No abstract

Atrophia maculosa varioliformis cutis was described in 1918 by Heidingsfeld as a type of idiopathic noninflammatory macular atrophy typically occurring in young individuals. Only 13 cases have been reported since the first description. Considering that atrophia maculosa varioliformis cutis can be mistaken for a scarring and artifact dermatitis, it is important for physicians to distinguish this condition. We report a new case in a 5-year-old boy.

Relational dynamics that are an essential factor in the development of a person and in the structuring of his/her physical, psychological and social reality can be conditioned in various ways by the health or disease of the skin. Thus, the condition of the skin can cause serious mental and social problems. It has been shown that emotional dysphoric life experiences, above all the different types of anxiety, are significant cofactors in psychosomatic dermatopathies, apart from being a secondary (somatopsychic) consequence in every type of skin disease. Nevertheless, this psychological discomfort does not always result in structured psychopathological disorders, even though the percentage of these disorders in dermatological patients is noticeably higher when compared with that of the general population or that of patients suffering from other types of organic diseases. We analyzed a group of 490 subjects aged between 1 and 17 years who showed various types of skin diseases (predominantly alopecia areata, atopic dermatitis, psoriasis, urticaria, genodermatosis, irritant dermatitis and localized infectious diseases) at different levels of severity. Among these patients 64% were free from any kind of structured psychopathological disorder while 36% suffered from some form of structured disorder. Psychopathological disorders occurring more frequently were generalized anxiety disorder, dysthymic disorder, separation anxiety disorder, attention deficit / hyperactivity disorder, and mental retardation.

The high visibility of dermatologic diseases and their easy accessibility make the skin a primary and direct target for dysfunctional behaviors. Self-harm tendencies can frequently be expressed through dermatologic lesions, and dermatitis artefacta falls within this clinical frame. The occurrence of this cutaneous manifestation in children is very rare, with a peak of greater frequency in adolescence. We describe the characteristics of a multidisciplinary intervention-dermatologic and psychologic. Our pediatric patient displays a dermatologic picture that has no etiologic confirmation. The source of this disorder must therefore be found in socio-relational difficulties within the family and school environments, which lead the patient to self-harm behaviors that have a high communication value.