Dermatitis Artefacta Mimicking Borderline Personality Disorder: Sometimes, Skin Could Be Misleading

Abstract

Dermatitis artefacta lies in a gray zone, between the specialities of psychiatry and dermatology. The condition could mimic a number of other lesions and therefore is a source of much confusion in clinical practice. Here, we describe a case of dermatitis artefacta in an 11-years old girl, which resembled self-harming behavior in Borderline personality disorder. We then discuss how the two could be differentiated and why this becomes imperative while dealing with such cases.

Therapeutic implications of personality disorders in dermatology

“…14 Such scars may be labeled as dermatitis artefacta lesions which come about in "mysterious ways while the patient denies all responsibilities for them". 15 BPD patients first consult dermatology because of these artefactual skin defects. 16 Being able to utilize behavioral therapy is just as important as providing pharmacological therapy for said scars.…”

“…given that the incidence of BDD amongst general dermatology patients was found to be 9% to 12% and can be even high as 37% in the cosmetic dermatology setting, whereas the incidence is only 0.7% to 2.4% in the general population. 15 Patients with BDD may "insist on receiving dermatologist treatments such as isotretinoin, dermabrasion, and laser abrasion" even if such treatments are not needed making the patient-physician more difficult. 20 In a study that utilized the BDD questionnaire-dermatology version and objective assessment of acne severity, it was found that amongst patients with mild acne "patients who had used systemic isotretinoin in the past or were currently using this drug were approximately twice as likely to meet criteria for BDD".…”

“…In study done with 93 patients who identified as performing self‐mutilation through a questionnaire, 34 patients or 37% were diagnosed with BPD through therapy 14 . Such scars may be labeled as dermatitis artefacta lesions which come about in “mysterious ways while the patient denies all responsibilities for them” 15 . BPD patients first consult dermatology because of these artefactual skin defects 16 .…”

“…Understanding of this disorder is important for dermatologists given that the incidence of BDD amongst general dermatology patients was found to be 9% to 12% and can be even high as 37% in the cosmetic dermatology setting, whereas the incidence is only 0.7% to 2.4% in the general population 15 . Patients with BDD may “insist on receiving dermatologist treatments such as isotretinoin, dermabrasion, and laser abrasion” even if such treatments are not needed making the patient‐physician more difficult 20 .…”

Dermatitis artefacta: A diagnostic dilemma

“…The typical presentation includes cutaneous lesions, which are bizarre and mimic many of the known inflammatory reactions in the skin. [ 6 , 7 ] The classic location of DA includes the following: face, most common, lower extremity, hands and forearm, trunk, upper arm and shoulder, scalp, and neck. The types of lesions seen in DA are as follows: abrasions or erosions, alopecia, and crusted lesions.…”