Brand-Ad-30-6
 IADVL
Indexed with PubMed and Science Citation Index (E) 
 
Users online: 6920 
     Home | Feedback | Login 
About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe What's New Contact  
  Navigate here 
  Search
 
   Next article
   Previous article 
   Table of Contents
  
 Resource links
   Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
   [PDF Not available] *
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   Abstract
   Introduction
   Case Report
   Discussion
   References
   Article Figures

 Article Access Statistics
    Viewed4999    
    Printed63    
    Emailed1    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal

 


 
CASE REPORT
Year : 1994  |  Volume : 60  |  Issue : 6  |  Page : 349-350

Dermatitis artefacta - A case of 'munchausen's syndrome by proxy'?




Correspondence Address:
Anuja E George


Login to access the Email id

Source of Support: None, Conflict of Interest: None


Rights and PermissionsRights and Permissions

  Abstract 

A case of dermatitis artefacta in a 1˝ year old boy induced by the mother of the child is presented.


Keywords: Dermatitis artefacta, `Munchausen′s syndrome by proxy′


How to cite this article:
George AE, Sarojini P A. Dermatitis artefacta - A case of 'munchausen's syndrome by proxy'?. Indian J Dermatol Venereol Leprol 1994;60:349-50

How to cite this URL:
George AE, Sarojini P A. Dermatitis artefacta - A case of 'munchausen's syndrome by proxy'?. Indian J Dermatol Venereol Leprol [serial online] 1994 [cited 2020 Oct 27];60:349-50. Available from: https://www.ijdvl.com/text.asp?1994/60/6/349/4102



  Introduction Top


Dermatitis artefacta (DA) is a psychocutaneous disorder where skin lesions are self induced, due to 1) compulsive habits like hairpulling, rubbing etc. 2) by conscious or unconscious actions for secondary gains or 3) by conscious or unconscious action to satisfy a deep psychological need. [1] Usually an emotionally immature, inward-looking self­centred woman is involved and sometimes psychosis can occur simultaneously in two closely associated persons as in 'Folie a' deux'. But the deliberate induction of skin lesions by a parent on a child with whom there is no distortion of relationship is rare, unlike in child abuse or 'Munchausen's syndrome by proxy' where the parent-child relation is distorted.


  Case Report Top


A 1 1/ 2 year-old boy was brought by his mother for discrete hyperpigmented macules and patches with a charred appearence on the back of trunk, buttocks and thighs of 3 days duration. The history given was vague, the lesions having developed overnight and of no apparent cause. The largest patch on the right thigh showed a clear streaking or `tailing' on its lower edge, as though something had been stroked on the body [Figure - 1]. Some of the charred macules on the trunk also showed tailing and a patterned equidistant distribution [Figure - 2]. When the skin over the patches was stretched it could be seen that the furrows in between the normal ridges was spared indicating that the staining was exogenous.

Clinical examination and investigations revealed him to be an otherwise healthy boy, of physical and mental developments normal for his age. The linear `tailing', the exogenous nature of pigment and the lack of other evidence gave rise to the possibility of DA. The mother was questioned and was found to be emotionally labile, under much, sychological stress, being recently separated from her husband. There was also history of psychiatric problems in her father, but it could not be assessed. Psychiatric consultation was done and it was of the opinion that the mother could be the inducer of lesions, with the objective of gaining the attention of the child's father, but she denied having produced them. The child's father was also interviewed and he reported that his wife used to display undue anger, temper tantrums etc. Repeat interview with the mother was advised by the psychiatrist to confirm the diagnosis but she failed to report again.


  Discussion Top


Lesions with bizarre configuration and linear streaking, usually symmetric, occurring in areas easily accessible to the dominant hand, more often in a woman, quite indifferent to the situation, constitutes DA. The bizarre configuration with `tailing' in some lesions and an unusual pattern of distribution in this case, suggested DA. The child is too young to produce the lesions and the lesions are not in the accessible part of the body, suggesting that it was induced by the mother. It is rare to get purposely induced lesions in a child by its mother for secondary gain, though child abuse or 'Munchausen's syndrome by proxy' resulting from distortion of child-parent relationship, is not a rarity. In this case, there was no distortion of mother-child relation and so, we would like to call it as a case of DA, rather than 'Munchausen's syndrome by proxy'.

 
  References Top

1.Koblenzer CS. Psychocutaneous diseases. In: Text book of Dermatology (Moschella SL, Hurley HL. eds), 3rd edn. Philadelphia : WB Saunders Co. 1992; 2025-47.  Back to cited text no. 1    


    Figures

[Figure - 1], [Figure - 2]



 

Top
Print this article  Email this article
Previous article Next article

    

Online since 15th March '04
Published by Wolters Kluwer - Medknow