Dermatitis artefacta

Dermatitis artefacta [DA] is an intentional self-inflicted dermatitis produced by patients for unconscious psychological gain. Characteristically, patients deny the responsibility for their creation. It is a poorly understood condition and, in most cases, goes on for a long period of time before a diagnosis is made. This condition creates a lot of anxiety for physicians due to a lack of awareness of the disorder and involves a considerable amount of time and resources to deal with. Suspicion usually arises when there is an unconvincing history of the evolution and recurrence of these lesions, their locations on the body, and their bizarre shapes. Here we report a typical case of DA in a 33-year-old male who repeatedly presented with oddly shaped recurrent skin lesions in the left lower leg for nine years. He had numerous doctors' visits and tests, and was admitted to a number of different hospitals without reaching a diagnosis or a cure

Oral propranolol for the treatment of periorbital infantile hemangioma: a preliminary report from Oman

To investigate the efficacy and safety of oral propranolol in the management of periorbital infantile hemangioma in four subjects. Consecutive patients who presented with periorbital capillary hemangioma with vision-threatening lesions were prospectively enrolled in this study between January 2009 and October 2010. All subjects underwent treatment with 2 mg/kg/day oral propranolol. All subjects underwent ocular, systemic, and radiologic evaluations before treatment and at periodic intervals after starting therapy. Side effects from therapy were also evaluated. Four subjects, between 3 months and 19 months of age, with periorbital hemangioma were enrolled in this study. Two subjects had been previously treated with oral corticosteroids with unsatisfactory response. All subjects had severe ptosis, with the potential for deprivation amblyopia. Three subjects had orbital involvement. After hospital admission, oral propranolol was initiated in all subjects under monitoring by a pediatric cardiologist. Subsequent therapy was performed with periodic out-patient monitoring. All subjects had excellent response to treatment, with regression of periorbital and orbital hemangioma. There were no side effects from therapy. Oral propranolol for periorbital hemangioma was effective in all the four subjects. Oral propranolol may be appropriate for patients who are nonresponsive to intralesional or systemic steroids. In patients with significant orbital involvement and lesions causing vision-threatening complications, oral propranolol can be the primary therapy