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LETTER TO EDITOR
Year : 1994  |  Volume : 60  |  Issue : 3  |  Page : 178-179

Keratotic papules on chin : A neurodermatitis or dysmorphophobia ?



Correspondence Address:
VS Babu Hanis


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How to cite this article:
Hanis VB. Keratotic papules on chin : A neurodermatitis or dysmorphophobia ?. Indian J Dermatol Venereol Leprol 1994;60:178-9

How to cite this URL:
Hanis VB. Keratotic papules on chin : A neurodermatitis or dysmorphophobia ?. Indian J Dermatol Venereol Leprol [serial online] 1994 [cited 2019 Jun 18];60:178-9. Available from: http://www.ijdvl.com/text.asp?1994/60/3/178/4036


To the Editor,

The lettr on keratotic papules on chin (KPC) by M M Udagani published in IJDVL 1993: 59: 45 was interesting. I wish to report a case of KPC which may throw some light on the aetiopathogenesis of the condition. A female student aged 18 years presented with asymptomatic bilateral skin coloured follicular papules on the chin of 9 months' duration. Size was that of a rupee coin and the skin in between the papules showed mild hyperpigmentation. though the patient denied any rubbing, her parents had noticed her constantly picking at the hairs on the chin. Further queries revealed that the girl was deeply worried about the unwanted hair growth on her face.

To reassure her, the prominent hairs on the chin were removed by electrolysis. Pimozide 2mg as a single morning dose along with topical Tretinoin (0.05%) produced almost complete clearing of her lesions in 6 weeks, leaving only a little residual hyper­pigmentation. With only alternate day application for another 1 month and a follow up period of 2 months, ther was no recurrence.

Predominance of the condition in female teenagers with one or other congenital or acquired blemishes on their face,' the particular localization on the chin, the typical appearance of chronic follicular keratinization due to constant rubbing, and the psychological disturbance all point towards the tentative diagnosis of a neurodermatitis. Chin is the most easily accessible area for students sitting with their elbows on the desktops and the chin resting between the thumb and forefinger. Modesty may be preventing them from reaching out to other areas of the body.

However, when the patient firmly denies any conscious rubbing in the presence of real or, more important, imagined disfigurement, the diagnosis of dysmorpho-phobia has to be ruled out. In dysmorpho-phobia. a condition of disturbed psychological body image, the face and nose represent the indivisual's main areas of concern of his/her body image. These patients may present with psychogenic itching, burning, imagined facial hair and imagined distortions and the sequelae thereof. An attempt must be made to differentiate these patients into two groups-one, psychologically deluded and the other, anxiousely and neurotrically preoccupied with their skin.' This condition has been considered as ominous because it is often a harbinger of schizophrenia. [3] This again underlines the importance of exercising extra caution while dealing with females presenting with facial symptoms. Meanwhile it will no doubt be fruitful to have psychological assessment carried out on all cases of keratotic papules on chin.

 
  References Top

1.Sharma R, Kanwar A J, Abraham A, et al. Keratotic Papules on chin. Ind J Dermatol Venereol Leprol 1990; 56: 391-2.  Back to cited text no. 1    
2.Cotteril J A. Dermatological non-disease. Br J Dermatol 1981 ; 104: 611 - 9.  Back to cited text no. 2    
3.Gopalakrishnan G, Neki J S. Dysmorpho­phobia - a case report. Ind J Psychiat 1985; 27 : 91 - 4.  Back to cited text no. 3    




 

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