Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 3468

AbstractCase ReportDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Case Series
Year : 2022 | Month : December | Volume : 16 | Issue : 12 | Page : WR01 - WR04 Full Version

Dermatosis Neglecta Involving Different Age Groups- A Series of Four Cases


Published: December 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/57353.17315
Devaraj Yogesh, Nikitha Reddy Mittamidi, Zigu S Krshn, Taranpreet Kaur Kalra, Priyanka Yogananda

1. Associate Professor, Department of Dermatology, Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka, India. 2. Junior Resident, Department of Dermatology, Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka, India. 3. Senior Resident, Department of Dermatology, Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka, India. 4. Junior Resident, Department of Dermatology, Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka, India. 5. Junior Resident, Department of Dermatology, Adichunc hanagiri Institute of Medical Sciences, Mandya, Karnataka, India.

Correspondence Address :
Dr. Devaraj Yogesh,
Associate Professor, Department of Dermatology, Adichunchanagiri Institute of Medical Sciences, B.G Nagara, Nagamangalataluk, Mandya, Karnataka, India.
E-mail: yogeshdevaraj86@gmail.com

Abstract

Dermatosis neglecta is a benign cutaneous condition which is often misdiagnosed. It occurs due to poor local hygiene or inadequate washing of a part of the body resulting in progressive accumulation of sebum, sweat, keratin and other debris which form an adherent crust of dirt. It mainly occurs in individuals who are unable to take care of themselves, like those with physical disability or psychosis. It is usually asymptomatic and is characterised by localised hyperpigmented patch or verrucous papules and plaques. Rubbing the affected area with alcohol-soaked gauze results in complete clearance of the lesion which is both diagnostic and therapeutic. The present case series describes four patients of different age groups. The first patient was a 65-year-old female, who underwent amputation of the gangrenous toes of right foot. She did not wash that leg for several weeks following surgery and developed cornflakes-like scaly lesions. Later lesions were diagnosed as dermatosis neglecta. Second case was an 18-year-old male, who presented with lesions on neck, which was misdiagnosed initially as Pityriasis vesicolor. The third patient was a 20-year-old female, who presented with lesions on neck and was earlier diagnosed and treated as acanthosis nigricans. The fourth patient was a two-year-old female who developed lesions on neck due to accumulation of dirt and debris. In all these patients, lesions resolved on rubbing with alcohol-soaked swab. Very little data is available in medical literature about this condition. Therefore this case series is being reported to bring awareness among dermatologists. This would enable prompt clinical recognition and obviate the need for expensive investigations and treatment strategies.

Keywords

Diagnostic challenge, Poor local hygiene, Psychosis, Unwashed dermatosis

Dermatosis neglecta is a cutaneous condition that occurs in patients with physical or psychological morbidities like trauma, surgery, hyperaesthesia, neurological deficits, psychiatric illnesses (1). These patients are unable to maintain personal hygiene because of their morbidity and physical immobility leading to accumulation of dead skin cells, dirt and debris manifesting as scaly and crusted plaques. (1),(2). Lesions are asymptomatic and patients are often unaware of the skin lesion. Treatment involves complete removal of the lesions and counselling the patients and caregivers to cleanse the skin regularly with soap and water thereby preventing recurrence (3). In this case series the authors describe dermatosis neglecta in four patients with age group ranging from 2-65 years. Lack of awareness among doctors has lead to misdiagnosis. With this case series, the authors intend to create awareness among physicians about this benign, easily treatable condition.

Case Report

Case 1

A 65-year-old lady presented to Dermatology Outpatient Department (OPD) with chief complaints of multiple skin lesions on right leg since one month. There was no history of itching, pain or any other associated symptom. Lesions were insidious in onset and started simultaneously over multiple areas on the right leg and gradually progressed to involve the entire leg over a period of one month. There was no relevant family history.

General physical examination and systemic examination were normal. On cutaneous examination, there were multiple scaly, cornflake-like greasy plaques on her right leg (Table/Fig 1). She was a known case of uncontrolled diabetes mellitus since several years. She developed gangrene of 4th and 5th toes of right leg and amputation (Table/Fig 2) was done for the same six weeks back.

