Histopathological patterns in dermatitis artefacta

Abstract

In general, there are only few studies investigating the histological features of factitious skin disorders. Another problem arises from the fact that, even if clinical and histological findings are suggestive of dermatitis artefacta, subsequent confirmation of the exact mechanism of injury is frequently not possible, thus leaving room for speculation. This complicates defining specific histological patterns based on the various types of injuries. Overall, the results of the present study suggest that a factitious disorder should be considered if histological findings include blistering with a mild inflammatory infiltrate, rupture of collagen fibers, multinucleated keratinocytes, or elongated and vertically aligned keratinocytic nuclei.

Relapsing–remitting linear ecchymosis

“…We are increasingly seeing patients during the COVID‐19 pandemic with unusual dermatoses that, following extensive exclusion of a number of organic causes, may point to a diagnosis of medically unexplained skin symptoms (dermatitis artefacta). Indeed, the scattered dermal eosinophils seen in one of our patients have been reported in burn‐like injuries associated with dermatitis artefacta 4 . A similar presentation, Gardner–Diamond syndrome, has been proposed in young women 5 .…”

“…Indeed, the scattered dermal eosinophils seen in one of our patients have been reported in burn-like injuries associated with dermatitis artefacta. 4 A similar presentation, Gardner-Diamond syndrome, has been proposed in young women. 5 Also known as psychogenic purpura, this rare condition is characterized by painful bruising on the extremities during times of stress.…”

A 37‐year‐old woman with dermatitis artefacta: A case report

“…The mechanism of injury may be varied. 4 It could be mechanical (rubbing/scratching/blows), consistent with our case; thermal, chemical induced (acids, foreign body, drugs), infectious (injection of bacteria or other pathogens) or electrical.…”

Perturbação Factícia Bolhosa Simulando Penfigoide Bolhoso: Relato de Caso e Revisão da Literatura

“…6 As alterações mais comuns quando se trata de bolhas, ainda que não patognomônicas são: necrose epidérmica bem demarcada; clivagem intraepidérmica subcórnea, dermoepidérmica ou subepidérmica; queratinócitos com núcleos alongados e alinhados verticalmente; queratinócitos multinucleados e homogeneização do colágeno na derme superficial. 1,6,[8][9][10]12,14 O infiltrado é discreto e composto por neutrófilos, linfócitos e eosinófilos e sem acantólise. 1,8,9 Hemograma, VHS e PCR não apresentam alterações.…”

“…5 A lesão cutânea pode ser criada de forma consciente ou, muitas vezes, sem plena consciência, podendo ocorrer durante um estado dissociativo. 3,4,6 Neste estado, o paciente pode se desligar de si mesmo e do ambiente, ser incapaz de lembrar de informações pessoais importantes e ter sua identidade e memórias fragmentadas. 3,4,6 A PF pode ser precipitada a partir de um gatilho externo, como o estresse emocional, porém o principal fator patogênico parece encontrar-se no inconsciente e ter mecanismos psicológicos complexos.…”