Dermatosis neglecta

Dermatosis neglecta
A 35-year-old male, with multiple fractures, neurological deficit and immobility sustained in a fall, leading to the development of dermatosis neglecta of the left hand. Upper image: Dorsum of hand (at presentation). Lower image: Dorsum of hand (after two weeks).
Specialty	Dermatology

Dermatosis neglecta is a skin condition in which accumulation of sebum, keratin, sweat, dirt and debris leads to a localized patch of skin discoloration or a wart-like plaque. It is caused by inadequate hygiene of a certain body part, usually due to some form of disability or a condition that is associated with pain or increased sensitivity to touch (hyperesthesia) or immobility. Can simply be caused by insufficient exfoliation when cleansing skin. If condition is advanced, Dawn dish soap can be very effective: dampen skin, add thick layer of the soap and let it sit for a few minutes. Follow up with light scrubbing with a wet washcloth in circular motion.^[1]

Dermatosis neglecta typically develops several months after a disability or other affliction leads to improper cleaning. Patients may deny that negligence is the cause of the lesion, even though it completely resolves on vigorous rubbing with alcohol swabs or water and soap (which provides both diagnosis and treatment). Recognizing the diagnosis avoids unnecessary skin biopsies.