Dermatosis neglecta is a skin condition in which accumulation of sebum, keratin

Keratin

Keratin refers to a family of fibrous structural proteins. Keratin is the key of structural material making up the outer layer of human skin. It is also the key structural component of hair and nails...

, sweat

SWEAT

SWEAT is an OLN/TSN show hosted by Julie Zwillich that aired in 2003-2004.Each of the 13 half-hour episodes of SWEAT features a different outdoor sport: kayaking, mountain biking, ice hockey, beach volleyball, soccer, windsurfing, rowing, Ultimate, triathlon, wakeboarding, snowboarding, telemark...

, dirt and debris leads to a localized patch of skin discoloration or a wart

Wart

A wart is generally a small, rough growth, typically on a human’s hands or feet but often other locations, that can resemble a cauliflower or a solid blister. They are caused by a viral infection, specifically by human papillomavirus 2 and 7. There are as many as 10 varieties of warts, the most...

-like plaque. It is caused by inadequate hygiene of a certain body part, usually due to some form of disability

Disability

A disability may be physical, cognitive, mental, sensory, emotional, developmental or some combination of these.Many people would rather be referred to as a person with a disability instead of handicapped...

 or a condition that is associated with pain

Pain

Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...

 or increased sensitivity to touch (hyperesthesia

Hyperesthesia

Hyperesthesia is a condition that involves an abnormal increase in sensitivity to stimuli of the sense. "When a non-noxious stimulus causes the sensation of pain the area will be termed hyperaesthetic". Stimuli of the senses can include sound that one hears, foods that one tastes, textures that...

) or immobility.

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 with vigorous rubbing with alcohol swaps or water and soap (which is both a form of diagnosis and treatment). Recognizing the diagnosis avoids unnecessary skin biopsies.

Examples of case reports from the literature include a man who avoided washing the skin area surrounding an artificial pacemaker

Artificial pacemaker

A pacemaker is a medical device that uses electrical impulses, delivered by electrodes contacting the heart muscles, to regulate the beating of the heart...

 out of fear it might be damaged, a woman who didn't clean the right side of her chest due to hyperesthesia following an amputation for breast cancer

Breast cancer

Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...

 (mastectomy

Mastectomy

Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. Mastectomy is usually done to treat breast cancer; in some cases, women and some men believed to be at high risk of breast cancer have the operation prophylactically, that is, to prevent cancer...

), a girl who was afraid to wash the area around an abdominal scar, or a man with multiple fractures, shoulder dislocation and radial nerve palsy.

Differential diagnosis

Many other conditions can lead to localized scaling

Desquamation

Desquamation , also called skin peeling, is the shedding of the outermost membrane or layer of a tissue, such as the skin.-Skin:Normal, nonpathologic desquamation of the skin occurs when keratinocytes, after moving apically over about 14 days, are individually shed unnoticeably...

 or hyperpigmentation

Hyperpigmentation

In dermatology, hyperpigmentation is the darkening of an area of skin or nails caused by increased melanin.-Causes:Hyperpigmentation may be caused by sun damage, inflammation, or other skin injuries, including those related to acne vulgaris...

.

This condition should firmly be distinguished from dermatitis artifacta which is the factitious creation of a skin lesion, whereas dermatosis neglecta results from unconscious avoidance of cleaning due to pain or immobility.

Other skin conditions that should not be mistaken for dermatosis neglecta include terra firma-forme dermatosis (in which there is no history of inadequate cleaning), confluent and reticulated papillomatosis of Gougerot and Carteaud

Confluent and reticulated papillomatosis of Gougerot and Carteaud

Confluent and reticulated papillomatosis of Gougerot and Carteaud is an uncommon but distinctive acquired ichthyosiform dermatosis characterized by persistent dark, scaly, papules and plaques that tend to be localized...

, several forms of ichtyosis, acanthosis nigricans

Acanthosis nigricans

Acanthosis nigricans is a brown to black, poorly defined, velvety hyperpigmentation of the skin. It is usually found in body folds, such as the posterior and lateral folds of the neck, the axilla, groin, umbilicus, forehead, and other areas.-Causes:...

 and Vagabond's disease.