Skin Health More Skin Conditions An Overview of Dermatitis Neglecta By Colleen Doherty, MD Colleen Doherty, MD Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis. Learn about our editorial process Updated on February 19, 2020 Medically reviewed by Leah Ansell, MD Medically reviewed by Leah Ansell, MD LinkedIn Leah Ansell, MD, is a board-certified dermatologist and an assistant professor of dermatology at Columbia University. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Causes Symptoms Diagnosis Treatment Dermatitis neglecta is a rare skin condition that is caused by poor hygiene. As a result of a lack of cleaning, scales form on the skin that are dark, waxy, and resemble cornflakes. The diagnosis of dermatitis neglecta is almost always made through a medical history and skin examination alone. Less commonly, a skin biopsy may be performed, mostly to rule out mimicking diagnoses. Once diagnosed, treatment of this condition entails daily, light scrubbing with soap and water or isopropyl alcohol wipes. In more severe cases, a keratolytic agent (such as salicylic acid) may be needed to remove the scales. John Banagan / Getty Images Causes Dermatitis neglecta occurs as a result of improper hygiene, specifically when a person avoids or neglects to clean certain parts of their body When the skin is not properly washed or scrubbed (as you normally do in the shower or when taking a bath), the outermost layer of the skin is not exfoliated, leading to scaly patches that consist of corneocytes, oil, sweat, and bacteria accumulate. Corneocytes are cells that compose the outermost layer of your skin (called the stratum corneum). Risk Factors You may wonder why a person would neglect to wash certain areas of their body—and it can occur due to several reasons. Inadequate washing may occur as a result of immobility, pain, neurological deficits, or psychiatric illness. Excessive skin sensitivity (called hyperesthesia), possibly from prior surgery or trauma, is another reason a person may avoid cleaning. For example, after a facelift, the skin builds up behind the ears, leading to a loss of sensation and a build up of oils on the skin. Misguided information is another possible culprit. For example, in one case a patient was instructed to not wash her face with a washcloth after a facial peel. Prolonged avoidance led to the development of brown scales, which the patient actually presumed was a reaction to the peel. Symptoms While a painless and harmless condition, dermatitis neglecta can be cosmetically unappealing and bothersome. The symptoms include: Waxy and cornflake-like scalesAdherent scales, meaning the scales stick well to the skinHyperpigmentation (darkening) of the scales, with normal skin underneath Diagnosis A medical history and skin examination are sufficient to diagnose dermatitis neglecta. Keep in mind, during your skin examination, your healthcare provider will likely swab the affected area with alcohol. Alcohol swabbing is a useful diagnostic tool because it will clear the scale(s) and reveal normal skin underneath. Soap and water can generally clear away the scale as well. Tests and Labs Sometimes a healthcare provider will perform other tests, such as a skin biopsy and a KOH test, to confirm the diagnosis of dermatitis neglecta and rule out alternative diagnoses. That said, more awareness of this condition among dermatologists has hopefully avoided the use of skin biopsies, which can be uncomfortable. Differential Diagnoses Other conditions that your healthcare provider may consider, besides dermatitis neglecta, include: Atopic dermatitis ("eczema") Acanthosis nigricans Tinea versicolor Seborrheic dermatitis Treatment The treatment of dermatitis neglecta is straightforward and consists of daily light scrubbing of the affected area with soap and water or isopropyl alcohol For more severe cases, a keratolytic agent (e.g. urea or salicylic or glycolic acid) along with an emollient may be recommended. Examples of keratolytic agents include: UreaSalicylic acidGlycolic acidRetinoic acid A Word From Verywell If you think you may have dermatitis neglecta and/or are experiencing a new or bothersome skin condition, please be sure to see your primary care healthcare provider or a dermatologist. If you end up being diagnosed with this condition, the upside is that the treatment is simple and inexpensive—some good old-fashioned soap and water. 3 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Saha A, Seth J, Sharma A, Biswas D. Dermatitis neglecta—a dirty dermatosis: report of three cases. Indian J Dermatol. 2015;60(2):185-187. doi:10.4103/0019-5154.152525 Moon J, Park HS, Yoon HS, Cho S. A case of dermatosis neglecta caused by an inappropriate habit of applying a moisturizer. Ann Dermatol. 2017;29(5);657-659. doi:10.5021/ad.2017.29.5.657 Lopes S, Vide J, Antunes I, Azevedo F. Dermatitis neglecta: a challenging diagnosis in psychodermatology. Acta Dermatovenerol Alp Pannonica Adriat. 2018;27(2):109-110. Additional Reading Langar S, Sonthalia S. Dermatitis neglecta. Indian J Med Res. 2018;147(3):322. doi:10.4103/ijmr.IJMR_43_17 Martín-gorgojo A, Alonso-usero V, Gavrilova M, Jordá-cuevas E. Dermatosis neglecta or terra firma-forme dermatosis. Actas Dermosifiliogr. 2012;103(10):932-4. doi:10.1016/j.adengl.2011.12.006 Perez-Rodriguez IM, Munoz-Garza FZ, Ocampo-candiani J. An unusually severe case of dermatosis neglecta: a diagnostic challenge. Case Rep Dermatol. 2014;6(2):194-199. doi:10.1159/000366515 By Colleen Doherty, MD Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit