Neglecta dermatitis

What is it dermatitis neglecta?

Neglecta dermatitis, first described by Poskitt and colleagues in 1995, is a dermatological disorder resulting from voluntary or unconscious inadequate friction cleaning of the skin. [one].

Who gets dermatitis neglecta?

Dermatitis neglecta has been reported in all ages and skin types, but occurs more frequently in people with physical or mental disabilities, or sensory disorders, pain, traumaor 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 probably attributable to a lack of reporting and misdiagnosis.

What causes dermatitis neglecta?

The exact Pathogenesis of neglecta dermatitis remains unclear. Inadequate exfoliation of the skin leads to the accumulation of tallowsweat curb, bacteriaand other decomposition products that form a compact Cortex of dirt [6].

Patients often deny lack of cleanliness.

What are the clinical characteristics of neglecta dermatitis?

The clinical features of dermatitis neglecta include:

• Located hyperpigmented patches or warty plates with adhesion, peeling scale
• Evolution in 2 to 4 months.
• Trunk, genital, limb, face, and surgical site involvement (eg, after pacemaker insertion or waterfall extraction) [2–8].

Injuries are generally asymptomatic but it can be aesthetically annoying for some patients.

Which is the differential diagnosis for neglecta dermatitis?

Neglecta dermatitis is mimicked by other localized hyperpigmented skin lesions. The main differential is terra firma-forma skin disease (Duncan's dirty dermatosis), which is due to delayed maturation of corneocytes (full of dead keratin scaly cells in the epidermis) [9]. Other conditions to consider in the differential diagnosis include:

• Artifact dermatitis
• Confluent and lattice papillomatosis by Gougerot and Carteaud
• Acanthosis nigricans
• Warty epidermal nevus
• Pityriasis versicolor

How is dermatitis neglecta diagnosed?

Dermatitis neglecta should be clinically suspected with any localized hyperpigmentation patch or license plate with scales, especially in people with disabilities.

• The successful removal of scabs with isopropyl alcohol is highly suggestive [2,3].
• Biopsy Usually not necessary. Orthokeratotic sample hyperkeratosis, papillomatosis and mild acantholysiswithout a inflammatory infiltrate [10].

• Malassezia yeast has been isolated from some lesions, but probably represents diner overgrowth rather than a causal factor [3].

What is the treatment for dermatitis neglecta?

The patient can be assured that no harm will be caused by gently rubbing the skin, even where there are scars, dysesthesia, or a pacemaker.

• Friction washing of the affected area with isopropyl alcohol or soap and water generally cleanses in days or weeks or months. [2.3]
• For more severe or resistant injuries, a regimen of keratolytic agent (eg 20% urea, 5% glycolic acid, 12% lactic acid as combination lotion), emollient, and daily washing may be useful [2,3]

What is the result of dermatitis neglecta?

Patients should be encouraged to wash their skin at least twice a week. [2.3]. Associated disorders (eg. chronic pain) must be evaluated and managed. Daily light washing with soap and water or isopropyl alcohol can provide prophylaxis in high risk cases [2,3].