Following this, she did not wash her legs properly due to pain and fear of causing trauma to the operated site.

A provisional diagnosis of dermatosis neglecta and icthyosis vulgaris were made. On wiping the lesions with gauze soaked with spirit, the lesions were coming-off, revealing the normal underlying skin (Table/Fig 3), which confirmed the diagnosis of dermatosis neglecta. She was counselled about the benign nature of her condition and was advised to regularly wash her legs with soap and water with mild scrubbing in order to prevent recurrence. The patient was followed-up monthly in Dermatology OPD along with follow-up in Surgery OPD. There was no recurrence for four months, after which she was lost to follow-up.

Case 2

A 18-year-old male presented to Dermatology OPD with chief complaints of multiple dark flat skin lesions and few dark raised lesions over the neck since one month (Table/Fig 4). There was no history of itching, pain or any other associated symptom. Lesions were asymptomatic initially, started as a pea sized lesion and gradually progressed to the present size over a period of one month. There was no significant family history.

General physical examination and systemic examination were normal. On cutaneous examination, there were multiple hyperpigmented macules and papules over the neck just below the earlobes. Lesions were extending from 3 cm behind the ear to 2 cm below and in front of the left ear. It was initially diagnosed as pityriasis versicolor and treated with ketoconazole cream. However, patient did not respond to the treatment. On follow-up after three weeks, a few lesions had become hyperkeratotic. On close inspection, it was giving a stuck on appearance. On rubbing cotton soaked in spirit vigorously over the lesion, it was coming-off and underlying normal skin was revealed.

On further questioning about his hygiene habits, he said that he was not washing his neck properly during bath. In the OPD, removal of all lesions was done by vigorously rubbing with cotton and spirit. Thus all the lesions disappeared which confirmed our suspicion of DN and also formed the treatment. He was counselled about good hygiene in the form of daily bath with soap and occasional mild scrubbing to prevent recurrence. The patient was followed-up during one month and two months interval, during which there was no recurrence of the lesions.

Case 3

A 20-year-old female presented to Dermatology OPD with chief complaints of multiple dark raised lesions over the neck since childhood. Lesions were insidious in onset and located in a small area over nape of neck during childhood and progressed gradually over a period of several years to involve the entire neck crease. There was no itching or burning sensation. There was no significant family history.

On examination there were multiple hyperpigmented, velvety plaques on the neck (Table/Fig 5). Other areas such as axilla, groin and face were not involved. Systemic examination was normal. A provisional diagnosis of acanthosis nigricans was made. She was treated with triple combination cream containing hydroquinone, tretinoin and fluocinolone along with sunscreen. Since, her Body Mass Index (BMI) was in the normal (23 kg/m2) she was not given alpha-lipoic acid tablets.

After three weeks she reported for follow-up. This time some of the hyperpigmented lesions over the neck were clear and there was mild erythema over the skin. Other area of the neck were still hyperpigmented and velvety. The diagnosis was reviewed and provisional diagnosis of dermatosis neglecta was made. The lesions were rubbed with gauze soaked in spirit and it was found that the lesions were coming off (Table/Fig 6). When enquired about her bathing habits, she revealed that she was not cleaning her neck with enough soap while bathing since her school days. This has led to progressive accumulation of dirt on her neck. Removal of the lesion on rubbing with cotton and spirit confirmed the diagnosis. Since, the lesions were hyperkeratotic, she was treated with keratolytic agents such as urea containing moisturisers and salicylic acid, which lead to resolution of the lesions. She was advised to wash her neck thoroughly while bathing in future. On follow-up after six weeks, there was complete resolution of the lesions without recurrence.

Case 4

A two-year-old female child was brought to Dermatology OPD with chief complaints of dark patches over the neck since three weeks. The mother gave a history that these pigmented lesions started over the neck and gradually increased in size linearly, to involve the shoulder area. There was history of fever two weeks back, which was treated by Pediatrician and resolved. There was no history of itching or pain over the lesions.

