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LETTER TO EDITOR
Year : 2020  |  Volume : 12  |  Issue : 3  |  Page : 138-139  

Dermatosis neglecta of the scalp complicated with alopecia areata


Department of Dermatology, Peking University People's Hospital, Beijing, China

Date of Submission06-May-2019
Date of Decision01-Jul-2020
Date of Acceptance19-Jul-2020
Date of Web Publication14-Aug-2020

Correspondence Address:
Dr. Cheng Zhou
Department of Dermatology, Peking University People's Hospital, Beijing
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijt.ijt_46_19

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How to cite this article:
Chen X, Zhang J, Zhou C. Dermatosis neglecta of the scalp complicated with alopecia areata. Int J Trichol 2020;12:138-9

How to cite this URL:
Chen X, Zhang J, Zhou C. Dermatosis neglecta of the scalp complicated with alopecia areata. Int J Trichol [serial online] 2020 [cited 2020 Sep 30];12:138-9. Available from: http://www.ijtrichology.com/text.asp?2020/12/3/138/292099



Sir,

Dermatosis neglecta is a dirt-associated condition caused by the failure of washing.[1] The lesion is usually distributed on the trunk, neck, or shoulders,[2] showing a hyperpigmented, verrucous surface with adherent scales or crust. Herein, we introduce a case of dermatosis neglecta complicated with alopecia areata on the scalp.

A 30-year-old male presented with patches of hair loss with a dirt-adherent lesion on the frontal scalp for 4 months. He was diagnosed as alopecia areata for the initial two patches of hair loss and treated with topical 5% minoxidil, which was withdrawn after 3 days because of erythema and itching. He then strictly avoided washing the hair loss patches, which finally developed asymptomatic, yellowish-brown plaques with a verrucous surface and adherent crust and scales [Figure 1]. The center of the lesion was removed easily when rubbed with 70% alcohol during physical examination. Dermoscopy showed broken hairs, “black dots,” and exclamation-mark hairs, which indicated the diagnosis of alopecia areata, and cornflake-like scales were on the periphery. Fluorescence staining of adherent scales showed numerous spores, indicating the infection of Pityrosporum orbiculare. The final diagnosis was dermatosis neglecta complicated with alopecia areata. All the scales and crust were rubbed off, and he was encouraged to wash his hair with shampoo every day. After 2 weeks of oral itraconazole and two sessions of intralesional triamcinolone acetonide injection, the hair regrew completely without recurrence of dermatosis neglecta.
Figure 1: (a) A hyperkeratotic, verrucous-like plaque on the hair loss region can be seen. (b) Dermoscopy showed irregularly distributed cornfl ake-like scales on the periphery (the central lesion was already rubbed) and the feature of alopecia areata including broken hairs and “black dots”

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Dermatosis neglecta was firstly described in 1995 as an acquired, asymptomatic condition with a verrucous surface, which is caused by the failure of washing and accumulation of sebum, sweat, keratin, cellular debris, and other dirt from the environment on the skin.[1],[3] Lesions may accompany P. orbiculare as a result of a suitable environment for overgrowth, rather than a cause of disease.[4] Soap water can easily remove the lesion and expose the normal skin. Orthokeratosis with anastomosing rete ridges and minimal inflammation might be revealed in histopathology examination.[4],[5]

The differential diagnoses include various dermatoses with verrucous surface and hyperpigmentation, such as terra firma forme dermatoses (TFFD), verrucous epidermal nevus, pediculosis corporis, acanthosis nigricans, and hyperkeratotic Malassezia dermatosis. History of washing failure and positive soap water rubbing test indicate the diagnosis of dermatosis neglecta. TFFD shows a similar verrucous lesion, but patients should maintain good hygiene and only 70% isopropyl alcohol can remove the lesion.

Dermatosis neglecta has been reported as a complication of operation, trauma, and mental disorder. To the best of our knowledge, no case associated with alopecia areata has been published in literature before. Psychological factors including anxiety and depression play a significant role in both alopecia areata and dermatosis neglecta. In this case, allergic dermatitis of minoxidil exploded the patient's anxiety, made him avoid washing, and finally resulted in dermatosis neglecta.

Treatment for dermatosis neglecta is simple and inexpensive. Rubbing with soap water or alcohol can remove the lesion easily, but it is much more important to treat the primary diseases. Consulting with the patient and encouraging him/her to maintain personal hygiene would be helpful.

This study was financially supported by the National Natural Science Foundation of China (No. 81773311).

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot bechrological order guaranteed.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Poskitt L, Wayte J, Wojnarowska F, Wilkinson JD. 'Dermatitis neglecta': Unwashed dermatosis. Br J Dermatol 1995;132:827-9.  Back to cited text no. 1
    
2.
Sasaya EM, Ghislandi C, Trevisan F, Ribeiro TB, Mulinari-Brenner F, Gaiewski CB. Dermatosis neglecta. An Bras Dermatol 2015;90:59-61.  Back to cited text no. 2
    
3.
Ruiz-Maldonado R, Durán-McKinster C, Tamayo-Sánchez L, Orozco-Covarrubias ML. Dermatosis neglecta: Dirt crusts simulating verrucous nevi. Arch Dermatol 1999;135:728-9.  Back to cited text no. 3
    
4.
Lucas JL, Brodell RT, Feldman SR. Dermatosis neglecta: A series of case reports and review of other dirty-appearing dermatoses. Dermatol Online J 2006;12:5.  Back to cited text no. 4
    
5.
Han YJ, Kim SY, Choi HY, Myung KB, Choi YW. A Case of Dermatitis Neglecta. Ann Dermatol 2008;20:257-9.  Back to cited text no. 5
    


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