Diogenes Syndrome: A Case Report

Cessation of normal skin cleansing seen in geriatric or self-neglected patients can cause accumulation of keratinous crusts on the skin. In the extreme end of this spectrum is a condition known as Diogenes syndrome (DS). These patients may have psychiatric disorders like paranoid disorders, mood affection, or temporofrontal dementia. Subjects are mainly the elderly but few cases in younger age group of patients have also been reported. Lesions of DS are usually found over upper central chest, back, and groin. In the young, lesions are mainly found over scalp, face, or arms. Absence of normal skin cleaning causes keratin and dirty debris to accumulate and with time form a thick shell. These debris can be secondarily infected by bacteria, fungus, and so forth. These skin lesions are not usually seen in individual with proper hygiene. We report a case of Diogenes syndrome in a 34-year-old young male patient who had associated schizophrenia. 1. Introduction Diogenes syndrome (DS) is characterized by self-neglect and social withdrawal with abnormal collecting pattern, tendency to hoard excessively (syllogomania), and refusal of help, wich may be precipitated by stressful event [1]. DS is named after the Greek Philosopher “Diogenes of Sinope” (4th century BC) who taught about cynicism philosophy. He kept his need for clothing and food to a minimum by begging. He used to follow some ideas like “life according to nature,” “self-sufficiency,” “freedom from emotion,” “lack of shame,” “outspokenness,” and “contempt for social organization” [2]. Diogenes syndrome has been described in different psychiatric literature and very few cases associated with dermatological presentation have been reported. 2. Case Report 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. 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. They also reported that the man had not taken a bath for longer than 2 years. His home was filthy and was crowded with furniture, old books, and scraps of papers in huge heaps. On examination multiple nodular lesions with crusting on an erythematous base were present mainly over the trunk and upper extremities (Figure 1). Few lesions were acneiform and there were multiple furuncles (Figure 2). His scalp, groin, and face were almost spared. There was no suggestive feature of scabies or pediculosis clinically. Patient