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Diseases Similar to Scleroderma (Main Menu) |
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| Dermatitis
Artefacta or Factitial Dermatitis |
| This page
was written by Shelley
Ensz, and has not yet been medically edited. See Disclaimer. |
|
| Overview of Dermatitis
Artefacta or Factitial Dermatitis |
| Dermatitis artefacta means that
somebody has injured their own skin, by any method. They may
injure their skin by: |
- scratching it, with their fingernails or a knife or other
sharp instrument.
|
- burning it with fire such as cigarettes, matches, or
candles.
|
- burning it with caustic chemicals, such as bleach.
|
They may or may not be aware
that they caused the damage themselves, but they typically
deny having intentionally inflicted the injury. |
| Dermatitis artefacta means self-inflicted
lesions of the skin. The lesions are in sites readily accessible
to the patient's hands. The methods used to injure the skin
include deep excoriations with a sharp instrument, scarification
with a knife, the application of caustic chemicals and burning,
sometimes with a cigarette. Elastic bands may be used to produce
oedema (swelling.) DermIS. |
| Other Terms for Dermatitis
Artefacta |
| Other terms for dermatitis artefacta
include: Dermatitis artifacta, dermatitis factitia, dermatitis
factitia, dermatitis ficta, dermatitis simulata, dermatitis,
factitia, excoriation, neurotic, factitial dermatitis, factitional
dermatitis, factitious dermatitis, feigned dermatitis, neurotic
excoriation, simulated dermatitis. DermIS. |
| Causes of Dermatitis
Artefacta |
| People with dermatitis artefacta
usually have an underlying psychological problem. It can be
caused by stress and drugs (particularly methamphetamine or "crank").
Abuse and Munchausen's Syndrome by Proxy are other causes of
what may seem to be self-infliction of injuries, at first glance. |
| Types of Dermatitis
Artefacta |
| Single Episode: If
the dermatitis artefacta is a single episode that was triggered
by a particularly difficult situation (such as job loss or
divorce), about 70% will stop injuring themself once the triggering
situation is resolved. |
| Multiple Episodes: However
for about 30%, dermatitis artefacta is ongoing and recurrent,
as part of a long history of psychological problems. |
| Drugs: People on
drugs, particularly street drugs such methamphetamine, which
is known as "crank", sometimes think they see and/or
feel bugs on their body. They pick at the "bugs" trying
to remove them, creating open wounds and scabs. |
| Methamphetamine:
Crank Bug Bites. A phenomenon sometimes seen in methamphetamine
users is referred to as "crank bug bites." Patients
claim to see and/or feel bugs on their body and attempt to
remove them or pick at them until they create open wounds
and scabs. |
| Fraudulent: Sometimes
people inflict their own skin injuries on purpose in order
to file for insurance claims or disability payments. |
| Abusive: In abusive
situations, sometimes the victim (and/or the perpetrator) will
claim that the injury was self-inflicted in order to skirt
the issue of abuse. |
| Munchausen's
Syndrome by Proxy: Skin injuries are also
common in Munchausen's by proxy, whereby a parent will
inflict injuries on a child in an attempt to convince
doctors their child is sick. SIDS Network. |
| Dermatitis
artefacta is a condition in which skin lesions are solely
produced or inflicted by the patient's own actions. This
usually occurs as a result or manifestation of a psychological
problem. It could be a form of emotional release in situations
of distress or part of an attention seeking behaviour. In
very rare cases there may be an underlying attempt to secure
an insurance claim. Patients present with lesions that are
difficult to recognise and do not conform to those of known
dermatoses. (Photos included.) DermNet NZ. |
| Diagnosis of Dermatitis
Artefacta |
| 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. |
| Thus, even though dermatitis artefacta
is, thankfully, quite rare, it usually comes to light. Then
the doctor needs to determine whether it is intentionally self-inflicted
for fraudulent purposes (such as to collect insurance or disability)
or for other (usually psychiatric) reasons. |
| Differential Diagnosis
of Dermatitis Artefacta |
| Dermatitis
artefacta as the presenting feature of auto-erythrocyte sensitization
syndrome and naproxen-induced pseudoporphyria in a single
patient.The case emphasizes that patients with apparent
artefactual lesions, or with a previous history of dermatitis
artefacta, still require careful evaluation to identify organic
disease. Br J Dermatol. 1992 Jan;126(1):86-9. |
| Munchausen's
syndrome by proxy (child abuse) presenting as apparent autoerythrocyte
sensitization syndrome: an unusual presentation of Polle
syndrome. Pediatrics, Volume 74, Issue 6, pp. 1100-1102,
12/01/1984. |
| Differential Diagnosis:
Medical Causes of Itching |
| Medical
causes of itching skin. Dozens of illnesses and skin
diseases can cause itching, ranging from mild to severe.
