CASE REPORT A Psycho-Cutaneous Disorder: Dermatitis Artefacta

Turan Sönmez F et al.
CASE
REPORT
Feruza Turan Sönmez1
Harun Güneş1
Ayhan Sarıtaş1
Hayati Kandiş1.
1. Duzce University, School of
Medicine,
Department
of
Emergency Medicine, Duzce,
Turkey.
A Psycho-Cutaneous
Artefacta
Disorder:
Dermatitis
SUMMARY
Dermatitis artefacta is a psycho-cutaneous disorder that is commonly
associated with mood and anxiety disorders. The morphology of lesions
may call to mind violence exposure. Studies have shown preponderance
of female, and frequency of the disease among main psycho-cutaneous
disorders is about 6-7%. Emergency physicians frequently encountered
with many lesions that need differential diagnosis. Dermatitis artefacta
is one of them and often it is a challenge for clinicians, because it is
relatively rare disease with vague history, bizarre and polymorphic
morphology. We, hereby, report a case of acute onset cutaneous
reactions that later was diagnosed as Dermatitis artefacta.
Key words: Dermatitis Artefacta, Psycho-Cutaneous Disorders,
Emergency
Corresponding Author:
Dr. Feruza Turan Sönmez
Duzce University School of
Medicine,
Department
of
Emergency Medicine, Duzce,
Turkey.
Mail: [email protected]
Geliş Tarihi: 04.04.2016
Kabul Tarihi: 15.04.2016
Prusias Medical Journal
Prusias Tıp Dergisi
e-ISSN 2459–0681
[email protected]
www.prusiasacademic.com
Psiko-kütanöz Bozukluk: Dermatitis Artefacta
ÖZET
Dertamitis artefakta, sıklıkla duygu durum ve anksiyete bozuklukları ile
ilişkili olan bir hastalıktır. Lezyonların görünüşü akla şiddete maruziyeti
akla getirebiliyor. Çalışmalar, bu hastalıkta bayan sayısının ağırlıkta
olduğunu gösteriyor ve majör psikodermatozlar arasında % 6-7’lik
orana sahiptir. Acil hekimleri sıklıkla ayırıcı tanı gerektiren deri
lezyonlarıyla karşılaşırlar. Dermatitis artefakta bunlardan biridir ve
göreceli olarak nadir görülmesi, hikayesinin müphem olması, değişken
ve polimorfik morfolojiye sahip olması nedeni ile klinisyenler için bir
sorundur. Bu yazımızda akut gelişen ve daha sonra dermatitis artefakta
olarak tanı alan bir deri reaksiyonu sunduk.
Anahtar Kelimeler: Dermatitis Artefakta, Psiko-Kütanöz Bozukluklar,
Acil
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Turan Sönmez F et al.
INTRODUCTION
Dermatitis artefacta (DA) is a psychocutaneous disorder that is commonly associated
with mood and anxiety disorders. The patient
intentionally induces skin lesion to mimic an
illness. Dermatitis artefacta lesions usually appear
at an indistinguishable stage of development, can be
single or multiple, are often geometric, unilateral or
bilateral, and generally within reach of the hands
(1).
The patient forms lesions by rubbing or
scratching, by the use of a sharp instrument or not
or by applying chemical substance into the skin.
Characteristically, patients describe the sudden
appearance of complete lesions, with little or no
prodrome ("hollow history"), and usually deny
taking part in the process, exhibiting a "belle
indifference" and lack of frustration despite the
recurrent nature of their symptomatology (2,3).
Studies have shown preponderance of female, and
frequency of the disease among main psychocutaneous disorders is about 6-7% (4). We, hereby,
report a case of acute onset cutaneous reactions that
later was diagnosed as DA.
CASE REPORT
A 24-year-old female presented with
swallowing of periorbital skin, multiple cone-form,
hyperemic lesions no face and forehead and
irregular, non-itchy ecchymotic areas on neck
(Figure 1). She appeared anxious and had slight
tremor. On physical examination heart rate was 110
beats/minute.
The patient denied self-harm or violence,
she could not explain the cause of the lesions. She
declared that ever she has a trouble to bear any
anxiety she suffers from such itchy lesions that
appear immediately after. We investigated allergic
reaction history, questioned for assault, checked
laboratory findings and found no further
abnormalities.
We treated the patient with diazepam for
anxiety and with prednisolone and feniramine for
the lesions. Later we consulted the patient to
dermatology. Skin biopsy was determined. Biopsy
samples showed diffuse non-specific inflammatory
pattern and the patient was diagnosed as dermatitis
artefacta.
Figure 1. A 24-year-old female presented with swallowing of periorbital skin, multiple cone-form, hyperemic lesions no face
and forehead and irregular, non-itchy ecchymotic areas on neck
DISCUSSION
Dermatitis artefacta is a self-inflicted
cutaneous lesion where the patient denies self-harm
(5).
Lesions may call to mind violence
exposure and generally unwillingness to provide
any explanation about the lesions maces the
decision
critical.
Important
dermatological
differentials are necrotizing vasculitis, pyoderma
gangrenosum, and cutaneous T-cell lymphoma. The
Munchausen syndrome should be considered as an
important psychiatric differential, characterized by
flamboyant males who feign multiple symptoms
and shifting complains not limited to only the skin,
just to draw attention (6).
Emergency
physicians
frequently
encountered with many lesions that need
differential diagnosis. DA is one of them and often
it is a challenge for clinicians, because it is
relatively rare disease with vague history, bizarre
and polymorphic morphology (6).
For, dermatitis artefacta is a psychocutaneous disorder, management of the patient
should be supportive, non-confrontational, flexible,
and should involve building mutual trusts and
understanding between patient and treating
clinician.
Conflict of interest: The authors declared no
conflicts of interest with respect to the authorship and/or
publication of this article.
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Turan Sönmez F et al.
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