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    Introduction
    Case Report
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CASE REPORT
Year : 2003  |  Volume : 69  |  Issue : 7  |  Page : 78-79

Dermatitis artefacta-a ‘focal suicide’


Department of Skin and STD, Kasturba Medical College Hospital, Attavar, Mangalore-575 001

Correspondence Address:
Department of Skin and STD, Kasturba Medical College Hospital, Attavar, Mangalore-575 001

   Abstract 

Dermatitis artefacta is a psychocutaneous disorder most likely to be seen by a dermatologist rather than a psychiatrist. We report an unusual and interesting case of dermatitis artefacta in a 17-year-old female.

How to cite this article:
Mariyath R, Kumar P. Dermatitis artefacta-a ‘focal suicide’. Indian J Dermatol Venereol Leprol 2003;69, Suppl S1:78-9


How to cite this URL:
Mariyath R, Kumar P. Dermatitis artefacta-a ‘focal suicide’. Indian J Dermatol Venereol Leprol [serial online] 2003 [cited 2019 Aug 17];69, Suppl S1:78-9. Available from: http://www.ijdvl.com/text.asp?2003/69/7/78/5869



   Introduction Top

Dermatitis artefacta is an artefactual skin disease produced entirely by the actions of the fully aware patient. There is no rational motive for this behaviour.[1] There is a marked female preponderance, the ratio of female to male very from 4:1 to 8:1. It is associated with a variety of psychiatric disorders and can be produced by different methods.


   Case Report Top

A 17-year-old female was brought to the skin OPD by her mother with multiple, painful erosions with crusting on the right side of the body of 2 weeks duration. According to her mother erosions started first on the dorsal aspect of right foot and gradually ascended upwards to reach the right side of the abdomen. Patient used to get four erosions every day above the previous lesions. Erosions appeared suddenly at a particular time of the day.
Cutaneous examination revealed multiple, crusted erosions of almost uniform size and shape over the anterior aspect of right lower limb and right side of abdomen, arranged in a horizontal and parallel pattern [Figure - 1]. There were four fresh erosions below the right costal margin. Skin in between the erosions was normal.
Diagnosis of dermatitis artefecta was suspected and patient was admitted for observation. She developed multiple fresh erosion of three consecutive days following admission. Skin biopsy showed ulcerated epidermis and dense inflammation of dermis. Patient was observed continuously for next 3 days with her hands immobilized. No fresh lesions appeared thereafter. On repeated questioning patient confessed that she produced the lesion by pinching. Psychiatric evaluation did not reveal any major psychiatric disorder and the psychiatrist found no stresses or secondary gain.


   Discussion Top

Dermatitis artefacta describes cutaneous lesions that are wholly self inflicted, however the patient typically denies their self inflicted nature.[2] It is a form of 'focal suicide'.[3] Dermatitis artefacta has been associated with severe personality disorders, dissociative disorders, sexual abuse, child abuse, obsessive compulsive disorder, depression, psychosis and mental retardation.[4] However in the vast majority of patients obvious evidence of secondary gain is not present.[4]
Characteristic clinical features are 'hollow history'[1] i.e. sudden appearance of complete lesions without prodrome, lack of history of progression of lesions, strenuous denial by the patient of inflicting the lesions and patient can forecast the site and timing of lesions. Patient appears indifferent towards her disease - 'la belle indifference.[1] Lesions are bizarre with sharp angulated, geometric borders and surface necrosis, do not correspond to any known dermatosis and confined to areas accessible to the dominant hand.
Diagnosis can be confirmed when so fresh lesions appears when patient is under total surveillance 24 hours a day and when no lesions appear in an area totally protected. Diffferential diagnosis vary greatly because of the various methods used for inflicting the lesions.
In cases where skin involvement is mild and patient is relatively healthy psychologically, supportive and symptomatic therapy is adequate. Severe cases with borderline personality need long term and intensive psychotherapy. Psychotic patients are best referred to a psychiatrist.[5]
Thus the visible symptoms of dermatitis artefecta serve as a non verbal communication - a 'cry for attention and help' from a patient incapable of meaningful verbal communication. 

   References Top

1.Cotterill JA and Millard LG. Psychocutaneous disorders. In : Champion RH, Burton JL, Burns DA et al, eds. Textbook of Dermatology Vol 4,6th edn. 1998; 2785-2813.  Back to cited text no. 1    
2.Fabisch W. Psychiatric aspects of dermatitis artefecta Br J Dermatol 1980; 102;29-34.  Back to cited text no. 2    
3.Stankler L. Factitious skin lesions in a mother and two sons. Br J Dermatol 1977; 97:217.  Back to cited text no. 3  [PUBMED]  
4.Gupta MA, Gupta AK. Psychodermatology An update. J Am Acad dermatol 1996; 34:1030-1046.  Back to cited text no. 4    
5.Koblenzer CS. Psychsomatic concepts in Dermatology. Arch Dermatol 1983; 119:501-512.  Back to cited text no. 5    

 

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