By Gary M. White, MD

Terra firma-forme dermatosis

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


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 [ BJD 1995;132;827]. 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 [AD 1999;135;728].

Although neglect and poor hygiene may be associated, many patients bath daily [Dermatol Pract Concept. 2015 Jul 31;5(3):29-33]. For some unknown reason, soap and water are not sufficient to remove the outer layers of the skin in these patients.


Cleaning the skin with isopropyl alcohol is both diagnostic and therapeutic. Unfortunately, the condition may recur. Rarely, patients may require weekly cleaning of affected areas with isopropyl alcohol for prophylaxis.

Additional Pictures

Terra firma-forme dermatosis


Diogenes syndrome. Indian J Dermatol 2015;60:287-9

Dermatología Argentina


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