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].
Gastrointestinal
- Pruritus Ani
Similar Codes ICD-9 Code ICD-9 Description 698.0 Pruritus ani 698.1 Pruritus of genital organs 698.2 Prurigo 698.3 Lichenification and lichen simplex chronicus 698.8 Other specified pruritic conditions 698.9 Unspecified pruritic disorder This page was [healthprovidersdata.com]
ani 698.1 - Pruritus of genital organs 698.2 - Prurigo 698.3 - Lichenification and lichen simplex chronicus 698.8 - Other specified pruritic conditions 698.9 - Unspecified pruritic disorder Browse Medical Billing and Coding Databases: ICD-9-CM ICD-9 [emedcodes.com]
Skin
- 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]
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]
neurotic, Factitial dermatitis, FACTITIONAL DERMATITIS, Factitious dermatitis, Feigned dermatitis, neurotic excoriation, Neurotic, excoriation, Simulated dermatitis [dermis.net]
[…] or a problem admitting that you are doing this, then you may have neurotic excoriations. [sclero.org]
- 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]
Subacute or chronic irritant dermatitis morphologically presents with erythema, lichenification, excoriation, scaling, and hyperkeratosis ( Figure 1 ). Figure 1. Chronic irritant contact dermatitis of the hand secondary to extensive water exposure. [dermatologyadvisor.com]
- Skin Rash
Urticaria, commonly known as ‘hives’, is a skin rash which can have allergic and non-allergic causes. [books.google.ro]
- 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]
Psychiatrical
- 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]
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]
Thus, hypochondriasis circumscripta seems to be a serious treatment challenge. Further treatment studies are required. Fig. 3. [medicaljournals.se]
In 11 cases, treatment resulted in significant reduction of the urticaria, but only 7 patients still complained of itching. [hungary.pure.elsevier.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]
Prognosis Simple dermographism is the most common variant, and patients with this form are asymptomatic. However, other forms are associated with pruritus, and this can significantly affect quality of life. [emedicine.medscape.com]
Etiology
Laboratory studies and histopathological examination of the skin could be performed in order to exclude other etiologies. [symptoma.com]
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]
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]
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]
Psycho-cutaneous disorders: an epidemiologic study. J Eur Acad Dermatol Venereol. 2009 Mar 11. [Medline]. Koblenzer CS. Dermatitis artefacta. Clinical features and approaches to treatment. Am J Clin Dermatol. 2000 Jan-Feb. 1(1):47-55. [Medline]. [emedicine.medscape.com]
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]
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]
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]
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
- Rodríguez Pichardo A, García Bravo B. Dermatitis artefacta: a review. Actas Dermosifiliogr. 2013;104(10):854-866.
- 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.
- 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.
- 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.
- Chatterjee SS, Mitra S. Dermatitis Artefacta Mimicking Borderline Personality Disorder: Sometimes, Skin Could Be Misleading. Clin Psychopharmacol Neurosci. 2016;14(3):311-313.
- 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.