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Dermatitis Factitia

Neurotic Excoriations

Dermatitis factitia, also known as dermatitis artefacta, is defined as a deliberate self-infliction of trauma resulting in the appearance of skin lesions for which the individual denies any responsibility. An array of lesions can be seen depending on the mechanism of injury. Their localization is usually within the reach of the dominant hand. The diagnosis requires a careful multidisciplinary approach comprised of a detailed psychiatric and dermatologic evaluation.


Presentation

Belonging to the group of self-inflicted dermatoses, dermatitis factitia (more commonly termed dermatitis artefacta) is rarely described in the medical literature, although various reports suggest it is not uncommon in clinical practice [1]. Dermatitis factitia is primarily a psychiatric disorder characterized by the presence of intentional, self-inflicted injuries for which the patient claims he/she had nothing to do with them [1] [2] [3] [4]. This condition is most commonly diagnosed around 20 years of age, with a significant predilection toward female gender [1] [2] [5]. The clinical presentation is quite broad, and various types of skin lesions have been identified. The predominant type of lesion, however, are ulcers that might be of various sizes and shapes (depending on the underlying mechanism of injury, eg. cigarette or chemical burns) [1] [6]. Excoriations are also common, usually arising from fingernail-induced injury or by using sharp objects [1]. Additional types of skin lesions that may be encountered in dermatitis factitia are blisters, scarring, bruises, and eczema [1] [2] [5] [6]. The majority of injuries are localized within the reach of the patient's dominant hand [1]. In most cases, the exact shape and size, as well as the appearance of the lesion, can provide sufficient information about the mechanism of trauma [1] [2] [6]. One of the distinguishing features of dermatitis factitia is that individuals cause self-harm in areas covered by clothing (concealment of wounds), which is used to discern from malingering and other types of self-inflicted dermatoses [1].

Pathologist
  • A dermatolopathologist is a pathologist or dermatologist who specializes in the pathology of the skin and this field is shared by dermatologists and pathologists.[wikivisually.com]
Pneumonia
  • […] effects Male Female Male Malignant neoplasms Meningitis Motor vehicle myocardial infarction nephrotic syndrome Newborn affected Ninth Revision International Ninth Revision lnternational Numbers after causes obstruction period of gestation peritoneum Pneumonia[books.google.com]
Excoriation
  • , neurotic, Factitial dermatitis, FACTITIONAL DERMATITIS, Factitious dermatitis, Feigned dermatitis, neurotic excoriation, Neurotic, excoriation, Simulated dermatitis[dermis.net]
  • Excoriation (skin-picking) disorder ( ICD-10-CM Diagnosis Code F42.4 Excoriation (skin-picking) disorder 2017 - New Code 2018 2019 Billable/Specific Code Type 1 Excludes factitial dermatitis ( L98.1 ) other specified behavioral and emotional disorders[icd10data.com]
  • The ICD code L981 is used to code Neurotic excoriations Neurotic excoriations is a condition in which patients produce skin lesions through repetitive, compulsive excoriation of their skin.:392:61 Specialty: Dermatology MeSH Codes: , ICD 9 Codes: , 698.4[icd.codes]
  • ., dermatitis artefacta and malingering), the patient with neurotic excoriations acknowledges the self-inflicted nature of the lesions. American Family Physician. Excoriation Disorders.[sclero.org]
Chronic Dermatitis
  • dermatitis med. dermatitis facticia dermatitis artefacta med. dermatitis factitia dermatitis factitia med. dermatitis factitia dermatitis artefacta med. dermatitis herpetiformis herpes circinatus med. dermatitis herpetiformis Duhring's disease med. dermatitis[multitran.com]
  • The clinical history of chronic dermatitis is a predictor of future dermatitis. Diagnosis and treatment at late stages of irritant dermatitis have little effect on the course of the irritant dermatitis.[dermatologyadvisor.com]
Petechiae
  • A 59-year-old white woman was referred for dermatologic consultation with a tentative diagnosis of petechiae of undetermined origin. The patient had been under psychiatric treatment for several years.[jamanetwork.com]
Denial
  • Directly confronting the patient with the artifactual nature of the lesions should be avoided because it can result in unpleasant scenes of angry denial. 3,7 Likewise, a recommendation for psychiatric referral may be rejected immediately and the patient[annsaudimed.net]
  • […] suspicion of factitia is based on the following clues: ambiguous history of the lesions, chronic evolution, bizarre forms of skin lesions that are found on accessible parts of the body and that do not resemble any of the known dermatoses, the continuous denial[dovepress.com]