See your doctor if you have new onset of itching skin. WrongDiagnosis.com. |
| Differential Diagnosis:
Neurotic Excoriations |
| If you often create sores by picking
or scratching yourself until a sore forms (but not by using
such things as sharp instruments, fire, or chemicals to create
the sores) and you don't have an underlying disease or a problem
admitting that you are doing this, then you may have neurotic
excoriations. |
| Neurotic
excoriations are skin lesions produced by the patient
through repetitive scratching, without an underlying physical
pathology. The patient often has a comorbid mental illness
(usually anxiety or a mood disorder). Unlike other self-inflicted
dermatoses (e.g., dermatitis artefacta and malingering),
the patient with neurotic excoriations acknowledges the self-inflicted
nature of the lesions. American Family Physician. |
| Neurotic
Excoriations. Patients consciously create neurotic excoriations
(NEs) by repetitive scratching. This allows NEs to be distinguished
from dermatitis artefacta in which patients unconsciously
scratch. NEs can be initiated by some minor skin pathology,
such as an insect bite, folliculitis, or acne, but it can
also be independent of any pathology. Because no significant
underlying pathology is present in the skin, NEs are really
a psychologic process with dermatologic manifestations. eMedicine. |
| Differential Diagnosis:
What's Normal? |
| Let's say you got a mosquito bite,
pimple or other injury led to itching, picking, scratching
and worsening of the original injury, for no particular reason
at all. |
| It's not compulsive, you can (and
do) stop itching and digging at it as soon as you realize what
you are doing and that it's not helpful, and it does not become
a bad habit nor lead to an ongoing, nonhealing or infected
sore. |
| Also, you didn't originally create
the injury on purpose by using a knife or matches or chemicals.
You didn't do it to try to get sympathy or to impress your
friends or doctor with a "strange weird skin disease" or
to try to pull an insurance scam, or just because you are under
a lot of stress (such as a divorce). |
| By all means, it was triggered
by an intial injury that you did not intentionally inflict
on yourself; you know you made the injury worse yourself, and
you haven't tried to pass it off as an "unknown" or
mysterious new skin disease. |
| All in all, that's very likely
just a normal thing, and not dermatitis
artefacta or a neurotic excoriation. You really don't need
to have your head, or your motives, examined. |
| If you've only done a normal thing
or two like this, and nothing more serious, yet you're convinced you
have dermatitis artefacta or neurotic excoriations anyway,
then you might want to read up about hypchondriasis or anxiety
disorder. |
| Treatment of Dermatitis
Artefacta |
| A
Nonhealing Ulcer on the Face. When dermatitis artefacta
is suspected, direct confrontation should be avoided. Evaluation
of the patient's emotional situation or stresses should be
made, and psychiatric counseling, if necessary, should be
given. Sedatives and antidepressant agents may also be prescribed.
In a study by Sneddon and Sneddon,10 33 patients with artifactual
disease were followed up for 22 years. Most of the patients
had long histories of psychological illness; a few had family
difficulties. Seventy percent of the patients studied recovered
from their cutaneous lesions after resolution of the underlying
situation. Arch Fam Med. 2000;9:787-789. |
| Prognosis of Dermatitis
Artefacta |
| Self-inflicted
injury: A follow-up study of 43 patients.Forty-three
patients, 38 women and 5 men, with self-inflicted skin lesions
were studied. Thirty-three were followed up for up to 22
years. In most cases dermatitis artefacta was only one incident
in a long history of psychogenic illness. Of the 43 patients,
13 (30%), 12 women and one man, continued to produce lesions
or were disabled with other psychiatric disorders more than
12 years after the onset of symptoms. 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 Aug 30;3(5982):527-30. |
| Case Histories of
Dermatitis Artefacta |
| Recurrent
Erythematous Dermatitis artefacta in the Face Induced by
Benzyl Nicotinate. We report an example of an unusual
and treatment-resistant erythematous facial dermatosis in
an adolescent girl imitating a number of dermatological disorders
which led to a delay in the diagnosis of dermatitis artefacta
induced by benzyl nicotinate. Exogenous Dermatology, Vol.
1, No. 5, 2002. |
| Monosymptomatic
hypochondriacal psychosis complicated by self-inflicted skin
ulceration, skull defect and brain abscess. We report
an unusual case of MHP with severe mutilation of the skin
complicated by a skull defect and brain abscess. The patient
was a 66-year-old uneducated man who damaged his forehead
repeatedly because he believed that a `toxic root' in the
forehead was the source of his general ailment. He admitted
that the lesions were self-inflicted. British Journal
of Dermatology, August 1997, vol. 137, no. 2, pp. 299-302(4). |
| A
Nonhealing Ulcer on the Face. A 70-year-old Italian man
presented with a 6-month history of a deep ulcerative lesion
involving his left nasal ala after use of a nasal canula
during a recent hospitalization. The lesion failed to heal
and gradually expanded. At presentation, the patient was
noted to be missing approximately half of the left nasal
ala. Archives of Family Medicine, Vol. 9 No. 9, September
2000. |
