Extensive Dermatosis Neglecta with Severe Atopic Dermatitis: A Case that Presented as a Suicide Attempt

Abstract

In this report, we present a case of extensive dermatosis neglecta with severe atopic dermatitis which presented as a suicide attempt. A 19-year-old woman was admitted for a suicide attempt by drug overdose. Her body was almost entirely covered by dark brown plaque. During her recovery, she reported dermatological pain and hyperesthesia. She had suffered from atopic dermatitis (AD) since her childhood. She had stopped topical steroid therapy (TST) for fears of the side effects since becoming a teenager. She became socially withdrawn due to worsening AD and felt depressive. She had not bathed or showered for seven years and the plaque had developed over two years. She was diagnosed with depression and dermatosis neglecta with severe AD. She had emotional instability and strongly refused to receive TST. We started counselling from a psychiatrist and a Japanese traditional herbal (Kampo) medicine, Shofusan for her skin, which became a stepping-stone to undertaking and restarting TST. Her mental and dermatological conditions gradually improved. She continued these therapies as an outpatient. One year and ten months later, her skin had almost fully recovered, and she remained healthy. This case shows that severe AD and a misunderstanding of TST could contribute to extensive dermatosis neglecta. Comprehensive and integrated care was useful for the patient, who had depression with suicidal ideation and steroid phobia.