Case history

A 45-year-old man reported with dirty warty, asymptomatic lesions on his eyelids since 10 months. He was euglycemic, mildly hypertensive and normolipemic. He was a moderately heavy smoker and an occasional drinker.

On examination

Dirty warty papular and crusted lesions were seen on both the eyelids (Figs. 1 and 2).

Investigations

No investigations were needed. Only history was enough. He underwent an intraocular lens (IOL) transplantation operation about a year back. The doctor asked him to avoid direct water sprinkling on the eyes for a few days.

He was so apprehensive about his eyes; he never used water to wash his eyes in last 1 year.

Diagnosis

Dermatitis neglecta (DN).

Treatment

The ‘lesions’ were gently removed with saline soaked gauze piece and cleaned with spirit cotton. The apparent erythema on the ‘cured’ eyelids is due to the recent friction by the spirit cotton (Figs. 3 and 4).

Observations

DN, a condition which originates from inadequate frictional cleansing, presents diagnostic as well as therapeutic challenges.1 Clinically, patches of brown flake-like scales develop in patients who specifically avoid washing an area of skin for a variety of reasons.2 An isopropyl alcohol swab is a cost-effective, painless diagnostic test that works as treatment as well. Till today the exact pathophysiology is unknown. Insufficient exfoliation leading to a build up of adherent scales may be a probable sequence of events. These localized scaly patches are probably areas of the stratum corneum where corneocytes, sebum, sweat, and bacteria have accumulated.

Suggested reading

1. Poskitt L, Wayte J, Wojnarowska F, Wilkinson et al. Dermatitis neglecta: unwashed dermatosis. Br J Dermatol 1995;132(5):827-9.
2. Maldonado RR, Durn-McKinster C. Dermatitis neglecta: dirt crusts simulating verrucous nevi. Arch Dermatol 1999;135:728-9.