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Introduction: Diogenes syndrome is mostly seen in geriatric or demented patients. It is a behavioural disorder characterized by self neglect, social withdrawal, poor personal and domestic hygiene. A milder form of this is dermatitis passivata. Dermatitis passivata is a psychodermatological disorder marked by cessation of normal skin cleansing, leading to accumulation of keratinous crusts[1]. Herein, we report an extreme case of dermatitis passivata.
Case description: A 23 years old female presented with crusted hyperpigmented plaque accompanied with area of burning sensation on face since 1 year. The lesion started as faint erythema in peri orbital region after application of eyedrops for eye infection. It gradually progressed to involve the face. Patient consulted multiple local practitioners who had advised her topical cream for the face. All routine investigations were sent and were within normal limit. On examination, multiple hyperpigmented to crusted plaque extending from forehead to left chin with peripheral erythema seen.
Discussion: Dermatitis passivate is also known by Terre firme forme or Dermatitis heglecta. It results due to cumulative accretions of keratin and dirty debris in due course of time resembling carapace [2]. In our case, patient presented with these lesions with a long duration history suspecting leishmaniasis or morphea at first. After, close observation, and further follow up, dermatitis passivata with irritant contact dermatitis diagnosis was arrived. The lesions completely cleared after one month of treatment with topical corticosteroids. This case report highlights a diagnostic challenge at which a dermatitis passivate can be presented at extreme end.
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