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Review
. 2012 Oct;18(10):CS85-9.
doi: 10.12659/msm.883474.

A cry for help, do not omit the signs. Dermatitis artefacta--psychiatric problems in dermatological diseases (a review of 5 cases)

Karolina Wojewoda  1 , Jonas Brenner, Monika Kąkol, Matilda Naesström, Wiesław Jerzy Cubała, Dorota Kozicka, Roman Nowicki, Małgorzata Sokołowska-Wojdyło, Wioletta Barańska-Rybak
Affiliations
Review

A cry for help, do not omit the signs. Dermatitis artefacta--psychiatric problems in dermatological diseases (a review of 5 cases)

Karolina Wojewoda et al. Med Sci Monit. 2012 Oct.

Abstract

Background: Dermatitis artefacta (DA) is a dermatologicopsychiatric illness that is a conscious self-infliction of lesions to accessible regions of the body. The lesions usually do not resemble those of any know skin disease and there are no specific diagnostic tests to recognize them. This makes dermatitis artefacta a very slow, challenging and expensive disease to diagnose.

Case report: We present 5 different clinical cases of dermatitis artefacta treated in the Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk in 2011. Detailed anamnesis and physical examination were performed at the day of admission. All patients had biochemical and hematological blood tests, skin biopsies and swabs for bacteriological examination, and photographs were taken. Psychiatric consultation was recommended in all cases. Clinical symptoms before diagnosis lasted from 1 to 10 years. The female-to-male ratio is 1:0.7, with age range of 57-62 years. Of our patients, only 2 refused a psychiatric consultation. Three out of 5 patients denied self-mutilation (2 of those 3 patients finally admitted to self-manipulations). Lesions were usually within the reach of the dominant hand. Two patients have other personality disorders. In 4/5 cases visible improvement after treatment with occlusive dressings were observed.

Conclusions: We discuss and attempt to depict issues associated with collaboration between dermatologists and psychiatrists, reasons for poor recognition of the disease, very long diagnosis and high costs. To conclude, we found that close collaboration between dermatologists and psychiatrists is important in diagnosing and treating DA patients.

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Figures

Figure 1
Figure 1
Ulceration of the neck with visible scar above (Author – Wioletta Barańska-Rybak).
Figure 2
Figure 2
Erosions on the right hand the day of admission (Author – Wioletta Barańska-Rybak).
Figure 3
Figure 3
Erosions and ulceration on the second digit (A) at day of the admission (B) 30 days after admission (C) at the day of discharge from hospital, 60 days after treatment (Author – Wioletta Barańska-Rybak).
Figure 4
Figure 4
Erosions and scars on the back (Author – Wioletta Barańska-Rybak).
Figure 5
Figure 5
“Proof” brought by patient (Author – Wioletta Barańska-Rybak).
See this image and copyright information in PMC

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