An Overview of Dermatitis Neglecta

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.

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.

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.

While a painless and harmless condition, dermatitis neglecta can be cosmetically unappealing and bothersome.

The symptoms include:

• Waxy and cornflake-like scales
• Adherent scales, meaning the scales stick well to the skin
• Hyperpigmentation (darkening) of the scales, with normal skin underneath

A medical history and skin examination are sufficient to diagnose dermatitis neglecta. Keep in mind, during your skin examination, your doctor 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.

Sometimes a doctor 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.

Other conditions that your doctor may consider, besides dermatitis neglecta, include:

• Atopic dermatitis ("eczema")
• Acanthosis nigricans
• Tinea versicolor
• Seborrheic dermatitis

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:

• Urea
• Salicylic acid
• Glycolic acid
• Retinoic acid

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 physician 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.