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Dermatitis Artefacta or Factitial Dermatitis

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Overview
Other Terms
Causes of Dermatitis Artefacta
Types of Dermatitis Artefacta
Diagnosis of Dermatitis Artefacta
Differential Diagnosis
Medical Causes of Itching
Neurotic Excoriation
What's Normal?
Treatment of Dermatitis Artefacta
Case Histories of Dermatitis Artefacta

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.
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.

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

Dermatitis Artefacta (Includes Photos). When dermatitis artefacta is suspected, direct confrontation should be avoided. Instead the doctor should create an accepting, empathetic and non-judgemental environment. To minimise occurrences of dermatitis artefacta, a patient should continue to see their doctor on an ongoing basis for supervision or support, whether or not lesions are present. DermNet NZ.

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.
 
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