A Case of Dermatitis Neglecta: DISCUSSION

26 Feb

Poskitt et al first described dermatitis neglecta (unwashed dermatosis) in 1995. They reported 3 cases of pigmented hyperkeratotic plaques on various sites, and these plaques were the result of avoiding washing the affected areas. Ruiz-Maldonado et al added two more cases of dermatitis neglecta in 1999, and the lesions resembled verrucous nevi around the areolas and pubic areas. All of the lesions were rapidly resolved by normal washing with gentle wiping from an alcohol swab. For our patient, the lesion was on the umbilicus and it resembled psoriasis or nevoid acanthosis nigricans localized to the umbilicus, and this type of case has rarely been reported.

On histologic examination, the epidermis showed orthokeratotic hyperkeratosis with anastomosing rete ridges, and a mild peri- vascular lymphocytic infiltration was noted in the dermis. Psoriasis could be promptly ruled out by its histopathologic features, but nevoid acanthosis ni- gricans possesses some common histological features with dermatitis neglecta; hyperkeratosis, slight acan- thosis, undulating with dermal papillomatosis in the epidermis and a mild perivascular lymphocytic infiltration in the superficial dermis. However, nevoid acanthosis nigricans progresses for a certain period and then it remains stable, and so it requires treatment with various modalities; topical applica­tion of keratolytic agents, podophyllin, calcipotriol or retinoids, cryotherapy, dermabrasion, laser, excision, etc. In our case, gentle swabbing with H2O2 and saline gauze during skin biopsy treated the lesion, and this quick resolution of the lesion is a characteristic feature of dermatitis neglecta. suhagra

Dermatitis neglecta might occur in various circumstances. Poskitt et al stated that dermatitis neglecta is a result of willful and subconscious self-neglect, which is different from dermatitis artefacta that the lesions are not produced or aggravated by the patient’s own actions. Dermatitis artefacta is classified as an impulsive-aggressive type of obsessive-compulsive disorder by Stein and Hollander. This loss of self-control could be as­sociated with guilt or this may occur during a period of a hysterical trance during which time the ordinary personality has no conscious memory. Thus, the concept of dermatitis artefacta was not fulfilled for the previously reported cases or the present in­stance, since the lesions in these instances arose through acts of omission rather than commission. Dermatitis neglecta may occur in areas of unwashed hyperaesthetic skin, for example, in patients suf­fering from trigeminal neuralgia or in those patients whose mobility is compromised by stroke or severe arthritis, and so they are unable to wash ade­quately. In our case, patient had inadequate bathing habits so that he probably didn’t give much attention to cleaning the umbilical area.

In most cases, dermatitis neglecta is probably due to accumulation of sebum, sweat, corneocytes and bacteria, and these all form a compact, adherent crust of dirt. Recognizing its existence and cause are important to avoid unnecessary biopsies and poten­tially aggressive therapeutic measures. However, dermatitis neglecta might be overlooked and under- diagnosed.

We herein report on a case of dermatitis neglecta on the umbilicus. This case is the first report to describe the histologic characteristics of dermatitis neglecta.
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