![]() Dirt, dust, bacterial, fungal, and parasitic debris conglomerate to form thick crusts and scales over various parts of the body. Skin lesions are mainly due to uncleanliness which may result in various infestations and infections. Multiple deficiency states have been associated with DS including iron, folate, vitamin B12, vitamin C, calcium and vitamin D, serum proteins and albumin, water, and potassium. Such persons usually have above average intelligence and it is now clear that some stressful event precipitates the disease in predisposed individuals. Though principally affecting the elderly, young persons have been diagnosed with this condition. A question has been raised whether DS is due to self-neglect or maltreatment of the elderly but the latter has been identified as the most probable cause resulting in this pitiful condition. ![]() At least 4 of them are almost permanent symptoms: patients do not ask for any help although they possesses nothing unusually fond of objects (hoarding of rubbish, or nothing in the house) unusual behavior with other people (misanthropy) and extreme self-neglect. Certain characteristics of the Diogenes syndrome have been recognized these include social withdrawal, filthy home, neglected self care, squalor syndrome, collection of useless objects or hoarding, shameless attitude, and stubborn refusal of help. Alcohol abuse has been identified as a cofactor. Secondary DS is related to mental illness like schizophrenia, depression, and dementia. DS has been classified as primary or pure which is not associated with mental illness and secondary or symptomatic. The disorder follows a distinct sociodemographic profile where it is found that persons are usually single, aged, having average or above average intelligence, and also having good income. This usually affects elderly persons and there is no sex predilection. The term Diogenes syndrome was coined in 1975 by “Clark et al.”. With regular washing and treatment with antibiotics and antipsychotics improvement was satisfactory.ĭiogenes syndrome is also known as dermatitis passivata. We also did Gram staining, bacterial and mycological culture from the discharge of the lesion, which did not reveal growth of any organism. His blood VDRL in titre were nonreactive. Routine blood investigation and X-ray chest was noncontributory. Inflammatory cells were mostly found at perivascular and periappendageal regions and consisted of plenty of neutrophils with few lymphocytes and macrophages (Figures (Figures3 3 and and4). Skin biopsy was taken from a lesion and under light microscopy it showed hyperkeratosis with mainly upper dermal infiltrate. We sent the patient to the psychiatry OPD and there he was diagnosed as a case of schizophrenia. He was a graduate and working as a computer programmer. Patient was alert and cooperative but was severely depressed and had been stubbornly refusing help from neighbours. There was no suggestive feature of scabies or pediculosis clinically. ![]() His scalp, groin, and face were almost spared. Few lesions were acneiform and there were multiple furuncles ( Figure 2). On examination multiple nodular lesions with crusting on an erythematous base were present mainly over the trunk and upper extremities ( Figure 1). ![]() His home was filthy and was crowded with furniture, old books, and scraps of papers in huge heaps. They also reported that the man had not taken a bath for longer than 2 years. According to the persons who coaxed him to come to the OPD, the patient lived alone with least interaction with his neighbours and had no relatives to visit him. ![]() A 34-year-old male patient was brought to our OPD by his neighbours with multiple discrete papulonodular lesions mainly over the trunk with heaped up crusting, for the last 6 months. ![]()
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