History:

 A 20-year-old female had history of operative fixation of thoracic and lumbar vertebrae two years before. She suffers hyperesthesia over the operative site (mid-back). She admitted that she avoids cleaning and even touching the involved area (the only difference between dermatosis neglecta and terra firme dermatosis). She presented with asymptomatic, hyperpigmented, dirt-like plaques on both sides of the midline operative scar.The rash had been eradicated on vigorous rubbing with 70% isopropyl alcohol (third photo). Rubbing with 70% isopropyl alcohol or vigorous cleaning with soap and water is considered as both diagnostic and therapeutic test in dermatosis neglecta and terra firme dermatosis!