Psychiatric comorbidities in dermatitis artefacta: A systematic review and meta-analysis

Abstract

Dermatitis artefacta, also known as factitious or factitial dermatitis, is a rare and difficult-to-treat condition characterized by self-inflicted skin lesions. Despite the well-documented psychological disturbances that characterize this condition, little is known about the relative frequency of specific psychiatric disorders in this patient group. The current systematic review was undertaken to address this gap in our knowledge and was conducted in accordance with PRISMA guidelines. The PubMed and Scopus databases were searched using the terms “dermatitis artefacta,” “factitious dermatitis,” and “factitial dermatitis” in combination with “psychiatry,” “psychiatric diagnosis,” “psychiatric disorder,” “mental illness,” “depression,” and “anxiety.” After screening a total of 215 citations, a total of 11 papers were included in the final review. All the included studies were of low to very low quality as per the GRADE guidelines, and there was substantial heterogeneity among them (I2 = 50.4). It was observed that 46.2% of patients (95% CI: 35.4–57.4%) with dermatitis artefacta had a comorbid psychiatric disorder, with the most common diagnoses being depression, somatoform disorders, anxiety disorders, substance use disorder, and intellectual disability. About 20.1% of patients refused a psychiatric evaluation, while 40.9% reported a significant stressful life event. These results suggest that a significant proportion of patients with dermatitis artefacta suffer from psychiatric disorders, which may be related to their self-infliction of lesions either biologically or psychologically. Treatment of these disorders may lead to a partial or complete improvement in their dermatological condition. A sensitive, non-confrontational approach is essential when evaluating these patients to minimize the chances of refusal and improve patient compliance.

Artefaktinis Dermatitas: Diferencinė Diagnostika Ir Gydymas

“…Nustatyta, kad net 46,2 proc. pacientų, sergančių artefaktiniu dermatitu, serga ir psichikos liga, iš kurių dažniausios yra depresija, somatoforminiai bei nerimo sutrikimai, psichotropinių medžiagų vartojimas ir protinis atsilikimas [1]. Klinikinis ligai būdingas pažeistos odos vaizdas gali būti labai polimorfiškas ir imituoti daugelį dermatologinių būklių, dėl to yra sunkiai diagnozuojamas [2].…”

“…Svarbu skirti daugiau laiko paciento gyvenimo anamnezei, siekiant atrasti didelį stresą sukėlusį gyvenimo įvykį, kuris galimai turėjo įtakos asmenybės sutrikimo susiformavimui. Ligos diagnozės atskleidimas pacientui turi būti labai atsargus, vengiant tiesioginės konfrontacijos, nes dauguma nenori pripažinti sergantys psichiatrine liga ir atsisako psichiatrų konsultacijų [1]. Per anksti ir netaktiškai pasiūlyta gydytojo psichiatro konsultacija gali sutrikdyti pacientą ir sumažinti pasitikėjimą gydytoju [3].…”