Workup

A carefully obtained patient history and thorough physical examination are the essential steps during the diagnostic workup [1] [2] [5]. The presence of irregular, oddly shaped, or bizarre lesions seen in various forms (erosions, ulcerations, bruising, etc.) must raise suspicion toward intentional injuries [1]. Based on the behavior and mental status of the patients, history taking might be the vital component for narrowing the differential diagnosis. During the interview, patients may be either completely relaxed and almost "'too calm", or show obvious signs of anxiety [1]. The physician must not be too confronting when discussing the nature of the lesions with the patient, as they will strongly deny any involvement in the formation of skin lesions [1] [2] [3] [6]. Instead, a calm and careful approach is warranted, particularly if the patient's parents or relatives are present [1] [3]. If the patient or the accompanying persons are not cooperative (commonly occurring when suggesting self-infliction as the underlying cause), a detailed neurological and psychological assessment is necessary before pursuing treatment strategies [1] [6]. Laboratory studies and histopathological examination of the skin could be performed in order to exclude other etiologies [6].

Slowing
  • […] dermatitis) Presents with unhealed skin, erythema, vesicles, papules, scaling at site of injury Prolonged healing period Chronic and resistant to therapy Acneiform irritant dermatitis (pustular irritant dermatitis, follicular irritant dermatitis) Moderately slow-developing[dermatologyadvisor.com]

Treatment

  • Apply the latest best practices through new and updated treatment algorithms. Find therapeutic drug information more easily with guidance incorporated into each chapter.[books.google.com]
  • Arch Dermatol (1960) 1.12 The operative treatment of urinary incontinence in the male. Proc R Soc Med (1949) 1.05 Antihistaminic drugs in dermatologic therapy. Arch Derm Syphilol (1950) 1.00 Atabrine in the treatment of discoid lupus erythematosus.[pubrank.carbocation.com]
  • If the patient or the accompanying persons are not cooperative (commonly occurring when suggesting self-infliction as the underlying cause), a detailed neurological and psychological assessment is necessary before pursuing treatment strategies.[symptoma.com]
  • The patient had been under psychiatric treatment for several years. As part of her mental state she remained mute, refusing to answer any questions. A history, therefore, was not obtainable.[jamanetwork.com]
  • MEDICAL INTRO BOOKS ON OLD MEDICAL TREATMENTS AND REMEDIES THE PRACTICAL HOME PHYSICIAN AND ENCYCLOPEDIA OF MEDICINE The biggy of the late 1800's. Clearly shows the massive inroads in medical science and the treatment of disease.[doctortreatments.com]

Prognosis

  • Prognosis was difficult but recovery seemed to occur when the patient's life circumstances changed, rather than as a result of treatment. Br Med J., [1975].[sclero.org]
  • This book is a concise guide to different forms of the condition, from definition, classification and epidemiology, to pathogenesis, investigation and prognosis.[books.google.ro]
  • "The prognosis of contact dermatitis". J Am Acad Dermatol. vol. 23. 1990. pp. 300-7. (There is a similarly poor prognosis for occupational, nonoccupational, irritant, and allergic contact dermatitis.[dermatologyadvisor.com]
  • […] studies, but none has been tested in large enough populations to provide definitive evidence of their effectiveness. [8] Biofeedback [ edit ] Tentative evidence suggests that devices that provide feedback when the activity occurs can be useful. [18] Prognosis[en.wikipedia.org]

Etiology

  • Laboratory studies and histopathological examination of the skin could be performed in order to exclude other etiologies.[symptoma.com]
  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, ICDCM has a. Welcome to the urticaria network![hivesthatcome.club]
  • Morgellons disease: analysis of a population with clinically confirmed microscopic subcutaneous fibers of unknown etiology. Clin Cosmet Investig Dermatol . 2010;3:67–78. 8. Middelveen MJ, Mayne PJ, Kahn DG, Stricker RB.[dovepress.com]
  • Acta DermatoVenereologica Urticaria: Current Opinions about Etiology, Diagnosis and Therapy HTML Zur Kenntnis der Urticaria pigmentosa. A case of urticaria pigmentosa. Un caso di orticaria pigmentosa. Urticaria pigmentosa factitia Erwachsenen.[hivesfromallergies.club]
  • Rather, her unnaturally disarrayed marital state seemed to be a significant etiologic factor and she might have inflicted the lesion to draw attention to it.[annsaudimed.net]

