A case of post hair transplant dermatosis neglecta: A rare e
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Dermatosis neglecta (DN) is a condition which occurs due to inadequate or no frictional cleansing of specific area of the body. DN presents in patients with an underlying physical disability, hyperesthesia, previous trauma, or psychiatric etiology. Although not a life-threatening condition, it is cosmetically bothersome.

The case of a 29-year-old male patient, with multiple, hyperpigmented, and velvety plaques over the scalp, especially over the vertex and frontal areas was presented. On enquiry, the patient reported that he had undergone a hair transplant surgery 2 months ago.

He reported that, in the first 2 weeks of the postoperative phase, he followed all the instructions given by the operating surgeon and was doing well. However, in the COVID-19 lockdown time, the patient was not able to schedule a follow-up visit with his hair-transplant surgeon.

Due to fear of damaging of implanted hair grafts, the patient inadequately cleansed the recipient area for about 2 weeks, after which he developed the lesions which were asymptomatic. There were no systemic complaints. On examination, the patient had multiple, hyperpigmented, verrucous, well-defined waxy plaques diffusely distributed over fronto-parietal area of the scalp.

DN, also called unwashed dermatitis occurs chiefly due to the accumulation of sebum, sweat, keratin, and other forms of dirt leading to the formation of a verrucous plaque with adherent corn flake-like scales. The close differential diagnosis is terra firma forme dermatitis (TFFD), in which there is incomplete keratinocyte maturation, melanin retention, and compaction of scales. Usually, the hygiene is well maintained in TFFD and ill maintained in DN.

There is clearance of lesions of DN by washing with soap and water, while TFFD do not respond to similar action. 70% isopropyl alcohol-soaked gauze rubbed forcefully completely clears the lesion of TFFD and even DN.

DN is an under reported, asymptomatic, and many a times misdiagnosed condition. This case is probably the first ever case reported, where the patient had dermatitis neglecta of scalp after hair transplant operation, which adds a new element to already existing literature of dermatitis neglecta.

Source: https://www.ijtrichology.com/article.asp?issn=0974-7753;year=2020;volume=12;issue=5;spage=243;epage=244;aulast=Bansod
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