Dermatitis Artefacta: A Review

Abstract

Background: Dermatitis artefacta (DA) is a self-inflicted dermatologic injury sometimes produced for secondary gains. Laboratory investigations, including histologic examination of lesional tissue biopsy, are usually negative and do not give a clue to the correct diagnosis. Patients and Methods: Over a five-year period, 14 patients were diagnosed with DA at King Fahad Hospital (KFH) in Al Baha during routine outpatient and inpatient dermatologic consultations. The diagnoses were based on vagueness of history given by the patients, and the presence of bizarre skin lesions distributed over sites accessible to the patients' hands. Investigations excluded the possibility of other diseases. In some cases, consultant psychiatric assessment was sought in order to identify possible underlying psychopathologic factors. Seven patients were hospitalized while the rest were managed as outpatients. Results: The 14 patients comprised 12 females and two males aged 12 to 71 (mean 25.9) years. All except one were Saudis. DA in the males was probably caused for secondary gains. The females, four of whom were married and eight single, were aged 12-36 (mean 21.8) years. Nine of the females (64%) had identifiable severe emotional or psychiatric problems. The remaining two were unmarried and had no identifiable underlying factors. Conclusion: This study reveals that the presentation of DA in Saudi Arabia is essentially similar to what has been reported from other parts of the world. It brings into focus a medical problem which needs to be recognized, as greater awareness may bring about earlier correct diagnosis and treatment.

Histopathological patterns in dermatitis artefacta

“…The frequency of artifacts in the general population is estimated at 0.05–0.4 % . Given that patients are not aware of the cause of the skin lesions or consciously keep it to themselves, it is safe to assume a relevant number of undetected cases.…”

Bizarre appearance of chronic cutaneous lupus erythematosus of face mimicking factitial dermatitis

“…[1][2][3] Chronic cutaneous LE commonly involves the face (forehead, eyebrows, nose, lips, ears and external ear canal). [1][2][3][4][5][6][7][8][9] Eyelid involvement can be solitary and present either with swelling due to periorbital oedema and erythema or with discoid lesions. 1 Histopathological examination of skin biopsies is considered to be the gold standard in diagnosing cutaneous lupus.…”

“…It is quite uncommon to see classical dermatosis in such a symmetric and geometric pattern without further progression. 9 Some lupus variants like hypertrophic, verrucous, and lupus profundus variant can be exogenously induced along with some cases of DLE (isomorphic response, Koebner phenomenon). [1][2][3][4][5] Linear lupus following Blaschko lines should be considered in a paediatric population.…”

Clinical characteristics and comorbidities of the most common atypical wounds in Northern Finland in 1996–2019: A retrospective registry study

“…Contrary to other atypical wounds, a factitious ulcer is a self‐inflicted skin lesion 15 diagnosed by exclusion. It is primarily associated with psychiatric disorders, most commonly personality disorders 16,17 .…”