Digital Health Assistant & Symptom Checker | Symptoma
0%
Restart

Are you sure you want to clear all symptoms and restart the conversation?

About COVID-19 Jobs Press Scholarship Terms Privacy Imprint Medical Device Language
Languages
Suggested Languages
English en
Other languages 0
2.1
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.

Images

WIKIDATA, Public Domain

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].

Skin

  • Excoriation

    (disorder), Factitious skin disease, dermatitis; artefacta, dermatitis; factitia, excoriation; neurosis, excoriation; neurotic, factitia; dermatitis, neurosis; excoriation, neurotic; excoriation, artefacta; dermatitis, Dermatitis factitia [artefacta] [fpnotebook.com]

    […] or a problem admitting that you are doing this, then you may have neurotic excoriations. [web.archive.org]

    neurotic, Factitial dermatitis, FACTITIONAL DERMATITIS, Factitious dermatitis, Feigned dermatitis, neurotic excoriation, Neurotic, excoriation, Simulated dermatitis [dermis.net]

  • Chronic Dermatitis

    dermatitis exsiccants palmaris med. dermatitis exsudativa discoide et lichenoide chronica exudative discoid and lichenoid chronic dermatitis med. dermatitis facticia dermatitis artefacta med. dermatitis factitia dermatitis factitia med. dermatitis factitia [multitran.com]

    The treatment protocol may be simplified by categorizing irritant dermatitis as one of three forms: acute irritant dermatitis, chronic (cumulative) irritant dermatitis, or subacute irritant dermatitis. [dermatologyadvisor.com]

  • Skin Rash

    Symptoms Pruritus (intense at times) Itching awakens person from sound sleep Scabies and Rhus Dermatitis prevent getting to sleep Patient digs at skin Digs to relieve itch Digs to extract imaginary embedded materials in skin Rash Rash does not appear [fpnotebook.com]

    Urticaria, commonly known as ‘hives’, is a skin rash which can have allergic and non-allergic causes. [books.google.ro]

Psychiatrical

  • Denial

    The patient's denial of psychological distress and negative feelings aroused in healthcare personnel make management difficult. The doctor should create an accepting, empathic, and non-judgemental attitude and avoid confrontation. [statpearls.com]

    Female predominance is observed in many studies and reports of dermatitis artefacta. [4],[9],[10] For the diagnosis of dermatitis artefacta, there are some diagnostic clues, [11],[12] like denial, amnesia or indifference to the symptoms or how these lesions [ijdvl.com]

    Denial regarding the self-inflicted nature of injury/injuries is a common finding,[1] consistent with our cases. [ncbi.nlm.nih.gov]

    […] 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]

    Denial regarding the self-inflicted nature of injury/injuries is a common finding, [1] consistent with our cases. [e-ijd.org]

  • Anhedonia

    On mental status evaluation, she had coherent speech, markedly depressed mood, was indifferent to pain, overvalued ideations about acupuncture being able to relieve her pain, anhedonia, ideas of helplessness, worthlessness and suicidal ideations without [ijdvl.com]

Neurologic

  • Neuralgia

    Pyoderma gangrenosum Ecchymosis Postherpetic neuralgia or pruritus (see herpes zoster) Allergic contact dermatitis Irritant contact dermatitis Vasculitis Impetigo Arthropod reaction Delusions of parasitosis Lesch-Nyhan syndrome – Self-mutilation by biting [visualdx.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].

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]

In 11 cases, treatment resulted in significant reduction of the urticaria, but only 7 patients still complained of itching. [hungary.pure.elsevier.com]

Silvan Psychology, Medicine Dermatology and Psychosomatics / Dermatologie und Psychosomatik 2001 This article will describe the types of patients that are seen in a psychodermatology clinic where an integrated treatment approach is used to treat many [semanticscholar.org]

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]. [web.archive.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]

Except in mild transient cases triggered by an immediate stress, the prognosis for cure is poor. [ijdvl.com]

[…] associated with common stressors like pressure, anxiety or depression, the prognosis is good. [statpearls.com]

Etiology

In this review, we describe the clinical picture, comment on the etiology, detail the problems in differential diagnosis, warn about the dangers of ill-advised surgical intervention, and discuss the types of treatment which have been tried. [insights.ovid.com]

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]

The etiologies of both acute and chronic urticaria are numerous (see Causes in Presentation ). The etiologic agent is more likely to be identified in acute urticaria (40-60%) than in chronic urticaria (10-20%). [emedicine.medscape.com]

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]

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]

[…] not found Article: not found La pathomimie cutanée: à propos de 9 cas Journal Journal ID (nlm-ta): Pan Afr Med J Journal ID (iso-abbrev): Pan Afr Med J Journal ID (publisher-id): PAMJ Title: The Pan African Medical Journal Publisher: The African Field Epidemiology [scienceopen.com]

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]

Various psychosocial conflicts, emotional immaturity, unconscious motivations, and disturbed interpersonal relations have been implicated as the etiological factors.[3][4] Epidemiology In general, there is female preponderance (female-male ratio reported [statpearls.com]

Overview• Definition• Epidemiology• Classification• Diagnosis• Treatment 3. [slideshare.net]

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]

Patients with dermatitis artefacta require both dermatologic assessment and psychosocial support. [7] Pathophysiology The pathophysiology of dermatitis artefacta is poorly understood. [emedicine.medscape.com]

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]

Pathophysiology is still an enigma. [ncbi.nlm.nih.gov]

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]

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]

Symptoms Pruritus (intense at times) Itching awakens person from sound sleep Scabies and Rhus Dermatitis prevent getting to sleep Patient digs at skin Digs to relieve itch Digs to extract imaginary embedded materials in skin Rash Rash does not appear [fpnotebook.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]

You can help by adding to it. ( May 2019 ) Treatment [ edit ] Dermographism can be treated by substances which prevent histamine from causing the reaction (i.e. an antihistamine ). [en.wikipedia.org]

References

  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.
Languages
Suggested Languages
English en
Other languages 0
2.1
About Symptoma.com COVID-19 Jobs Press Scholarship
Contact Terms Privacy Imprint Medical Device