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A 75-year-old woman who was positive for metastatic breast cancer and left radical mastectomy complained of two month-history of dirty-appearing skin, composed of subtle but clear-cut brown to blackish areas with a velvety texture, symmetrically involving lateral sides of trunk and proximal upper limbs, chest, abdomen and the whole dorsum (Fig. 1). The discoloration was apparently unrelated to patient's medications, whereas showers and brushings with acid liquid soap did not lead to significant improvement. On dermatological consultation, partial removing of these patches by isopropyl alcohol swabbing confirmed the clinical suspicion so she was reassured about the benignity of the disease and the easiness of treatment.
What is the diagnosis?
Terra firma-forme dermatosis (TFFD), formerly Duncan's Dirty Dermatosis, is a benign condition whose name derives from the Latin expression terra firma, meaning ‘dirty land’.
The true prevalence of TFFD is probably underestimated.
According with literature, it affects a wide range of ages (4–72 years) with equal incidence in both sexes [
Physical exam usually discloses asymptomatic, localized or extensive and sometimes symmetrical clear-cut areas of brownish to black hyperpigmentation, variously characterized by the presence of palpable, papillomatous plaques and focal light scaling, involving most often the neck and trunk but also affecting scalp, back, limbs, axillary, umbilical and pubic areas [
Readily diagnosable by focal clearing using alcohol-soaked pads, thus avoiding further unnecessary evaluations (i.e. histologic examination, cultures for bacteria/fungi, hormonal assays), TFFD should be distinguished from pityriasis versicolor, Gougerot and Carteaud's reticular and confluent papillomatosis, acanthosis nigricans, and pseudoacanthosis nigricans, atopic dermatitis with post-inflammatory hyperpigmentation, frictional asymptomatic darkening of the extensor surfaces, idiopathic deciduous skin and dermatosis neglecta [