characteristic feature of the disease. 1–4 No serious medical treat- ment is required but it entirely causes cosmetic concerns. 2,4 Our patient has had brown, dirty like papules for over 1 year and the lesions disappeared after rubbing with 70% of alcohol before the biopsy. On our patient there was also no familial character- istic. Diagnosis is usually established clinically or after rubbing with alcohol during biopsy. 6 Histopathologically, it is diagnosed with emergence of atrophy in epidermis, hyperkeratosis, mild acanthosis and orthokeratosis in basal layer. Parakeratosis is not observed. With periodic acid schiff coloration, pity- rosporum can be observed in stratum corneum. 7 Acanthosis nigricans, confluent and reticular papillomatosis, pityriasis ver- sicolor, dermatosis neglecta, seborrheic keratosis should be taken into consideration during differential diagnosis. When rubbed with isopropyl alcohol lesions disappear entirely, and generally do not recur. Treatment of the disease is effective, inexpensive and painless. 7,8 We have decided to present this case due to the fact that it is a rare disease and it is easy to diagnose and treat. So, it should be avoided to do unnecessary tests and treatments. In patients who have pigmentation disorder, TFFD should be taken into consideration for differential diagnosis. Dr Yeliz Uçar Tavlı 1 Professor I ˙ nci Mevlitog ˘ lu 1 Associate Professor Hatice Toy 2 Dr Mehmet Unal 1 1 Department of Dermatology and Venerology 2 Department of Pathology Konya University Meram Medical Faculty Konya Turkey References 1 Duncan WC, Tschen JA, Knox JM. Terra firma forme dermatosis. Arch. Dermatol. 1987; 123: 567–9. 2 Guarneri C, Guarneri F, Canavo S. Terra firma-forme dermatosis. I ˙ nt. J. Dermatol. 2008; 47: 482–4. 3 Berk DR, Bruckner AL. Terra firma-forme dermatosis in a 4-month-old girl. Pediatr. Dermatol. 2011; 28: 79–81. 4 Akkash L, Badran D, Omari A. Terra firma forme dermatosis. Case series and review of the literature. J. Dtsch Dermatol. Ges. 2009; 7: 102–7. 5 Berk DR. Terra firma-forme dermatosis: a retrospective rewiev of 31 patients. Pediatr. Dermatol. 2012; 29: 297–300. 6 Browning J, Rosen T. Terra firma forme dermatosis revisited. Dermatol. Online J. 2005; 11: 15. 7 Öztürk F, Kocabas ¸ E, Ertan P, Ermertcan A. Terra firma forme dermatosis. Cutan. Ocul. Toxicol. 2010; 29: 303–5. 8 Pavlovic MD, Dragos V, Potocnik M, Adamic M. Terra firma forme dermatosis in a child. Acta Dermatovenerol. Alp. Panonica Adriat. 2008; 17: 4. 15 April 2012 Dear Editor, VENLAFAXINE INGESTION IN A 4-YEAR-OLD GIRL We report an acute dystonic reaction due to venlafaxine inges- tion in a 4-year-old girl. Case: A developmentally normal, previously well 4-year-old child was brought to the emergency department because of her acute development of akinetic mutism and urinary inconti- nence. She had been well the day before. On the day of pre- sentation she woke late and refused to walk. During the course of the day she sat in front of the television and ate little. She was described as flushed and ‘febrile’, although a raised temperature was not documented. Slight drooling was also noted. Her grand- mother brought her to hospital because it was increasingly apparent that she was mute and stiff, and because of the devel- opment of urinary incontinence. On examination she was mute, akinetic and hypomimic. There was a mild tachycardia (80–110 beats per minute). Her blood pressure was 80/60 mmHg and her vital signs otherwise normal. She made good eye contact, fixed and followed nor- mally. Her pupils were 4 mm, symmetric and reactive, and her extraocular movements were normal. Despite the absence of facial expression, her lips and teeth closed tightly and her gag reflex was normal. Secretions were pooled in her mouth and she had significant limb rigidity. Her neck was mildly extended and ankles held in equinus. Passive neck flexion was not painful. Minimal spontaneous movement was observed sym- metrically in the hands and feet. The deep tendon reflexes were symmetric and difficult to elicit due to rigidity. There was no clonus. The plantars were upgoing (striatal toes). Sensation was intact. The abdominal reflexes were present. She was unable to walk due to her rigid ankle equinus and marked truncal flexion when held erect. These findings, which were most consistent with an extrapy- ramidal syndrome, prompted specific interrogation as to drug exposure. The grandmother admitted that her husband’s Conflict of interest: None declared. Fig. 3 Hyperkeratosis in epidermis, increased pigmentation in basal layer, oedema and mononuclear cell infiltration in papillary dermis. Letters to the Editor Journal of Paediatrics and Child Health 48 (2012) 1045–1049 © 2012 The Authors Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians) 1047