ABSTRACT
BACKGROUND: The distribution of atopic dermatitis (AD) lesions and its impact on quality of life (QOL) is not well established in the US adult population. OBJECTIVE: To elucidate the distribution of AD lesions and its impact on QOL in US adults with AD. METHODS: A cross-sectional, population-based study of 602 adults was performed. AD was determined using modified UK Diagnostic Criteria, and its lesional distribution was assessed. QOL was assessed using Dermatology Life Quality Index (DLQI). Latent class analysis (LCA) was used to determine distinct phenotypes of AD lesional distribution. Multivariable logistic regression was used to determine the relationship between DLQI and distinct phenotypes. RESULTS: The most common sites of skin lesions were reported to be the popliteal fossae, lower legs, dorsal feet and antecubital fossae. Most persons reported partial (19.0%) or complete (63.0%) symmetry of lesions on the extremities. Lesions on the trunk were significantly more common in blacks and Hispanics. Age ≥ 60 years was associated with significantly lower proportions of active lesions on the face and scalp, and significantly higher proportion of lesions on the buttocks or genitals. LCA identified 5 classes of lesional distribution: 1. lower probabilities of lesions affecting any sites; 2. Higher probability of lesions involving the anterior and posterior neck and trunk; 3. lesions involving the antecubital fossae and upper extremities; 4. lesions involving the arms, posterior hands, genitals and buttocks, and to a lesser extent face, palms and legs; 5. lesions affecting all sites. Class-2 (multivariable logistic regression; adjusted odds ratio [95% confidence interval]: 7.19 [3.21-16.07], class-3 (7.11 [3.20-15.80]), class-4 (6.90 [3.07-15.50]) and class-5 (7.92 [3.54-17.71]) were all significantly associated with higher DLQI scores compared to class 1. CONCLUSION: AD is associated with heterogeneous distribution of AD lesions, and distinct phenotypes that are associated with QOL impact.
Subject(s)
Dermatitis, Atopic/epidemiology , Dermatitis, Atopic/psychology , Quality of Life , Adolescent , Adult , Black or African American , Age Factors , Aged , Aged, 80 and over , Arm , Buttocks , Cross-Sectional Studies , Dermatitis, Atopic/ethnology , Facial Dermatoses/epidemiology , Facial Dermatoses/psychology , Female , Foot Dermatoses/epidemiology , Foot Dermatoses/psychology , Genitalia , Hand Dermatoses/epidemiology , Hand Dermatoses/psychology , Hispanic or Latino , Humans , Latent Class Analysis , Leg Dermatoses/epidemiology , Leg Dermatoses/psychology , Male , Middle Aged , Prevalence , Scalp Dermatoses/epidemiology , Scalp Dermatoses/psychology , Surveys and Questionnaires , Torso , United States/epidemiology , White People , Young AdultABSTRACT
Dermatitis artefacta is one of a spectrum of factitious diseases etiologically responsible for skin lesions denied by patients. These factors often make it difficult to identify the causative agents of the condition. Herein, we report a case of bullous dermatitis artefacta in a 12-year-old girl, for which a deodorant spray was suspected as the probable cause. Pathological examination revealed subepidermal blistering with full-thickness necrosis of the epidermis, suggesting a thermo- or cryo-induced injury. Psychological testing demonstrated her immaturity and dependence. In searching for the causative agent, we suspected a deodorant spray as a blister-inducing agent. We succeeded in reproducing a similar blister lesion on the volunteer's healthy skin using the same spray. Psychiatric involvement significantly complicates the treatment of factitious diseases, including dermatitis artefacta. Cooperation among dermatologists, psychiatrists and the patient's family members is required for ensuring a favorable prognosis.
Subject(s)
Deodorants/adverse effects , Dermatitis/diagnosis , Leg Dermatoses/diagnosis , Self-Injurious Behavior/diagnosis , Child , Dermatitis/etiology , Dermatitis/pathology , Dermatitis/psychology , Diagnosis, Differential , Female , Humans , Leg Dermatoses/chemically induced , Leg Dermatoses/pathology , Leg Dermatoses/psychology , Self-Injurious Behavior/chemically induced , Self-Injurious Behavior/pathology , Self-Injurious Behavior/psychologyABSTRACT
Self-induced factitial dermatitis, or dermatitis artefacta, is a rare and difficult condition to treat. We present an unusual case of factitious dermatitis with its subsequent severe complications. The clinical features, radiographic findings, histopathologic features, and treatment options are reviewed.
