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Dermatosis neglecta in inpatients of a tertiary care center: A case series

Background: Dermatosis neglecta (DN) is an underdiagnosed localized pigmentary disorder, characterized by asymptomatic hyperpigmented patches and plaques with adherent scales in an inadequately cleansed area. It is a diagnostic challenge leading to unnecessary interventions and burden to patients. Dermoscopy is a noninvasive handy diagnostic tool, though its utility in the diagnosis of DN is unexplored. Objective: To describe the various clinical and dermoscopic patterns in patients with DN. Materials and Methods: An observational study in 10 admitted patients of a tertiary hospital with DN was done, who consulted in department of dermatology in view of hyperpigmented lesions. After a thorough history and clinical examination, dermoscopy was done over the lesions. Results: In 10 patients, DN was confirmed with a resolution of part of lesion on the application of water-soaked gauze. On dermoscopy, dark-brown polygonal, cornflake-like scales are seen arranged in a mosaic pattern with intervening normal skin, sometimes over an erythematous background. On further probing, most patients gave the history of unintentional neglect of the affected part related to their primary illness. Limitations: Small sample size. Conclusions: DN is an underreported localized hyperpigmented disorder, mimicking other dermatoses. It should always be kept in mind in patients with morbidities that lead to the inability to maintain hygiene in the relevant areas, which may not be the classically described sites of DN. Dermoscopy helps to differentiate it from other hyperpigmented lesions, especially in its milder forms, avoiding the act of wiping the lesions especially in areas associated with hyperesthesia and helps in reinforcing the diagnosis. However, the criteria to diagnose DN based on dermoscopy is not definite.