ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferencesView all Images (4)
Dermatosis neglecta - Skin
Other Resources UpToDate PubMed

Dermatosis neglecta - Skin

Print Images (4)
Contributors: Gil Weintraub MD, Noah Craft MD, PhD, Lindy P. Fox MD, Lowell A. Goldsmith MD, MPH, Michael D. Tharp MD
Other Resources UpToDate PubMed


Dermatosis neglecta (DN) is a condition characterized by patches and plaques of hyperpigmentation and adherent scales that form due to inadequate cleaning or exfoliation of the skin. Whether due to deliberately poor or unwittingly neglectful personal hygiene, the lack of washing over the course of months allows for the accumulation of sebum, sweat, keratin, debris, bacteria, and yeast on unwashed areas of the skin. Pruritus may develop over the site, but there are no systemic symptoms. Washing with soap, water, and a washcloth for friction or with isopropyl alcohol-soaked gauze will often result in complete removal of the lesions.

DN presents in patients with an underlying physical disability, hyperesthesia, previous trauma, or psychiatric etiology resulting in areas of skin that remain persistently unwashed. Although not a life-threatening or contagious condition, it can be cosmetically bothersome.

The complaint of skin scaling and hyperpigmentation is a nonspecific dermatologic finding; thus, early recognition of DN can help prevent unnecessary diagnostic and therapeutic procedures.


L85.9 – Epidermal thickening, unspecified

402344000 – Retention hyperkeratosis due to neglect

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

  • Terra firma-forme dermatosis (TFFD) – Brown or dirt-like discoloration of the skin that is impervious to normal hygiene but is readily removed by swabbing with isopropyl alcohol pads. A history of longstanding resistance of the discoloration to regular washing or scrubbing is suggestive of TFFD.
  • Dermatitis artefacta – Wide range of lesions, from red patches to swellings, scars, crusts, and denuded areas that are self-inflicted by the patient via mechanical or chemical means. Lesions appear in bizarre patterns (eg, geometric or linear) that are clearly demarcated on areas accessible to the patient's hands (eg, on the face, arms, legs). Classically seen in young females who are immature or attention seeking.
  • Acanthosis nigricans – Brown velvety plaques arising in the body folds, often serving as a marker of hyperinsulinemia secondary to insulin resistance in obese patients.
  • Pityriasis versicolor – Superficial mycosis typically presenting in warm and humid environments. Can appear as either hyper- or hypopigmented macules. Potassium hydroxide (KOH) preparation reveals hyphae and spores, commonly referred to as "spaghetti and meatballs."  
  • Seborrheic keratosis – Nearly ubiquitous in older adults. Initially presents as flat to slightly raised tan or brow macules that develop a familiar verrucous "stuck-on" appearance.
  • Epidermal nevi – Benign overgrowth of epidermis. Often present at birth or develop during childhood.
  • Confluent and reticulated papillomatosis – Presents with brown papules arranged in a reticulated pattern primarily along the intermammary, epigastric, and interscapular regions. More common among young adults, particularly women and darker-skinned individuals.

Best Tests

Subscription Required

Management Pearls

Subscription Required


Subscription Required


Subscription Required

Last Updated: 07/18/2014
Copyright © 2020 VisualDx®. All rights reserved.
Dermatosis neglecta - Skin
Print 4 Images
View all Images (4)
(with subscription)
Dermatosis neglecta : Poor hygiene, Verrucous scaly papule, Verrucous scaly plaque, Hyperpigmented plaques, Hyperpigmented patches
Clinical image of Dermatosis neglecta
Copyright © 2020 VisualDx®. All rights reserved.