Dermatitis artifact

Dermatitis artefacta is conscious or unconscious self-harm of 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-harming the skin. Damage can occur with the help of nails, various objects, cigarettes, chemicals or thermal effects, application of foreign objects to the skin.

Clinical picture
The finding is often atypical or bizarre, with an unusual location, configuration and range of manifestations.

Linear excoriations from the nails are in places where the patient can reach, omitting localization between the shoulder blades. Cigarette burns are circular in shape and leave pigmentation and scars. The application of foreign substances into the subcutaneous tissue can cause panniculitis.

Dermatitis artefacta can be a part of Münchausen syndrome, when patients report very complex problems, on the basis of which they often overcome risky examinations and procedures. Patients are dissatisfied with care and often change medical facilities.

Diagnosis
The course, anamnesis or appearance do not correspond to known dermatoses. The ineffectiveness of the treatment, histological findings (e.g. evidence of foreign material) and also the patient's behavior help the diagnosis.

Differential diagnosis
Includes vasculitides, pityriasis lichenoides , scabies , dermatitis herpetiformis Duhring , granulomatous diseases, lymphocytoma , panniculitis.

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