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].

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• Turkish

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• Excoriation

  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]

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

  dermatitis artefacta and malingering), the patient with neurotic excoriations acknowledges the self-inflicted nature of the lesions. American Family Physician. Excoriation Disorders. [sclero.org]

  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]

• 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]

• Koilonychia

  Arch Derm Syphilol (1948) 0.75 A case for diagnosis (arsenical hyperpigmentation; scleroderma; koilonychia?). Arch Derm Syphilol (1946) 0.75 [Conduct of anesthesia during operation in the pediatric patient]. [pubrank.carbocation.com]

• Denial

  […] 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]

• Incontinence

  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]

• Urinary Incontinence

  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]

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].

• Microsporum

  GP (1959) 0.75 Tinea capitis (Microsporum audouini): has there been recent significant progress in therapy? N Y State J Med (1952) 0.75 Xanthoma tuberosum; keloid; Jacquet posterosive syphiloid. [pubrank.carbocation.com]

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.