Self-Inflicted Lesions in Dermatology: Terminology and Classification – A Position Paper from the European Society for Dermatology and Psychiatry (ESDaP)

Abstract

The terminology, classification, diagnosis and treatment of self-inflicted dermatological lesions are subjects of open debate. The present study is the result of various meetings of a task force of dermatologists, psychiatrists and psychologists, all active in the field of psychodermatology, aimed at clarifying the terminology related to these disorders. A flow chart and glossary of terms and definitions are presented to facilitate the classification and management of self-inflicted skin lesions. Several terms are critically discussed, including: malingering; factitious disorders; Münchausen's syndrome; simulation; pathomimicry; skin picking syndrome and related skin damaging disorders; compulsive and impulsive skin picking; impulse control disorders; obsessive compulsive spectrum disorders; trichotillomania; dermatitis artefacta; factitial dermatitis; acne excoriée; and neurotic and psychogenic excoriations. Self-inflicted skin lesions are often correlated with mental disorders and/or patho-logical behaviours, thus it is important for dermatologists to become as familiar as possible with the psychiatric and psychological aspects underlying these lesions.

New Trichoscopy Findings in Trichotillomania: Flame Hairs, V-sign, Hook Hairs, Hair Powder, Tulip Hairs

“…From the psychiatric point of view, this term encompasses an entire syndrome of pathological hair-pulling. According to the American Psychiatric Association's Diagnostics and Statistic Manual of Mental Disorders, 4 th edition (DSM-IV) diagnostic criteria for TTM are: (i) recurrent pulling out of one's own hair that results in noticeable hair loss; (ii) increasing sense of tension immediately before pulling out the hair, or when attempting to resist the behaviour; (iii) pleasure, gratification, or relief when pulling out the hair; (iv) the diagnosis is not given if the hair-pulling is better accounted for by another mental disorder; and (v) the disturbance must cause significant distress or impairment in social, occupational, or other important areas of functioning (4,5). This definition describes a mental disorder, which should be rather called "TTM syndrome".…”

Religious stigmata as malingering artifact

“…The intrinsic motive of these lesions is a request for family and society attention, as a reaction to difficulties or adverse situations with involuntary cutaneous somatization, masochism with physical pain, and guilt or spiritual responses. As showed by the literature, [1–9] cases of unconscious simulators, mainly women with chronic cutaneous diseases, belong to this group. Such patients always deny self-induced illness and seem unconcerned about the disease.…”

“…The issue about self-inflicted skin lesions (SISL) [1] has been critically discussed in a recent position paper of the European Society for Dermatology and Psychiatry. SISL are divided into 2 main groups: the first group is represented by syndromes associated with a denied or hidden pathological behavior, with (malingering) or without (factitious disorders) external incentives; the second group is represented by syndromes associated with a nondenied and nonhidden pathological behavior (compulsive and impulsive disorders).…”

Self-inflicted skin lesions: the importance of a proper diagnostic and therapeutic approach

“…Various relevant terms can be found in the medical literature. A position paper from the European Society for Dermatology and Psychiatry (ESDaP) proposed in 2014 a new classification and terminology for SISL [4]. The precise epidemiology is difficult to establish for a range of reasons: the diagnostic challenge, the terminological controversies, the behavior of the patients characterized by concealing the facts and misguiding the physicians, etc.…”