Dermatosis autoinfligida: presentación de un caso y revisión / Self-inflicted dermatosis: presentation of a case and review

Las dermatosis autoinfligidas representan un motivo habitual de consulta, así como un desafío diagnóstico y terapéutico. Se caracterizan por la autoprovocación de lesiones cutáneas de manera consciente o inconsciente en el contexto de trastornos psiquiátricos complejos. Comunicamos el caso de una paciente que consultó al Servicio de Dermatología por úlceras irregulares y sobreinfectadas localizadas en rostro, de 2 meses de evolución. El caso representó una dificultad diagnóstica ya que solo a partir del interrogatorio exhaustivo y los exámenes complementarios, que descartaron otras patologías, se arribó al diagnóstico de úlceras autoprovocadas en contexto de patología psiquiátrica que requirió manejo interdisciplinario. (AU)

Self-inflicted dermatoses are a frequent cause for consultation and represent a diagnostic and therapeutic challenge. They are characterized by the conscious or unconscious self-generation of cutaneous lesions in the context of complex psychiatric disorders. We report the case of a patient who consulted at the dermatology department with two months history of irregular and superinfected ulcers located on the face. This case represented a diagnostic difficulty since only from an exhaustive interrogation and complementary examinations, which ruled out other pathologies, we arrived at the diagnosis of self-inflicted ulcers in the context of psychiatric pathology that required interdisciplinary management. (AU)

Dermatitis Artefacta Mimicking Borderline Personality Disorder: Sometimes, Skin Could Be Misleading

Dermatitis artefacta lies in a gray zone, between the specialities of psychiatry and dermatology. The condition could mimic a number of other lesions and therefore is a source of much confusion in clinical practice. Here, we describe a case of dermatitis artefacta in an 11-years old girl, which resembled self-harming behavior in Borderline personality disorder. We then discuss how the two could be differentiated and why this becomes imperative while dealing with such cases.

Dermatite factícia: relato de um caso exuberante / Factitial dermatitis: report of an exuberant case

Dermatite factícia é uma condição na qual o paciente provoca lesões na própria pele, negando qualquer envolvimento no surgimento das mesmas. O aspecto da lesão é variável, com morfologia relacionada com o objeto utilizado. Representam com frequência um desafio diagnóstico devido à dificuldade de obtenção de informações verídicas na anamnese. Relata-se caso clínico com apresentação exuberante em paciente feminina de 45 anos, enfatizando a importância da abordagem multiprofissional nas dermatoses psicogênicas.

Psychodermatology: A comprehensive review.

Psychodermatology is an interesting domain of dermatology that overlaps with psychiatry. This arena in dermatology has received limited diligence, partly due to lack of training in this realm. We present here a comprehensive review of salient features and treatment updates in primary psychiatric dermatoses and have also discussed the role of psyche in psychophysiological cutaneous disorders. Secondary psychiatric morbidity is relatively common among patients visiting the dermatologists but often overlooked and uncared for. Dermatologist should be able to initiate basic pharmacotherapy, should be knowledgeable about various non-pharmacological treatments and know the right time to refer the patient to the psychiatrist. Awareness and pertinent treatment of psychodermatological disorders among dermatologists will lead to a more holistic treatment approach and better prognosis in this unique group of patients.

Munchausen's Syndrome Presenting as Dermatitis Artefacta / 대한피부과학회지

Dermatitis artefacta is defined as self-inflicted skin lesions that the patient denies having caused. Munchausen's syndrome (MS) is characterized by pathological lying, the intentional production of physical symptoms, and a restless wandering from hospital to hospital to obtain hospitalization or extensive interventions. MS, presenting as dermatitis artefacta, should be cautiously differentiated from classic dermatitis artefacta by psychoanalytic approaches. In pediatric groups, MS is extremely rare. Thus, a pediatric case of MS should be differentiated from child abuse by caregivers. Herein, we describe an unusual case of MS in a 10-year-old boy, who presented with multifocal facial ulcerations. In addition, a case of MS in a 40 year-old man will be described.

Dermatitis artefacta: Keloids and foreign body granuloma due to overvalued ideation of acupuncture.

Skin is well recognized as an important somatic mirror of one's emotion and a site for the discharge of one's anxieties. We present a case of a 42-year-old female patient presenting with a vague history of generalized body pain and skin lesions in the form of cotton threads buried under the skin, crusted plaque, multiple keloids and rusted pin buried through the skin mostly in the easily accessible areas of the body. Histopathology from the crusted plaque revealed foreign body granuloma. To satisfy her psychological or emotional need, it is the deliberate and conscious production of self-inflicted skin lesions through overvalued ideation of acupuncture on her part.

