Trigeminal trophic syndrome: an important simulator of discoid cutaneous lupus erythematosus - a case series.

Trigeminal trophic syndrome occurs secondary to trigeminal nerve injury, leading to anaesthesia and paraesthesia, with consequent vigorous facial skin manipulation and lesion production, simulating other facial diseases such as ulcerative discoid lupus erythematosus, tumours and other artificially produced lesions. Ulceration and destruction of the ala nasi is a typical feature besides scratching end excoriations in the cutaneous segment affected. In this series, we present the features of five patients with trigeminal trophic syndrome, highlighting possible confusion with cutaneous lupus. Differential diagnoses, including discoid lupus erythematosus, are discussed, as well as possible treatment modalities.

Dermatitis artefacta mimicking cutaneous vasculitis: case report and literature overview.

A 31-year-old Caucasian woman with a history of anxiety disorder presented with chronic ulcerative lesions of the skin in arms and legs, treated initially as cutaneous vasculitis, evolving with relapsing during corticosteroid tapering, was diagnosed, after thorough investigation and no organic disease found, with dermatitis artefacta - a self-inflicted harm due to psychological disorders. Dermatitis artefacta is a rare condition, more frequent in women, in which traumatic skin lesions are caused by the patient him/herself, over accessible parts of the body, due to personality disorders. Clinicians should be aware of this alternative aetiology, especially as a differential diagnosis for refractory cutaneous vasculitis.

Ointment Pseudo-Cheilitis: A Disease Distinct From Factitial Cheilitis. A Series of 13 Patients From São Paulo, Brazil.

BACKGROUND: The terms exfoliative cheilitis, factitial cheilitis, and morsicatio labiorum are used to describe self-inflicted lesions of the lip. OBJECTIVE: Here we report and analyze clinical, pathological, and therapeutic data on 13 patients with a form of factitial cheilitis that we believe should be considered a separate entity. RESULTS: Eight patients were male and 5 patients were female. All patients reported pain and presented with crusts consisting of dried saliva and topical medications adherent to the surface of the lips. These patients expressed great concern with their condition, and reported several previous, ineffective treatments. Simple reassurance only was not effective; saline compresses alleviated symptoms for a few patients. Most patients were lost to follow-up. Biopsies were not performed on all patients. CONCLUSION: This particular type of cheilitis artefacta has been previously described, but some features described herein are new and allow a specific approach: patient's behavior, the "protrusion sign," and possible improvement with antidepressants. For these cases, we propose the term ointment pseudo-cheilitis because it comprises the nature of the attached material and the lack of true inflammation. Further psychiatric characterization is a logical next step in further characterizing this difficult-to-treat condition.

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)

Obsessive-compulsive behaviour related cutaneous ulcers: two cases with therapeutic considerations.

Obsessive-compulsive-related cutaneous disease most often includes trichotillomania, neurotic excoriations and nail biting. In this report, we present two cases of self-inflicted severe wounds that were diagnosed as secondary to obsessive-compulsive behaviour. Patients were middle-aged females who presented with deep cutaneous ulcers that were acknowledgedly maintained through repetitive manipulation. Obsessive-compulsive-related cutaneous disease is better treated with serotonin reuptake inhibitor antidepressants in higher dosages than those used to treat depression. Both patients were treated with fluoxetine 60-80 mg that resulted in adequate healing of the ulcers; relapses were observed during attempts to taper fluoxetine dosage. An adequate psychic diagnosis is required if an effective therapeutic response to self-inflicted cutaneous lesions is desired, because clinically identical lesions can also be caused as a result of distinct mental mechanisms: anxiety, depression, psychosis, obsessive-compulsive disorder and classic dermatitis artefacta.

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.