Acquired, long-standing, nonsymptomatic, dark, verrucous plaques of dirt simulating verrucous nevi have been recognized as dermatitis neglecta.1 They may represent a diagnostic and therapeutic challenge.
A 13-year-old girl consulted for dark brown plaques with a verrucous surface around both areolas. The lesions had first appeared 4 months previously and progressively grew in size and thickness. Her breast development was consistent with Tanner II stage; breast ache was occasionally present. At the time of consultation, dermatology residents made a presumptive diagnosis of acquired verrucous nevus. When one side of the pigmented plaque was rubbed with alcohol-soaked gauze, the dark lesion disappeared completely, leaving beneath it normal-appearing skin (Figure 1 and Figure 2).
Ruiz-Maldonado R, Durán-McKinster C, Tamayo-Sánchez L, de la Luz Orozco-Covarrubias M. Dermatosis Neglecta: Dirt Crusts Simulating Verrucous Nevi. Arch Dermatol. 1999;135(6):728-729. doi:10-1001/pubs.Arch Dermatol.-ISSN-0003-987x-135-6-dlt0699