What is dermatitis neglecta?
Dermatitis neglecta, first described by Poskitt and colleagues in 1995, is a dermatological disorder that results from voluntary or unconscious inadequate frictional cleansing of the skin .
Who gets dermatitis neglecta?
Dermatitis neglecta has been reported in all ages and skin types, but most commonly occurs in individuals with a physical or mental disability, or sensory disturbance, pain, trauma, or previous surgery in the affected area [2–5]. It is believed to be quite common, although there are only a handful of cases in the literature. This is likely attributable to underreporting and misdiagnosis.
What causes dermatitis neglecta?
The exact pathogenesis of dermatitis neglecta remains unclear. Inadequate exfoliation of the skin leads to the accumulation of sebum, sweat, keratin, bacteria, and other breakdown products forming a compact crust of dirt .
Patients often deny a lack of cleanliness.
What are the clinical features of dermatitis neglecta?
Clinical features of dermatitis neglecta include:
- Localised hyperpigmented patches or verrucous plaques with adherent, flaking scale
- Evolution over 2–4 months
- Involvement of trunk, genitalia, limbs, face, and surgical sites (eg after pacemaker insertion or cataract extraction) [2–8].
Lesions are generally asymptomatic but may be cosmetically bothersome for some patients.
What is the differential diagnosis for dermatitis neglecta?
Dermatitis neglecta is mimicked by other localised hyperpigmented skin lesions. The main differential is terra firma-forme dermatosis (Duncan's dirty dermatosis), which is due to a delay in maturation of corneocytes (dead keratin-filled squamous cells in the epidermis) . Other conditions to consider in differential diagnosis include:
- Dermatitis artefacta
- Confluent and reticulated papillomatosis of Gougerot and Carteaud
- Acanthosis nigricans
- Verrucous epidermal naevus
- Pityriasis versicolor.
How is dermatitis neglecta diagnosed?
Dermatitis neglecta should be suspected clinically with any localised hyperpigmented patch or plaque with a flake-like scale, especially in those with disability.
- Successful removal of crusts with isopropyl alcohol is highly suggestive [2,3].
- Biopsy is usually not necessary. It shows orthokeratotic hyperkeratosis, papillomatosis, and mild acantholysis, without an inflammatory infiltrate .
- Malassezia yeast has been isolated from some lesions but likely represents commensal overgrowth rather than a causative factor .
What is the treatment for dermatitis neglecta?
The patient can be reassured that no harm will be caused by gently scrubbing the skin, even where there is scarring, dysesthesia, or a pacemaker.
- Frictional washing of the affected area with isopropyl alcohol or soap and water generally produces clearing in days or weeks to months [2,3]
- For more severe or resistant lesions, a regimen of a keratolytic agent (for example, 20% urea, 5% glycolic acid, 12% lactic acid as a combination lotion), emollient, and daily scrubbing may be useful [2,3]
What is the outcome of dermatitis neglecta?
Patients should be encouraged to wash their skin at least twice weekly [2,3]. Associated disorders (eg, chronic pain) should be assessed and managed. Dedicated daily light scrubbing with soap and water or isopropyl alcohol may provide effective prophylaxis in high-risk cases [2,3].