Dermatitis artefacta

Dermatitis artefacta is a conscious or unconscious self-damage to the skin. It can be an expression of the patient's effort to achieve a certain benefit (incapacity for work, compensation). It most often affects young women.

Etiology and Pathogenesis
It arises on a psychopathic or psychiatric basis. Most often, it is the patient's attempt to escape from a difficult situation and to attract attention by self-damaging the skin. Damage can occur with the help of nails, various objects, cigarettes, chemicals or heat, application of foreign objects to the skin.

Clinal picture
The finding is usually atypical to bizarre, with an unusual location, configuration and range of manifestations.

Linear excoriations from the nails are where the patient reaches, omitting localization between the scapulae. Cigarette burns are circular in shape and leave pigmentation and scarring. Application of foreign substances to the subcutaneous tissue may cause paniculitis.

Dermatitis artefacta can be part of Münchhausen's syndrome,, where patients report very complex difficulties, on the basis of which they often overcome risky examinations and procedures. Patients are dissatisfied with care and often change healthcare facilities.

Diagnosis
The course, anamnesis and appearance do not correspond to known dermatoses. The diagnosis is aided by treatment ineffectiveness, histological findings (eg evidence of foreign material) as well as patient behavior.

Differential diagnosis
Includes vasculitis, pityriasis lichenoides, scabies, dermatitis herpetiformis Duhring, granulomatous diseases, lymphocytoma, paniculitis.

Therapy
It is important to gain the patient's trust and cooperation, to obtain his consent for a consular psychological or psychiatric examination.