Dermatitis Artefacta

Dermatitis artefacta is conscious or unconscious self-harm 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.

Ethiologiy a 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 heat, application of foreign objects to the skin.

Clinical 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'  have a circular shape and leave pigmentation and scarring. Application of  'foreign substances'  to the subcutaneous tissue can cause paniculitis.

Dermatitis artefacta may be part of  'Münchhausen's syndrome' , where patients report very complex difficulties, often overcoming risky examinations and procedures. Patients are dissatisfied with their care and often change healthcare facilities.

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

Used literature



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