On examination, the child was afebrile and active. Systemic examination was normal. Cutaneous examination revealed, multiple linear hyperpigmented plaques over the neck crease anteriorly (Table/Fig 7). Similar lesions were present over the right shoulder. Since, the morphology did not conform to any particular diagnosis, the lesion was wiped with cotton soaked with spirit. The lesion started to clear off on wiping (Table/Fig 8) revealing the underlying normal skin. On further questioning, the parents revealed that since the child was suffering from fever and because the weather was cold, the child was given bath only once a week for the past three weeks. Based on the history of poor hygiene and the cutaneous examination, a diagnosis of dermatosis neglecta was made. Confluent and reticulate papillomatosis was kept as a differential diagnosis. The remaining lesion was removed by rubbing with cotton and spirit. The parents were counselled regarding the benign nature of the condition and were asked to cleanse the neck area thoroughly with soap and water with mild scrubbing and to regularly bathe the child. The parents were informed for follow-up visit after one month, to check for recurrence of lesions. However, they were lost to follow-up.

Discussion

Dermatitis neglecta (DN) was first described by Poskitt L et al., in 1995 (4). Later, in 1999 Ruiz-Maldonado R et al., proposed the term dermatosis neglecta as there was no associated inflammation (5). It is a benign condition occurring as a result of failure to adequately clean or scrub the skin. Hence it is also known as ‘unwashed dermatosis’. Failure to clean or scrub the skin may be due to a wide variety of causes like trauma, hyperaesthesia, surgery, immobility secondary to hemiplegia or other neurological disorders, physical disability. The exact prevalence is not known as there is gross under diagnosis and misdiagnosis leading to an underestimate of the true prevalence of this condition (6). Of late there has been an increase in the incidence of dermatosis neglecta developing in a setting of psychiatric background like schizophrenia or frank psychosis (2). Lack of adequate washing or scrubbing results in progressive accumulation of corneocytes, dirt, sebum, keratin, sweat and bacteria resulting in a characteristic clinical pattern.

The exact pathophysiology is not known. It is probably due to insufficient exfoliation, progressive accumulation and incomplete maturation of corneocytes with retention of melanin, thus leading to a build up of adherent scales (3). Skin lesions are seen as dirty looking hyperpigmented, hyperkeratotic or greasy, verrucous plaques over these areas of the body (7).

Dermatosis neglecta should be differentiated from other skin conditions that present as dirty dermatosis such Terra firma forme dermatosis, Confluent and reticulated papillomatosis also known as Gougerot-Carteaud syndrome, verrucous naevi, acanthosis nigricans, post inflammatory hyperpigmentation, atopic dermatitis, frictional asymptomatic darkening of the extensor surfaces, idiopathic deciduous skin, vagabond’s disease, acanthosis nigricans, hyperkeratotic Malassezia dermatosis, X-linked ichthyosis (6).

Terra firma-forme dermatosis can be differentiated from dermatosis neglecta by a history of good personal hygiene, lack of corn-flake scale, unresponsiveness to soap and water cleansing and histopathology showing Periodic Acid-Schiff (PAS) stain positive yeast (2). Confluent and reticulated papillomatosis of Gougerot-Carteaud syndrome has a velvety appearance and is associated with Pityrosporum orbiculare. It is seen on the central trunk and is not related to cleaning and has a negative alcohol swab test. In dermatitis artefacta, the lesions are associated with acts of commission, whereas in DN, the lesions are associated with acts of omission (6). (Table/Fig 9) depicts an algorithm proposed by Tan C to diagnose various conditions that present as dirt-like lesions on the skin (8).

