Dermatitis Artefacta: A Review of 14 Cases

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.

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

“…[6,8] Precipitating factors range from simple anxiety to severe personality disorders, including attention-seeking traits, obsessions, compulsions, depression and psychotic disturbances. In our patient, all the characteristic findings were noted right from female gender [2,3] to typical history [2,7,13] to skin lesions and associated psychological factors, [1,4] which has been mentioned in various studies and reports for the diagnosis of dermatitis artefacta. The cause for self-infliction of skin lesions in our case is either psychosocial factors like family dysfunction and inadequate family support that lead to marked depression or overvalued ideations of acupuncture to get rid of pain.…”

“…Female predominance is observed in many studies and reports of dermatitis artefacta. [4,9,10] For the diagnosis of dermatitis artefacta, there are some diagnostic clues, [11,12] like denial, amnesia or indifference to the symptoms or how these lesions have occurred. The history may be vague cited by Lyell as hallow.…”

“…[2,3] Various psychosocial conflicts and unconscious motivating factors have been held responsible for this self-destructive activity. [4] The patient typically denies their self-inflicted nature. [2] The various methods of producing the skin lesions are highly imaginative and depend on the patient's background and education.…”

Dermatite factícia desencadeada pela síndrome de Münchausen

“…5,6 É imprescindível a abordagem do ponto de vista psiquiátrico, que é a principal responsável pela cura completa dos pacientes, evitandose, assim, frequentes recidivas. 6,7 FIGURA 1: Lesões bolhosas e exulceradas em região periumbilical FIGURA 2: Epiderme paraceratótica com exsudação neutrofílica intracórnea. Na derme, infiltrado inflamatório misto, monomorfonuclear e polimorfonuclear, principalmente perivascular (HE 100x)…”

Dermatitis artefacta unter dem Bild einer Lichtdermatose

“…Andererseits befindet sich der Arzt in dem Dilemma, den Patienten mit der von ihm verleugneten echten Diagnose zu konfrontieren, um ihn so einer adäquaten psychiatrischen Behandlung zeitnah zuführen zu können. Die meisten Patienten mit Artefakten weisen eine entsprechend lange Anamnese und häufige Arztwechsel auf [6].…”