Cutaneous artifactual disease. A review, amplified by personal experience

Abstract

Cutaneous artifactual disease is part of the general syndrome of contrived disease. While classical examples are easy to recognize, it can present in unusual ways. Difficulties in recognition include the unusual doctor-patient relationship, the doctor's fear of missing organic disease, and the reality of the disease to the patient's family and the family doctor. The diagnosis depends upon finding lesions whose morphology is consistent and an emotionally immature patient, whose personality shows, or has shown, hysterical and masochistic traits. Lesions "arrive" fully developed. Once there they begin to heal, so that a continuous supply of new ones is necessary if the illness is to continue. High intelligence is compatible with the diagnosis, but a mature personality is not. The differential diagnosis is extensive. Investigations prove negative or equivocal; in the latter case, the investigator is led even further into unfamiliar territory. It is suggested that the essence of management is to keep in contact with the patient.