Author: Vanessa Ngan, Staff Writer, 2003.
Dermatitis artefacta is a condition in which skin lesions are solely produced or inflicted by the patient's own actions. This usually occurs as a result or manifestation of a psychological problem. It could be a form of emotional release in situations of distress or part of an attention seeking behaviour. In very rare cases there may be an underlying attempt to secure an insurance claim.
The condition is also known as factitial dermatitis.
Dermatitis artefacta occurs more commonly in women than men. Usually affected women are in their teens or early adulthood and tend to be emotionally immature or have psychosocial or interpersonal difficulty. Intelligence of the patient varies but many have some superficial medical knowledge.
Patients present with lesions that are difficult to recognise and do not conform to those of known dermatoses. Features of dermatitis artefacta include:
When dermatitis artefacta is suspected, direct confrontation should be avoided. Instead the doctor should create an accepting, empathetic and non-judgemental environment. Close supervision and symptomatic care of skin lesions will hopefully lead to a doctor-patient relationship in which psychological issues may gradually be introduced. If appropriate, psychiatric referral may be recommended, although this is often refused .
Resolution of the current underlying psychological problem will bring about a cure for the time being but dermatitis artefacta tends to wax and wane with the circumstances of the patient's life. To minimise occurrences of dermatitis artefacta, a patient should continue to see their doctor on an ongoing basis for supervision or support, whether or not lesions are present.
Textbook of Dermatology. Ed Rook A, Wilkinson DS, Ebling FJB, Champion RH, Burton JL. Fourth edition. Blackwell Scientific Publications.
Koblenzer CS. Dermatitis artefacta. Clinical features and approaches to treatment. Am J Clin Dermatol. 2000 Jan-Feb;1(1):47-55. Review. Medline
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