J.J.Y. Leong , S.I. Tee
A 22-year-old Chinese female presented with brown dirtylooking spots on the sides of her face of 2 months duration. They were asymptomatic and could not be removed with vigorous scrubbing. During that time she was active in gardening thrice a week, during which time she had noted the rashes to be darker, more widespread on the face, and also occurring on the forearms. Since stopping her garden- ing 3 weeks ago, the spots had lessened in area covered and intensity.
On examination, there were brownish reticulate patches over both cheeks and sideburn areas. The limbs and trunk were clear. The patches were easily removed when rubbed ﬁ rmly with 70% isopropyl alcohol, revealing mildly erythematous skin beneath. The clinical ﬁ ndings were consistent with the diagnosis of terra ﬁ rma-forme dermatoses (TFFD). This unusual yet easily treated condition is thought to involve abnormal and delayed keratinisation of the epidermis 1 . The association in our case with gardening and sun exposure may suggest and environmental trigger for the dermatosis.
The diagnosis of TFFD is also its treatment, which involves removing the lesions by rubbing the area with 70% isopropyl or ethyl alcohol 2 . Prophylaxis with once weekly use of isopropyl alcohol may also be useful in cases of recurrence. Given the modest number of reports in the literature, it may go unrecognised by the primary physician and hence lead to delay in diagnosis or unnecessary investigations. Therefore, awareness of this easily treated dermatosis is essential.