A Clinical Study of Self-Inflicted Dermatosis / 대한피부과학회지

BACKGROUND: Self-inflicted dermatosis is a kind of self-inflicted skin disease. Most Vietnam veterans from Korea have visited the Veterans Hospitals for dermatological examination to determine the relationship between their skin diseases and Agent Orange. We were suspicious of the possibility that several Vietnam veterans intentionally produced their own skin lesions. OBJECTIVE: We conducted this study to determine the clinical characteristics of self-inflicted dermatoses of Korean Vietnam veterans. METHODS: From January, 1999 to December, 2007, a total 24 Vietnam veterans who were diagnosed as having self-inflicted dermatoses during their dermatological examinations at our hospital were included in this study. We investigated their clinical presentation, the laboratory examinations, the pathologic examinations, the medical records and the associated diseases. RESULTS: Itching was the most common subjective complaint and the duration of the itching was as follows; 20 to 30 yrs (50.0%), 1 to 10 yrs (25.0%), 10 to 20 yrs (20.8%) etc. The skin lesions were all multiple, and the involved area was as follows; upper extremities (83.3%), trunk (75.0%), lower extremities (70.8%) etc. There were two categories of clinical skin presentation. The first was the cases with lesion that were thought to be made by physical trauma such as stinging or excoriation, and the second more common cases had lesions that were thought to be made by chemical agents (70.8%). These cases resembled allergic or toxic irritant dermatitis and the lesions were composed of vesicles, erosions, ulcers and crusts that were within an arm's reach. Only 4 cases admitted to intentionally inflicting their skin lesions because of intense itching, and the others denied that they made the skin lesions by themselves. Skin biopsies were carried out in 19 of the total 24 cases, and the most common finding was spongiotic dermatitis (57.8%). CONCLUSION: This study showed the distribution and characteristics of self-inflicted dermatoses, and the study provides fundamental data for dermatologists to assess patients with self-inflicted dermatoses.

Clinical Observation of 13 Cases of Dermatitis Artefacta / 대한피부과학회지

BACKGROUND: Dermatitis artefacta is a self-inflicted skin disease. Laboratory investigations, including histopathologic examination, are usually negative and do not give a clue to the correct diagnosis. OBJECTIVE: Over an eleven-year period from 1995 to 2005, 13 patients were diagnosed with dermatitis artefacta at the Asan Medical Center. We evaluated the patients' age and sex, the clinical characteristics of skin lesions, the presence of underlying psychological disease, and the clinical course. METHODS: We obtained the clinical information from record reviews of 13 patients diagnosed at the Asan Medical Center between 1995 and 2005. RESULTS: The male-female ratio was 1 to 1.6. The mean age at diagnosis was 44.7 years. There were 10 cases (76.9%) that had a history of psychological disease such as schizophrenia, depression, or avoidant personality disorder. The skin lesions were multiple in 76.9% of the patients. The clinical appearance included papules, excoriations, and ulcers. The face and extremities were the favored sites. The average number of outpatient visits was 4.3 times among the 6 outpatients. CONCLUSION: Greater awareness of dermatitis artefacta may bring about earlier correct diagnosis and treatment. The management of dermatitis artefacta needs close cooperation with a mental health professional.

A Case of Dermatitis Artefacta with Widespread Skin Necrosis / 대한피부과학회지

Dermatitis artefacta is an artefactual skin disease caused entirely by the self-destructive behavior. We report, herein, an interesting case of dermatitis artefacta showing recurrent widespread skin necrosis and yellowish color changes of both fingernails in a 28-year-old, unmarried woman. Initially, we examined for an underlying collagen vascular disease, infections, pyoderma gangrenosum, as well as dermatitis artefacta and eventually diagnosed as dermatitis artefacta. We suggest that dermatitis artefacta should be considered in case of recurrent widespread skin necrosis.

A Case of Dermatitis Artefacta Treated with Pimozide / 대한피부과학회지

We report a case of 64-year-old female patient who has had factitious skin lesions for 20 years. She complained formification sense and severe itching on her face. These symptoms were improved with squeezing and bleeding. There were scuare shaped ulcerated nodule on the right cheek and white depressed scar on the left cheek. She was treated with wet dressing and occlussive dressing, and skin lesions were nearly cleared within 3 weeks, but new lesion appeared. Pimozide 2mg #1 p.o were given under the diagnosis of delusion of parasitosis from June, 1984. Her symptoms were improved without recurrence till now. Treatment with pimozide in monosymptomatic hypochondriacal syndrome is discussed.