Primary psychiatric conditions: Dermatitis artefacta, trichotillomania and neurotic excoriations

Wong, Jillian W.; Nguyen, Tien V.; Koo, John

doi:10.4103/0019-5154.105287

Cited by 44 publications

(68 citation statements)

References 35 publications

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“…It often requires a multi-disciplinary approach involving dermatologic and psychiatric expertise for effective management. The underlying psychiatric disorders are most commonly borderline personality disorder, depression, anxiety or rarely psychosis (3). To the best of authors' knowledge, Dhat syndrome following recovery from dermatitis artefacta is not reported in literature so far.…”

Section: Discussionmentioning

confidence: 91%

Debilitating Itching: An Unusual Presentation of Dhat Syndrome Following Recovery from Dermatitis Artefacta

Penchilaiya

Menon

2016

Iran J Psychiatry Behav Sci

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Introduction: Dhat syndrome is a culture bound sex neurosis more common in the orient. The condition is primarily characterized by overriding concerns about loss of semen resulting in a variety of physical and psychological problems. Though a variety of modes of discharge of Dhat is described, its discharge through skin lesions, following recovery from dermatologic conditions is not reported so far. Case Presentation: A young, single adult male, hailing from a rural area (Tamil Nadu, a state in South India) was treated adequately for dermatitis artefacta and showed good recovery. He referred to the psychiatry outpatient department with complaints of lassitude and inability to work or concentrate all of which he attributed to the passage of a fluid comprising of semen and pus through the healed skin lesions. His friends reinforced his belief about the nature and origin of his symptoms. There was significant distress and dysfunction in the absence of underlying depression and anxiety. He was effectively managed with a combination of psychoeducation and low dose anxiolytics. Conclusions: Dhat syndrome may present variably with regard to its mode of passage and constituents. Clinicians need to watch for development of Dhat syndrome following recovery from dermatologic conditions. Offering explanations synchronous with patient beliefs about symptoms may result in faster response and greater treatment satisfaction.

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Section: Discussionmentioning

confidence: 91%

Debilitating Itching: An Unusual Presentation of Dhat Syndrome Following Recovery from Dermatitis Artefacta

Penchilaiya

Menon

2016

Iran J Psychiatry Behav Sci

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“…En nuestro caso la infección por herpes y estafilococos, así como una posible enfermedad ampollosa fue considerada. Desde el punto de vista psiquiátrico se debe considerar el delirio de parasitosis, el trastorno obsesivo compulsivo, un síndrome de Munchausen (SM), SM por poderes, trastorno somatomorfo y simulación (3,7). El tratamiento se debe realizar en base a un equipo multidisciplinar estableciendo una buena alianza terapéutica, realizando un enfoque biopsicosocial, sin confrontar inicialmente la versión del paciente y construyendo, de manera progresiva, una nueva narrativa común (7).…”

Section: Discussionunclassified

Dermatitis artefacta: a disease with difficult diagnosis

Arroyo¹,

Morente²,

Colmenero³

et al. 2014

Actual. Med.

