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].
Entire Body System
- Pain
The patient had vague complaints like weakness, joint pain, pain in both the eyes and pain in the abdomen for 2-3 years. The patient was not giving any history of trauma at the site of skin lesions. [ijdvl.com]
Then on attempting to walk she experienced severe pain in the left hip. She felt [jamanetwork.com]
The sensation is characterized with unbearable affective pressure of pain, predominance in patient’s consciousness, inability to prescinds from pain. [medicaljournals.se]
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]
[…] points in research domain (artifact: mabh-crg use case document) Identify any non-standard use cases or pain points in clinical domain (artifact: mabh-crg use case document) 3 Understand major conceptualizations of the concept Perform environmental scan [confluence.ihtsdotools.org]
- Swelling
Since then, swelling and ulceration appeared on his limbs one after another during a period of 2 years and 3 months. Abnormality was not discovered on various tests. [jstage.jst.go.jp]
Urticaria is characterized by fast appearance of redness with swelling and/or angioedema. The redness with swelling usually consists of: central swelling of different size surrounded by erythema. It is followed by an itch or burning feeling. [cbcsafe.org]
[…] 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, clogs, or inflames your skin can cause symptoms such as redness, swelling [icdlist.com]
Intramuscular injection of adrenaline (epinephrine) is reserved for life-threatening anaphylaxis or swelling of the throat. [dermnetnz.org]
Within minutes, redness, swelling, and intense itching result. [gaapp.org]
- Weakness
Very low All weak Trial with doxycyline p.o. [waojournal.biomedcentral.com]
He used physical symptoms as a defence mechanism to protect his weak ego structure, which made it difficult for him to fulfil social responsibilities. [journals.lww.com]
Due to the lack of antigens, histamine causes the skin to swell in affected areas. [3] If the membrane that surrounds the mast cells is too weak it will easily and rapidly break down under physical pressure, which then causes an allergic-like reaction [en.wikipedia.org]
The patient had vague complaints like weakness, joint pain, pain in both the eyes and pain in the abdomen for 2-3 years. The patient was not giving any history of trauma at the site of skin lesions. [ijdvl.com]
General examination was normal except for the presence of weakness, malaise, and pallor. [pigmentinternational.com]
- Malaise
General examination was normal except for the presence of weakness, malaise, and pallor. [pigmentinternational.com]
Investigations for a systemic condition or autoinflammatory disease should be undertaken in urticaria patients with fever, joint or bone pain, and malaise. [dermnetnz.org]
By chance it was discovered that the manifestations were caused by self-injections of milk that produced erythematous nodules around the injection site accompanied by chills, fever, sweating, and general malaise. [actasdermo.org]
Cardiovascular
- Hypertension
Delivery Models Health Care Economics, Insurance, Payment Health Care Policy Health Care Quality Health Care Reform Health Care Safety Health Care Workforce Health Disparities Health Informatics Health Policy Hematology History of Medicine Humanities Hypertension [jamanetwork.com]
The patient was diagnosed 10 years before with arterial hypertension well controlled by indapamide; a cardiological examination revealed no anomaly or no neurological symptoms. [dovepress.com]
Skin
- Dermatitis
[…] artefacta (disorder), Dermatitis factitia, Dermatitis artefacta, Dermatitis ficta, Neurotic excoriation, Dermatitis simulata, Factitious dermatitis, Feigned dermatitis, Simulated dermatitis, DA - Dermatitis artefacta, Dermatitis factitia (disorder), [fpnotebook.com]
Berloque dermatitis berloque dermatitis med. brucella-dermatitis Brucella dermatitis med. dermatitis actinica dermatitis actinica med. dermatitis actinica phototoxic dermatitis med. dermatitis actinica radiodermatitis med. dermatitis actinica X-ray dermatitis [multitran.com]
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. [symptoma.com]
Factitial dermatitis in Adult See also in: External and Internal Eye Alerts and Notices Synopsis Factitial dermatitis (dermatitis artefacta) is a psychiatric condition, characterized by skin lesions that are self-induced to satisfy an unconscious [visualdx.com]
- Urticaria
These conditions include urticaria factitia/symptomatic dermographism, delayed pressure urticaria, cold contact urticaria, heat contact urticaria, solar urticaria, and vibratory urticaria/angioedema. [unboundmedicine.com]
Scratching generates new lesions. synonyms Urticaria Factitia, Dermographic Urticaria, Factitious Urticaria images 5 images found for this diagnose related PeDOIA Same page in PeDOIA differential diagnoses Cold Urticaria (1) Urticaria Mechanica (3) related [dermis.net]
Chronic urticaria, i.e., spontaneous urticaria lasting more than six weeks, is very much rarer than acute urticaria. [ga2p2.org]
Natural Urticaria hivesfromallergies.clubc Urticaria Treatment 3 Proven Methods of Treating Chronic Idiopathic Hives. Zur Unterscheidung der Urticaria pigmentosa von der Urticaria xanthelasmoidea. Diskussion zu einer Demonstration von Adrian. [hivesfromallergies.club]
Classification: Spontaneous urticaria acute and chronic Physical urticaria urticaria factitia postponed pressure urticaria cold urticaria heat urticaria solar urticaria urticaria/angioedema from vibration Other urticaria types aquagenic cholinergic contact [cbcsafe.org]
- 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]
Patients will not admit to creating the lesions, which are usually more elaborate than simple excoriations. [visualdx.com]
neurotic, Factitial dermatitis, FACTITIONAL DERMATITIS, Factitious dermatitis, Feigned dermatitis, neurotic excoriation, Neurotic, excoriation, Simulated dermatitis [dermis.net]
- Pruritus
Burns Abuse Medical causes of pruritus (see pruritus without rash) Neuropathic (eg, trigeminal trophic syndrome) Best Tests Subscription Required Management Pearls Subscription Required Therapy Subscription Required References Subscription Required Last [visualdx.com]
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 Disease
Images: Related links to external sites (from Bing) Ontology: Factitious skin disease (C1274184) Concepts Disease or Syndrome ( T047 ) ICD9 698.4 ICD10 L98.1 SnomedCT 156384004, 27720003, 402736003 English Factitial dermatitis, Dermatitis factitia (artefacta [fpnotebook.com]
Diagnosis Skin injuries and diseases are quite well defined, so the cause of a skin injury or defect can be determined by how it looks, by certain details in the patient's description of the injury, and by microscopic examination of skin biopsies. [web.archive.org]
Allergies, irritants, your genetic makeup, and certain diseases and immune system problems can cause rashes, hives, and other skin conditions. Many skin problems, such as acne, also affect your appearance. [icdlist.com]
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]
[…] 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. [ncbi.nlm.nih.gov]
Denial regarding the self-inflicted nature of injury/injuries is a common finding, [1] consistent with our cases. [e-ijd.org]
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]
Prognosis
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]
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]
[…] 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]
Morphological Presentation. 62 Pradhan S...Mohapatra D 30775305 2019 40 Dermatitis artefacta. 62 Lavery MJ...Anolik RB 30446194 2018 41 Dermatitis artefacta in childhood and adolescence: a spectrum of disease. 62 Mohandas P...Bewley A 29683292 2018 42 Review of epidemiology [malacards.org]
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]
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]
Clark and Zirwas detail the important points of recognition, treatment, and prevention of occupational contact dermatitis. [dermatologyadvisor.com]
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.