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This case report details a 10-year-old boy presenting hyperpigmented brownish macules for one year and demonstrates how polarized dermoscopy and line-field confocal optical coherence tomography reveal characteristic epidermal changes. After rubbing with 70% isopropyl alcohol, complete clinical and dermoscopic clearing occurs and LC-OCT shows reduction of hyperkeratosis, supporting accurate noninvasive diagnosis.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/enhanced-diagnosis-of-terra-firma-forme-dermatosis-by-dermoscopy-and-line-field-confocal-optical-coherence-tomography-case-report/453029/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/enhanced-diagnosis-of-terra-firma-forme-dermatosis-by-dermoscopy-and-line-field-confocal-optical-coherence-tomography-case-report/453029.png","ImageObject",300,407,{"name":92,"@type":93},"Patrick","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-05","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",16,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is recognizing terra firma-forme dermatosis important in children?","Question",{"text":113,"@type":114},"Because it can be easily misdiagnosed as dermatosis neglecta, which stems from poor hygiene and may cause psychological discomfort.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What imaging methods were used to assess the case?",{"text":118,"@type":114},"Polarized dermoscopy and line-field confocal optical coherence tomography (LC-OCT) were used to visualize characteristic epidermal and corneous changes.",{"name":120,"@type":111,"acceptedAnswer":121},"What happened after rubbing the lesions with 70% isopropyl alcohol?",{"text":122,"@type":114},"Total clearing was observed clinically and on dermoscopy, and LC-OCT showed a consistent reduction of hyperkeratosis.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},453029,1791159687,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":52,"preview_page_count":4},549758146520,"https://ap-avatar.wpscdn.com/avatar/80002397d8c0411e94?_k=1775819394049821470","CASE REPORT  \nEnhanced diagnosis of terra firma-formedermatosis by dermoscopy and line-field confocal optical coherence tomografphy  \nAndrea Calogero Trecarichi, MD, Maria Rita Nasca, MD, PhD, Francesco Lacarrubba, MD, Giuseppe Micali, MD, and Anna Elisa Verz, MD  \nKey words: dermoscopy; LC-OCT; line-field confocal optical coherence tomography; pediatric; terra firmaforme.  \nINTRODUCTION  \nTerra firma-forme dermatosis (TFFD), also known as Duncan dirty dermatosis, is an idiopathic benign skin disease likely resulting from altered keratinocyte maturation.1 It has a bimodal peak of incidence with a first peak during the first 10 years of life and a second peak during 60 to 80 years of age. There is no gender predilection, and literature on genetic inheritance is inconclusive.2 The conditions’ average duration is a few months with alow recurrence rate.3 An association between TFFD and atopic dermatitis has been described in a pediatric population.4 Pathogenesis of TFFD is still unclear. Inhibition of the epidermal keratinoplastic activities, leading to impaired desquamation, corneocytes clumping, retention hyperkeratosis, and accumulation of sebum and dirt, has been considered.1,5,6 Histopathologic examination shows lamellar hyperkeratosis with intracorneal orthokeratotic whorls, keratotic plugging of follicular orifices, keratin globules in the stratum corneum, papillomatosis of the epidermis associated with irregular acanthosis, increased melanin pigment in the basal layer, and minimal lymphocytic liquefaction. In the dermis, edema, pigment-laden macrophages, perivascular lymphocytic infiltration, and erythrocyte extravasation may be observed.6,7 However, skin biopsies are seldom performed, and diagnosis is usually made based on clinical findings, with complete clearance of the typical polymorphous stuck-on appearing patches,  \nFrom the Dermatology Clinic, University of Catania, Catania, Italy.  \nFunding sources: None; this article has no funding source.  \nPatient consent: The authors attest that they have obtained written consent from patient/s, their legal guardian/s or person/s with legal authority, for their photographs and medical information to be published in print and online and with the understanding that this information may be publicly available. Patient consent forms were not provided to the journal but are retained by the authors to be made available upon request.  \nIRB approval status: Not applicable.  \nAbbreviations used:  \nLC-OCT: line-field confocal optical coherence tomography  \nTFFD: Terra firma-forme dermatosis  \nmimicking dirty skin, after rubbing with 70% isopropyl alcohol.2,3 Interestingly, noninvasive techniques such as dermoscopy and reflectance confocal microscopy have also been used in an attempt to provide valuable additional information in cases where the diagnosis is uncertain.2,7-9  \nIn this case report, we describe the features of a case of TFFD obtained by line-field confocal optical coherence tomography (LC-OCT), a recent noninvasive imaging tool that allows an‘‘in vivo’’ visualization with a cellular resolution, of the epidermal layers until the superficial dermis with both horizontal and vertical views.10  \nCASE REPORT  \nA 10-year-old Caucasian boy presented with a 1-year history of asymptomatic, hyperpigmented, brownish macules scattered on his trunk and limbs. Family and past personal history were negative for any concomitant disease and only revealed an episode of glomerulonephritis at the age of 4 years, which resolved without sequelae. Any local trauma or inflammatory  \nPrior presentation: The manuscript is an original unpublished work, and it is not submitted for publication elsewhere.  \nCorrespondence to: Giuseppe Micali, MD, Dermatology Clinic, University of Catania, Via S. Sofia 78, 95123 Catania, Italy. E-mail: [cldermct@gmail.com](cldermct@gmail.com).  \nJAAD Case Reports 2026;67:205-8 .  \n2352-5126  \n© 2025 The Author(s) . Published by Elsevier Inc. on behalf of the American Academ","cbCaigFfCeJ4sbOi","https://ap.wps.com/l/cbCaigFfCeJ4sbOi","pdf",6627413,"English","# Introduction\n## Case report\n# Discussion","[{\"question\":\"Why is recognizing terra firma-forme dermatosis important in children?\",\"answer\":\"Because it can be easily misdiagnosed as dermatosis neglecta, which stems from poor hygiene and may cause psychological discomfort.\"},{\"question\":\"What imaging methods were used to assess the case?\",\"answer\":\"Polarized dermoscopy and line-field confocal optical coherence tomography (LC-OCT) were used to visualize characteristic epidermal and corneous changes.\"},{\"question\":\"What happened after rubbing the lesions with 70% isopropyl alcohol?\",\"answer\":\"Total clearing was observed clinically and on dermoscopy, and LC-OCT showed a consistent reduction of hyperkeratosis.\"}]","Enhanced diagnosis of terra firma-forme dermatosis by dermoscopy and line-field confocal optical coherence tomography - case report | PDF",1790738092]