Dermatosis neglecta should be kept in mind in all conditions that present as localised hyperpigmented lesions in a setting of chronic illness. The time of evolution of the lesions is two to four months and the patients usually have an associated chronic disease characterised by pain or disability. Some of the recently reported cases of dermatosis neglecta, which posed a diagnostic challenge are as given in the (Table/Fig 10) (1),(7),(9),(10),(11). The authors encountered four cases of DN within a short span of time. This suggests that the condition has a high prevalence. In the first case, it was the amputation of toes which lead to lesions on the leg. In the fourth case, due to fever and cold weather, the parents were apprehensive about bathing the child, which lead to DN lesions in the child. However, in the second and third cases, authors were not able to pinpoint the exact reason for development of the hyperpigmented lesions. Probably differences in the bathing habits of these two individuals may have contributed to this condition. Due to lack of awareness, this condition, it is often misdiagnosed. Authors also misdiagnosed the second case and third case as pityriasis versicolor and acanthosis nigricans, respectively. These two patients did not respond to conventional treatment, which was when we suspected DN.

Treatment of DN is simple, rubbing the lesion with alcohol swab is both diagnostic and therapeutic. Urea 20% cream, glycolic acid 5% cream and lactic acid 12% cream along with daily light scrubbing with a soapless cleanser is also effective. Keratolytics and emollients should be used judiciously (3). Apart from this, counselling and encouraging the patient to maintain proper cleanliness of the affected region is essential.

Conclusion

Thus, dermatosis neglecta can occur in patients belonging to all age groups with varying underlying causes. A high degree of suspicion is required to diagnose it. Dilemma may occur due to similarities with other conditions, about the exact diagnosis which may prompts various investigations leading to loss of time and money of the patients. Timely diagnosis will save the patient from being subjected to expensive investigations. Hence, this case series is being reported to bring about an awareness among dermatologists and physicians regarding this entity.

References

1.
Kumar PN, Uvais NA, Gopalakrishnan A, Suresh R. Dermatitis neglecta: A case report in Psychodermatology. Prim Care Companion CNS Disord. 2021;23(4):20l02806. [crossref]
2.
Saha A, Seth J, Bindal A, Samanta AB, Gorai S, Sharma A. Dermatosis neglecta: An increasingly recognized entity with review of literature. Indian J Dermatol. 2016;61(4):450-52. [crossref] [PubMed]
3.
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(7):5. [crossref] [PubMed]
4.
Poskitt L, Wayne J, Wojnarowska F, Wilkinson JD. Dermatosis neglecta: Unwashed dermatosis. Br J Dermatol. 1995;132(5):827-39. [crossref] [PubMed]
5.
Ruiz-Maldonado R, Durán-McKinster C, Tamayo-Sánchez L, Orozco-Covarrubias M. Dermatosis neglecta: Dirt crusts simulating verrucous nevi. Arch Dermatol. 1999;135(6):728-29. [crossref] [PubMed]
6.
Choudhary SV, Bisati S, Koley S. Dermatitis neglecta. Indian J Dermatol Venereol Leprol. 2011;77(1):62-63. [crossref] [PubMed]
7.
Venkatachalam K, Anila PS, A Bindu SS. Dermatosis neglecta-Report of a case with verrucous plaque in a child. Indian Dermatol Online J. 2019;10(5):609. [crossref] [PubMed]
8.
Tan C. Dirt-adherent dermatosis: Not worth an additional name. Arch Dermatol 2010;146(6):679-80. [crossref] [PubMed]
9.
Devaraj Y, Mukunda RS, Shale M, Mittamedi NR, Yadav PY, Sundaram PM. Dermatosis neglecta: A case report. Int J Res Dermatol. 2020;6(5):696-98. [crossref]
10.
Saritha M, Karthikeyan K. Dermatitis neglecta-to be remembered, not neglected!. Indian Dermatol Online J. 2015;6(2):138-39. [crossref] [PubMed]
11.
Pérez-Rodríguez IM, Muñoz-Garza FZ, Ocampo-Candiani J. An unusually severe case of dermatosis neglecta: A diagnostic challenge. Case Rep Dermatol. 2014;6(2):194-99. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/57353.17315

Date of Submission: May 06, 2022
Date of Peer Review: Jul 20, 2022
Date of Acceptance: Oct 20, 2022
Date of Publishing: Dec 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 07, 2022
• Manual Googling: Oct 10, 2022
• iThenticate Software: Oct 19, 2022 (7%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com