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It is Dermatosis neglecta

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Letter: It is Dermatosis neglecta
Thaer Hassan Douri MD
Dermatology Online Journal 16 (12): 15



The case presented in the article “Severe retention hyperkeratosis occurring with Susac syndrome” in October 2010 of DOJ (16:10) is very dramatic. Although it was implied in the article, the authors did not state that this is actually Dermatosis neglecta, the same entity reported by Poskitt et al. 15 years ago. The description of the case in the article, histopathology, mechanism of pathogenesis, and treatment are consistent with Dermatosis neglecta, only with a different name.

The patient’s condition in “Severe retention hyperkeratosis occurring with Susac syndrome” in the October 2010 issue of DOJ [1] may also be called Dermatosis neglecta. Dermatosis neglecta, or unwashed face, is an acquired, long-standing, asymptomatic condition characterized by dark, verrucous plaques of dirt and retention hyperkeratosis [2]. The condition was first described in 1995 by Poskitt et al. [2] who proposed that it develops as a result of a patient’s willful or subconscious self-neglect. The disease results from the accumulation of sebum, sweat, corneocytes, and bacteria in a localized area of skin, forming a compact and adherent crust-like layer [3]. However, recognition of this condition and its causes is important in order to avoid aggressive, unnecessary diagnostic and therapeutic procedures. Simply washing with soap and a washcloth will produce clearing. The build-up can be easily rubbed off using soap and water or an alcohol soaked swab [4] and examination of material removed with alcohol swabbing also aids in the diagnosis [5].


1. Severe retention hyperkeratosis occurring with Susac syndrome. October 2010

2. Dermatitis neglecta: unwashed dermatosis. Poskitt L, Wayte J, Wojnarowska F, Wilkinson JD. Br J Dermatol. 1995 May;132(5):827-9. [PubMed]

3. Dermatosisneglecta: dirt crusts simulating verrucous nevi. Ruiz-Maldonado R, Durán-McKinster C, Tamayo-Sánchez L, Orozco-Covarrubias ML. ArchDermatol. 1999 Jun;135(6):728-9. [PubMed]

4. Dermatosisneglecta in a case of multiple fractures, shoulder dislocation and radial nerve palsy in a 35-year-old man: a case report. Qadir SN, Ejaz A, Raza N. J Med Case Reports. 2008 Nov 17;2:347. [PubMed]

5. Dermatosisneglecta: a series of case reports and review of other dirty-appearing dermatoses. Lucas JL, Brodell RT, Feldman SR.Dermatol Online J. 2006 Dec 10;12(7):5. [PubMed]

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