I read with great interest the article by Shan et al1 describing a patient with dirtlike lesions diagnosed as cutaneous dirt-adherent disease (CDAD).
Recently, I saw a similar case: a 5-year-old boy with asymptomatic pigmented and keratotic lesions of 3 months' duration. His parents assured me that the child maintained good hygiene, showering once or twice daily with soap. He was healthy and took no medications.
Tan C. Dirt-Adherent Dermatosis: Not Worth an Additional Name. Arch Dermatol. 2010;146(6):679-680. doi:10.1001/archdermatol.2010.106