Epidemiology

  • This book is a concise guide to different forms of the condition, from definition, classification and epidemiology, to pathogenesis, investigation and prognosis.[books.google.ro]
  • This report defines the prevalence of genital colonization in a large population of women, characterizes the women with S. aureus, and describes epidemiologic features of genital carriage. ‎ Página 50 - Lautenschlager S, Eichmann A.[books.google.es]
  • Overview• Definition• Epidemiology• Classification• Diagnosis• Treatment 3.[slideshare.net]
  • Only a few case reports have hives published, so epidemiological data is not available verlauf The most frequent reasons are passive warmth, e.[hivesfromallergies.club]
  • "Epidemiologic and clinical updates on impulse control disorders: a critical review" . European Archives of Psychiatry and Clinical Neuroscience . 256 (8): 464–75. doi : 10.1007/s00406-006-0668-0 . PMC 1705499 .[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • 564 Diagnosis 173 565 Prophylaxis and Therapy 174 57 Adverse Drug Reactions 175 5712 Pathophysiology 176 5773 Risk Factors 177 5715 Hyposensitization in Drug Allergy 180 5717 Rare Drug Reactions 183 References 184 572 Pseudoallergic Drug Reactions 185[books.google.ro]
  • Role of emotional stress in the pathophysiology of Graves' disease". New England Factitia of Medicine. Clinical and Hives Immunology. Experimental and Clinical Endocrinology and Diabetes. Identification of risk factors for urticaria neuropathy".[hivesthatcome.club]
  • "Excoriation Disorder: Practice Essentials, Background, Pathophysiology and Etiology" . 2018-07-10. "Excoriation Disorder: Practice Essentials, Background, Pathophysiology and Etiology" . emedicine.medscape.com . 2018-07-10 . Retrieved 2018-12-01 .[en.wikipedia.org]
  • Pathophysiology The irritant may cause any of three pathophysiologic changes: skin barrier disruption, cellular epidermal change and mediator release.[dermatologyadvisor.com]

Prevention

  • Your skin Holds body fluids in, preventing dehydration Keeps harmful microbes out, preventing infections Helps you feel things like heat, cold, and pain Keeps your body temperature even Makes vitamin D when the sun shines on it Anything that irritates[icdlist.com]
  • Lard as an ointment base is frequently used, with the addition of about five per cent, of benzoin to prevent rancidity.[books.google.com]
  • Transplantation Substance Use and Addiction Surgery Surgical Innovation Surgical Pearls Teachable Moment Technology and Finance The Rational Clinical Examination Tobacco and e-Cigarettes Toxicology Trauma and Injury Treatment Adherence United States Preventive[jamanetwork.com]
  • 241 653 Secondary Prevention 243 References 245 Psyche and Allergy 248 72 Stress 249 74 Psychoneuroallergology 250 75 Clinical Conditions 252 76 Therapy 253 References 254 Outlook 257 82 Clinical Studies 258 83 Diagnosis 259 84 Therapy 260 86 Controversies[books.google.ro]
  • Published on behalf of the Royal College of Psychiatrists, the journal’s overriding concern is to improve the prevention, investigation, diagnosis, treatment, and care of mental illness, as well as the promotion of mental health globally.[bjp.rcpsych.org]

References

Article

  1. Rodríguez Pichardo A, García Bravo B. Dermatitis artefacta: a review. Actas Dermosifiliogr. 2013;104(10):854-866.
  2. Chiriac A, Foia L, Birsan C, Goriuc A, Solovan C. Cutaneous factitia in elderly patients: alarm signal for psychiatric disorders. Clin Interv Aging. 2014;9:421-424.
  3. Sarin A, Ummar SA, Ambooken B, Gawai SR. Dermatitis Artefacta Presenting with Localized Alopecia of Right Eyebrow and Scalp. Int J Trichology. 2016;8(1):26-28.
  4. Barańska-Rybak W, Cubała WJ, Kozicka D, Sokołowska-Wojdyło M, Nowicki R, Roszkiewicz J. Dermatitis artefacta--a long way from the first clinical symptoms to diagnosis. Psychiatr Danub. 2011;23(1):73-75.
  5. Chatterjee SS, Mitra S. Dermatitis Artefacta Mimicking Borderline Personality Disorder: Sometimes, Skin Could Be Misleading. Clin Psychopharmacol Neurosci. 2016;14(3):311-313.
  6. Saha A, Seth J, Gorai S, Bindal A. Dermatitis Artefacta: A Review of Five Cases: A Diagnostic and Therapeutic Challenge. Indian J Dermatol. 2015;60(6):613-615.

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Last updated: 2018-06-22 04:18