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Verrucous Penile Plaque in an 11‐Year‐Old Boy

To the Editor: The case report of Sethi et al (1) of a hyperpigmented plaque on the penis is described as an example of terra firma-forme dermatosis. This diagnosis may not be correct. Terra firma-forme dermatosis presents as slowly progressive, poorly demarcated areas of hyperpigmentation without plaques of material that can be separated from the epithelial surface. One feature is that typically the family has been trying to clean the area without success. A second feature is that the hyperpigmentation can be removed using alcohol, usually requiring vigorous rubbing. It is more likely that the 11-year-old boy had retained epithelial cells and oxidized secretions. RuizMaldonado et al (2) and others have labelled this dermatosis neglecta. It presents as verrucous plaques that can occasionally be seen at the coronal sulcus of uncircumcised and circumcised boys, especially if there is a degree of buried penis. Some exposure to oxygen is needed to give the classic dark brown–black coloration. The confusion in this case arises because of the failure of the parents to get it clean with soap and water. In cases I have seen, this lack of success arises because of excessive caution in cleansing of this sensitive site. With more pressure, the plaques readily lift off painlessly, as described here. Alcohol is not needed for removal.