61.

3. Sechi A, Patrizi A, Savoia F, Leuzzi M, Guglielmo A, Neri I. Dermatosis en forma de tierra firme:una revisión sistemática. Int J Dermatol. 2021;60:933-43.

4. Saha A, Seth J, Sharma A, Biswas D. Dermatitis neglecta:una dermatosis sucia:informe de tres casos. Indian J Dermatol. 2015;60:185.

5. Zhou C, Chen X, Zhang J. Dermatosis neglecta of the scalp complicated with alopecia areata. Int J Trichology. 2020;12:138.

6. Babu S, Kareddy S, Pappala M. Dermatosis neglecta in inpatients of a tertiary care center:A case series. Indian J Dermatopathol Diagn Dermatol. 2022;9:59.