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dermatosis neglecta is a condition secondary to lack of cleanliness , characterized by the formation of hyperkeratotic plaques located in a specific region of the body , usually due to a psychiatric condition , physical disability or neurological deficit .
it is considered a diagnostic challenge   because it can mimic other entities such as hyperkeratotic syndromes or hyperchromic lesions .
an 18-year - old woman presented with a 2-month history of progressive brown verrucous plaque on the face , previously treated with no improvement ( fig .
our first impression was seborrheic dermatitis and we treated her with facial cleanser soap , topical hydrocortisone 1% b.i.d . per 3 days and then q.d .
one month later she arrived with new lesions , therefore our diagnosis changed to darier 's disease versus seborrheic pemphigus versus foliaceus pemphigus .
biopsy with histopathological and immunofluorescence studies were ordered with results being compatible with seborrheic dermatitis .
we performed a new patient interview and discovered depression secondary to her pathology as well as social withdrawal .
dermatitis neglecta or unwashed dermatosis was first described in 1995 by poskitt et al .   as a condition secondary to the accumulation of sebum , sweat , corneocytes and bacteria forming a hyperkeratotic plaque
if affects all age groups and both sexes and clinically presents as hyperkeratotic plaques with cornflake - like scales with an evolution of 24 months ; the lesions disappear with proper washing of the affected area [ 6 , 7 ] .
the diagnosis is clinical and lesions can be identified by removing the crusts with isopropyl alcohol .
a biopsy is usually not necessary and orthokeratotic hyperkeratosis , papillomatosis and mild acanthosis can be seen without an inflammatory infiltrate [ 8 , 9 ] .
the main differential diagnoses are terra firma - forme dermatosis , confluent reticulated papillomatosis of gourgeot and carteaud , acanthosis nigricans , verrucous nevi , vagabond 's disease , and genetic disorders such as darier 's disease and x - linked ichthyosis [ 1 , 8 ] .
terra firma - forme dermatosis is clinically very similar to dermatosis neglecta , but unlike dermatosis neglecta , it has a history of good hygiene and responds only to cleaning with isopropyl alcohol 70% [ 2 , 6 , 8 ] .
dermatitis artefacta presents as self - inflicted injuries or injuries worsened by the patient , while dermatosis neglecta is an act of omission of cleaning by the patient either intentionally or unconsciously .
a diagnostic algorithm can be used as a tool when confronted with a difficult pathology   ( fig .
treatment is based on reinforcing hygiene measures and using keratolytic agents such as urea , retinoic acid , glycolic acid , lactic acid or salicylic acid [ 1 , 7 , 11 ] .
dermatosis neglecta is a disease that can be frequently misdiagnosed , since it has many differential diagnoses which include hyperkeratotic syndromes .
the authors have no conflict of interest to declare . there were no funding sources .
dermatosis neglecta is a condition secondary to lack of cleanliness , characterized by the formation of hyperkeratotic plaques located in a particular region of the body , usually due to a disability , and it is considered a diagnostic challenge because it can mimic other entities . 
 we present the case of an 18-year - old woman with a 2-month history of progressive brown verrucous plaque in her face . 
 our first impression was seborrheic dermatitis and she was treated with facial cleanser soap and topic hydrocortisone 1% . 
 one month later , she arrived with new lesions . because of 
 this our diagnosis changed to darier 's disease versus seborrheic pemphigus versus foliaceus pemphigus . 
 histopathology and immunofluorescence studies were compatible with seborrheic dermatitis . 
 the patient complained of depression and social withdrawal and denied facial cleansing . 
 facial cleansing was performed during consultation presenting resolution of the lesions , which confirmed the diagnosis of dermatosis neglecta . 
 dermatosis neglecta is a disease that can be frequently misdiagnosed , since it has many differential diagnoses , such as hyperkeratotic syndromes . 
 it should be recognized early and aggressive diagnostic and therapeutic methods should be avoided .