ReferencesTERRA FIRMA FORME DISEASE Terra Firma Forme Disease (TFFD), first defined by Duncan and his collegues in 1987, is also known as Duncan's Dirty Disease. It is a rare type of keratinisation disorder with fully unidentified aetiology. While lesions look black dirt, thinly papillomatous and can not be removed by cleaning and rubbing with soap and water, they disappear totally after rubbing with 70% isopropyl or ethyl alcohol. Limited number of cases has been reported since it was diagnosed.The 14-year-old female patient visited our polyclinic with complaints of asymptomatic thinly papillomatous brown lesions on abdomen and back for 1 year. Medical and family history of the patient was examined and no significant pathology was detected. The patient stated that the problem still recurred despite rubbing with shampoo and soap. Dermotological examination revealed dirty, hyperkeratotic and hyperpigmented papules existed especially on the abdomen, back and shoulders. (Fig. 1) It was observed that the lesions disappeared totally after rubbing with 70% of alcohol. (Fig. 2) During histopathological examination, hyperkeratosis in the epidermis, increased pigmentation in the basal layer, oedema and mononuclear cell infiltration in papillary dermis were observed and no features were seen in periodic acid schiff coloration (Fig. 3).Lesions disappeared totally after rubbing with 70% of alcohol, and no emergence of new lesions were observed during the 8-month follow-up time.TFFD, defined by Duncan and colleagues, is a rare keratinisation disorder of unknown aetiology.1 Most of the cases reported in literature are about child and adolescent age groups (4 months minimum and as for age maximum 72) like our patient. No familial characteristic has been reported and no relationship with bathroom habits and hygiene have been observed. 2,3 The most frequent location of the disease is shoulder and back. However, some cases in which other body areas were affected have been reported. 2,4 Lesions are generally bilaterally symmetric and the most common comorbid conditions are atopic dermatitis and acne vulgaris. 5 The lesions disappearing entirely when wiped with 70% of isopropyl alcohol are Conflict of interest: None declared.

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ighteen-year-old female patient with with red scaly plaques on her forearms, legs and scalp, was referred to our out-patient clinic (Figure 1). The disease duration was over 10 years. The female patient was previously diagnosed as psoriasis. She was treated with various topical anti-psoriatic agents unsuccessfully. The lesions were not completely cleared. The patient was evaluated and clinical differential diagnosis included a number of erythematosquamous skin diseases. Due to the shape and arrangement of lesions , the diagnosis of seborrheic dermatitis, pityriasis rosea, lichen planus, pityriasis lichenoides et varioliformis acuta, pityriasis lichenoides chronica and parapsoriasis were excluded. And preliminary diagnosis of pityriasis rubra pilaris (PRP) and psoriasis were concluded. Skin punch biopsy was performed from her left forearm. Histopathological examination showed parakeratosis, loss of granular layer limited to small foci with diffuse hypergranulosis, and perivascular lymphocyte, histiocytes and extravasated erythrocytes in upper dermis (Haematoxylin-Eosin, original magnification x100) (Figure 2). These histopathological features were not fully consistent with psoriasis and did not exclude the diagnosis of PRP. Later, we performed dermoscopic examination on erythematous plaques and it revealed round/ oval yellowish areas surrounded by vessels of mixed linear and dotted morphology (Figure 3). These findings were consistent with dermoTurkiye Klinikleri J Dermatol 2016;26 (1) 69

Bu çalışma, 21-25 Ekim 2014 tarihleri arasında Antalya'da düzenlenen ''25. Ulusal Dermatoloji Kongresi''nde en iyi araştırma poster ödülüne layık görülmüştür.