Cutaneous Munchausen Syndrome by Proxy: A Diagnostic Challenge for Dermatologist

Abstract

Munchausen syndrome by proxy (MSBP) is a rare psychiatric disorder of a caregiver (commonly mother) who induces injury or symptoms on victim because of his or her psychiatry illness. The victims are usually under 6 years of age who cannot complain regarding inflicted injury. Diagnosis is challenging to the physician. We came across a 15-month-old girl child, who had consulted various specialists for episodes of blister followed by erosions on body since 6 months of age. Dermatological examination revealed blisters and healed leaf-shaped scars of different sizes which were suggestive of scalds. Smell of different varieties of oils, dribbling of hot oil from body at various intervals, and mother being the first to notice appearance of new skin lesions in all past episodes lead to suspicion of cutaneous MSBP with mother being the culprit. The family members were counselled regarding nature and course of the condition, mother was started on psychotropics, and the child was rescued from mother along with symptomatic treatment of the skin lesions.

Keywords: Hot oil burn; Munchausen syndrome by proxy; leaf-shaped scars; mother; skin.

Figure 1

(a) Linear ulcers on scalp and cheek. (b) Bizarre-shaped hypopigmented and hyperpigmented scars on various parts of body. (c) Patchy cicatricial alopecia on scalp. (d) Ectropion of left upper eyelid

Figure 2

(a-c) Scars with imprint of leaves on trunk, abdomen, and thighs