I read with interest the recent comment in the Archives titled “Dirt-Adherent Dermatosis: Not Worth an Additional Name” by Tan.1 The comment describes an interesting case of terra firma–forme dermatosis (TFFD) and, in the second figure, presents a nice stepwise approach to the diagnosis of clinically similar, dirtlike lesions. The author notes that TFFD should clear on 70% alcohol swabbing, in contrast to confluent and reticulated papillomatosis (CARP), which has classically been described as never responding to such swabbing. Indeed, other authors have similarly noted that “a response to rubbing with alcohol has never been reported in the literature [for CARP].”2(p104)
Patient with hyperpigmented, slightly scaly, centrally confluent papules and plaques on the back. A, Before treatment. B, Significant clearing of lesions in a linear area after gentle wiping with 70% alcohol swabs (C).
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