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When dirt is not dirt! Duncan’s dirty dermatosis put under the microscope
  1. Pinar Avci1,
  2. Manfred Wolter1,2,
  3. Ronald Wolf1
  1. 1 Dermatology and Allergology, Philipps-University Marburg, Marburg, Germany
  2. 2 Dermatology and Allergology, Goethe University Frankfurt, Frankfurt/Main, Germany
  1. Correspondence to Professor Dr. Ronald Wolf, Dermatology and Allergology, Philipps-University Marburg, Marburg 35043, Germany; ronald.wolf{at}

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Duncan’s dirty dermatosis (terra firma-forme dermatosis) is a skin condition of unknown aetiology. The brownish-pigmented macules look like dirt but cannot be removed by water. The histopathological features resemble certain reticulate and ichthyosis-like patterns, which are mirrored here by dermatoscopical findings. Clinically, rubbing the lesions with isopropyl alcohol usually clears the affected skin and thus helps both treating and distinguishing Duncan’s dirty dermatosis from similar conditions.

A 21-year-old woman presented to our clinic with a single symptomless 13 cm hyperpigmented tail-shaped macula on the medial side of her left knee (figure 1). The lesion had appeared a month ago and remained unchanged. Long-term sun exposure was denied. Dermatoscopic evaluation of the lesion revealed light brown scales in a mosaic pattern and white keratin dots (figure 1, inlet). Physical examination was otherwise unremarkable. The patient denied taking any medications, exposure to sun …

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  • Handling editor Runjan Chetty.

  • Contributors Obtained data and wrote manuscript: PA, MW. Concept and wrote the manuscript: RW.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.