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| LETTER TO EDITOR |
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| Year : 2020 | Volume
: 12
| Issue : 5 | Page : 243-244 |
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A case of post hair transplant dermatosis neglecta: A rare entity
Shashank Hemant Bansod1, Bhushan S Madke2
1 Hi.Tech Skin Clinic and Hair Transplant Centre, Nagpur, Maharashtra, India
2 Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| Date of Submission | 15-May-2020 |
| Date of Acceptance | 17-Jul-2020 |
| Date of Web Publication | 03-Nov-2020 |
Correspondence Address:
Shashank Hemant Bansod
Hi-Tech Skin Clinic and Hair Transplant Centre, Vijay Bhawan, Opposite Lokmat Building, Dhantoli, Nagpur - 440 012, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijt.ijt_78_20
How to cite this article:
Bansod SH, Madke BS. A case of post hair transplant dermatosis neglecta: A rare entity. Int J Trichol 2020;12:243-4 |
Sir,
Dermatosis neglecta (DN), alternative called as dermatitis neglecta, is a condition which occurs due to inadequate or no frictional cleansing of specific area of the body. DN presents in patients with an underlying physical disability, hyperesthesia, previous trauma, or psychiatric etiology. Although not a life-threatening condition, it is cosmetically bothersome.
We report the case of a 29-year-old male patient, who presented with multiple, hyperpigmented, and velvety plaques over the scalp, especially over the vertex and frontal areas. On enquiry, the patient reported that he had undergone a hair transplant surgery 2 months ago.
He reported that, in the first 2 weeks of the postoperative phase, he followed all the instructions given by the operating surgeon and was doing well. However, in the COVID-19 lockdown time, the patient was not able to schedule a follow-up visit with his hair-transplant surgeon.
Due to fear of damaging of implanted hair grafts, the patient inadequately cleansed the recipient area for about 2 weeks, after which he developed the lesions which were asymptomatic. There were no systemic complaints.
On examination, the patient had multiple, hyperpigmented, verrucous, well-defined waxy plaques diffusely distributed over fronto-parietal area of the scalp [Figure 1]. | Figure 1: Dermatitis neglecta: Multiple keratotic and velvety plaques over the scalp
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The patient was counseled regarding the importance of adequate cleansing of recipient area. He was prescribed a mild shampoo for cleansing the scalp regularly. After a few washes, he reported with complete clearance of lesions [Figure 2]. | Figure 2: Clearing of plaques after few sessions of hair wash with shampoo
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DN, also called unwashed dermatitis, was introduced first by Poskitt et al. in 1995.[1] It occurs chiefly due to the accumulation of sebum, sweat, keratin, and other forms of dirt leading to the formation of a verrucous plaque with adherent corn flake-like scales.[2]
The close differential diagnosis is terra firma forme dermatitis (TFFD), in which there is incomplete keratinocyte maturation, melanin retention, and compaction of scales. Usually, the hygiene is well maintained in TFFD and ill maintained in DN.
There is clearance of lesions of DN by washing with soap and water,[3] while TFFD do not respond to similar action.
Seventy percent isopropyl alcohol-soaked gauze rubbed forcefully completely clears the lesion of TFFD[4] and even DN.
Other main differential diagnoses include acanthosis nigricans, confluent and reticulate papillomatosis, pityriasis versicolor, and dirty neck of atopic dermatitis, all of which can be excluded by alcohol swab test.[5]
DN is an under reported, asymptomatic, and many a times misdiagnosed condition. The awareness of the condition prevents unnecessary laboratory work up. Our case is probably the first ever case reported, where the patient had dermatitis neglecta of scalp after hair transplant operation, which adds a new element to already existing literature of dermatitis neglecta.
Declaration of patient consent
The authors certify that they had obtained all appropriate patient consent forms. The patient understood that his name and initial would not be published, and due efforts would be taken to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Poskitt L, Wayte J, Wojnarowska F, Wilkinson J. Dermatitis neglecta': Unwashed dermatosis. Br J Dermatol 1995;132:827-9.  |
| 2. | Saha A, Seth J, Sharma A, Biswas D. Dermatitis neglecta-a dirty dermatosis: Report of three cases. Indian J Dermatol 2015;60:185-7. [ PUBMED] [Full text] |
| 3. | Saritha M, Karthikeyan K. Dermatitis neglecta-to be remembered, not neglected! Indian Dermatol Online J 2015;6:138-9. |
| 4. | Aslan NÇ, Güler Ş, Demirci K, Isiyel E. Features of terra firma-forme dermatosis. Ann Fam Med 2018;16:52-4. |
| 5. | Choudhary SV, Bisati S, Koley S. Dermatitis neglecta. Indian J Dermatol Venereol Leprol 2011;77:62-3. [ PUBMED] [Full text] |
[Figure 1], [Figure 2]
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