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Dermatitis artefacta: una patología con difícil diagnóstico ResumenLa dermatitis artefacta o facticia es una patología de base psicopatológica que usa la piel como modo de expresión, al ser la persona incapaz de verbalizar su malestar interno. Presentamos un caso de esta patología en una mujer de 34 años con lesiones ampollosas en región peribucal de difícil diagnóstico. Este tipo de pacientes acuden en primer lugar a la consulta del dermatólogo constituyendo un reto diagnóstico, ya que niegan cualquier tipo de alteración psíquica. La variabilidad clínica ocasiona gran dificultad diagnóstica y requiere un manejo multidisclipinar y consumo excesivo de recursos y tiempo. AbstractFactitious dermatitis is a condition of psychopathological basis using the skin as a means of expression, being the person unable to verbalize their internal unrest. We present a case of this disease in a 34 year old woman with bullous lesions in perioral region are difficult to diagnose. These patients come first consulting dermatologist to constitute a diagnostic challenge because they deny any mental impairment. The clinical variability brings great diagnostic difficulty and requires multidisclipinar handling and excessive consumption of resources and time. Enviado: 30-09-2014 Revisado: 20-11-2014 Aceptado: 23-12-2014 Palabras clave: Dermatitis artefacta; psicocutáneo; facticio Keywords: Dermatitis artefacta; psychocutaneous; factitious Dermatitis artefacta: a disease with difficult diagnosis INTRODUCCIÓNLa dermatitis artefacta (DA) o facticia es una patología en la que las lesiones cutáneas están producidas exclusivamente por acciones del paciente sin ningún motivo racional para este comportamiento, considerándose una manifestación de un trastorno psiquiátrico primario (1,2). Los pacientes con DA son atendidos generalmente en consultas de dermatología, por lo que para su diagnóstico y tratamiento precoz es necesario que el dermató-logo comprenda la psicopatología subyacente de este trastorno (3). Presentamos un caso de DA con difícil diagnóstico debido a la similitud con otras enfermedades cutáneas. CASO CLÍNICOMujer de 34 años de etnia gitana, soltera, sin hijos, con estudios básicos y sin ocupación laboral, la cual convive con sus padres en ámbito marginal con una red social limitada. Entre sus antecedentes médicos presenta hipotiroidismo y fue sometida a cirugía bariátrica hace un año por obesidad mórbida. Consulta por dermatitis perioral pruriginosa, no dolorosa de 15 días de evolución. En el examen físico mostraba costras serosas y placas circulares con centro oscuro y periferia ampollosa de 0,5-0,6 cm de diámetro, junto con ampollas tensas circulares en labios y región perioral. Fue tratada con aciclovir 200 mg vía oral cada 4 horas durante 5 días ante la sospecha de herpes simple tipo 1. A la semana la paciente no presentaba mejoría y mostraba progresión radial de las lesiones. Las pruebas de laboratorio consistentes en hemograma y bioquímica fueron normales y la reacción en cadena de la polimerasa (PCR) para virus herpes era...

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“…Women between 30 and 50 years of age are predominantly affected ([f:m] 1:3 or 1:20), with initial symptoms already starting in adolescence. Psychosocial stressors such as unemployment, separation, and others contribute to the exacerbation and maintenance of the disease . Here, affected individuals experience an “inner tension and strong inner stress,” which is temporarily reduced by the obsessive‐compulsive “scratching actions.” It has also been discussed that these – partly very painful – manipulations of one's own body are done in a dissociative state, i.e.…”

Section: Dermatillomaniamentioning

confidence: 99%

Obsessive‐compulsive disorder in dermatology

Mavrogiorgou

Bader

Stockfleth

et al. 2015

J Deutsche Derma Gesell

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SummaryPatients with obsessive-compulsive (OCD) and related disorders -primarily trichotillomania, body dysmorphic disorder, and skin picking disorder -frequently present to dermatologists due to associated hair and skin symptoms. It is therefore crucial that dermatologists be familiar with these disorders. In this review article, we provide an update on clinical features, neurobiology factors, and treatment options for OCD spectrum disorders. Employing PubMed and Cochrane Library databases, a selective literature search was conducted using keywords related to dermatological disorders within the OCD spectrum. OCD and its related disorders share several phenomenological as well as pathophysiological similarities, thus warranting their classification within a separate nosological category of psychiatric disorders. Another similarity of OCD spectrum disorders is the frequent concurrence of hair and skin diseases. Besides symptomatic dermatological treatment, the combination of psychotherapy (behavioral therapy) and psychopharmacotherapy (SSRIs) may be helpful. Although recent insights into OCD have contributed to a better understanding and treatment thereof, more research is required, especially with respect to OCD spectrum disorders, for which large controlled treatment studies are still lacking.

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Primary psychiatric conditions: Dermatitis artefacta, trichotillomania and neurotic excoriations

Cited by 44 publications

References 35 publications

Debilitating Itching: An Unusual Presentation of Dhat Syndrome Following Recovery from Dermatitis Artefacta

Debilitating Itching: An Unusual Presentation of Dhat Syndrome Following Recovery from Dermatitis Artefacta

Dermatitis artefacta: a disease with difficult diagnosis

Obsessive‐compulsive disorder in dermatology

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