Dermatitis neglecta as a complication after cataract surgery.

Dermatitis neglecta, a condition of the skin secondary to a primary underlying disease, is an important diagnosis to be kept in mind as the clinical presentation may mimic a severe disease, but the treatment basically includes patient counseling and personal hygiene.

Dermatitis neglecta (DN) is an unwashed dermatosis caused by progressive accumulation of sebum, sweat, keratin, and other dirt and debris, resulting in a localized hyperpigmentated patch or a verrucous plaque. Failure to adequately clean the skin of the affected area associated with pain or increased sensitivity to touch or prior trauma results in this condition. The management involves a lot of counseling to the patient because in the first instance, the patient may be very reluctant to accept the condition as an act of self-negligence. The treatment is simply cleaning the area with soap and water and by alcohol-soaked gauze. We are reporting a case series of DN in geriatric age group following cataract surgery.

Case Reports

Case 1

A 58-year-old female [Fig. 1] presented with 2-month duration of asymptomatic lesions over face. On examination, there were thick, moist, hyperpigmented scales over malar area of face, periorbital area, and extending to forehead. There was no erythema underlying the scales. The patient gave history of cataract surgery on the right eye 2½ months back. On cleaning with acetone, the scales were removed leaving normal underlying skin.

Figure 1

(a) Thick, hyperpigmented scales over malar area of face, periorbital area, and extending to forehead, (b) normal underlying skin on removal of scales with acetone

Case 2

A 62-year-old male [Fig. 2] presented with similar asymptomatic thick, hyperpigmented scales over periorbital area of 1-month duration postcataract surgery on the left eye. Cleaning with soap and water revealed normal underlying skin.

Figure 2

(a) Hyperpigmented scaling over the eyelids of left eye, (b) normal skin on cleaning with soap and water

Case 3

A 60-year-old female [Fig. 3] presented with minimal hyperpigmented, moist scaly lesions on the right lower eyelid, associated with a history of cataract surgery of the same eye 1 month back. The scales were easily removed with acetone leaving normal skin.

Figure 3

(a) Hyperpigmented minimal scales over the lower eyelid of right eye, (b) normal underlying skin after cleaning with acetone

Discussion

The term “DN” was first coined by Poskitt et al. in 1995 to denote a condition in which formation of a localized hyperpigmented lesion occurs as a consequence of inadequate frictional cleansing of a particular body part or region.[1] DN is characterized by localized area of hyperpigmentation and hyperkeratosis resulting from an act of omission, i.e., unconscious avoidance of self-cleaning due to pain or immobility. Common differential diagnosis includes verrucous nevi, acanthosis nigricans, hyperkeratotic Malassezia dermatitis, confluent and reticulated papillomatosis of gougerot and carteaud, idiopathic deciduous skin, and postinflammatory hyperpigmentation.[23] Alcohol swabbing or soap water cleaning can serve as a definitive tool in case of diagnostic dilemma. A literature search of the case reports of DN involving face has been associated with nasopharyngeal carcinoma, neuralgic pain and allodynia, surgery for brain tumor, eczema of eyelids, surgery for carcinoma lip, and following facial peeling.[2456] We encountered three cases of DN on the face following cataract surgery. After thorough literature search, we could get one article by Jha et al.,[7] where they have mentioned the association of DN mimicking pigmented basal cell carcinoma near medial canthus of the eye following cataract surgery done 1 month back which was not reported. As cataract surgery is very common in geriatric age group, to the best of our knowledge, no more case reports of DN associated with cataract surgery have been published until date.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.