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Terra firme‐forme dermatosis of the scalp

A 4-year-old girl had a 2-month history of fixed pigmentation on the scalp in an area of regrowing alopecia areata (Fig. 1). It could not be removed by water, soap or shampoo, but came away with an alcohol swab (Fig. 2). Terra firme-forme dermatosis is reported on the neck in children and young adults, and appears identical to dermatitis neglecta described on the arm, lips and around a naevus in adults. It has not been reported on the scalp. There was no history of preceding injury or topical application to the scalp and the nature of this exogenous pigment remains unknown.