Hyperkeratotic, hyperpigmented debris on the skin. Cleaning the skin with isopropyl alcohol (e.g. alcohol swab) removes it.

TERRA FIRMA-FORM DERMATOSIS and DERMATITIS NEGLECTA

Terra firma-forme dermatosis (TFFD) represents accumulation at the skin surface of a mixture of stratum corneum, sebum, sweat, and bacteria.

• It seems to have a preference for overweight patients and concave surfaces.
• Diagnosis is made by wiping off the hyperkeratotic lesions with isopropyl alcohol, e.g. an alcohol swab.
• In contrast to patients with dermatitis neglecta, patients with Terra Firma–Forme Dermatosis (TFFD) typically have good hygiene habits. Vigorous but unsuccessful attempts at cleansing the affected areas are often described.

Clinical

A hyperpigmented, hyperkeratotic covering of the skin is seen. The pigmentation is easily removed in the office with an alcohol swab. It may occur at any age, but older men predominate. It has been called both terra firma-forme dermatosis and dermatitis neglecta. TFFD has been seen in Diogenes syndrome which is characterized by extreme self-neglect, social withdrawal, and poor personal and domestic hygiene. It has been reported to simulate a verrucous nevus.

Many patients bath daily. For some unknown reason, soap and water are not sufficient to remove the outer layers of the skin in these patients.

RegionalDerm

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