What is Dermatitis Artefacta?

Dermatitis artefacta, also known as factitious dermatitis, is a skin-related psychological condition. Patients with this disorder deliberately harm their own skin, hair, nails or the moist tissues that line the body’s interior, often to meet a psychological need, draw attention, or avoid responsibility. These patients often hide what they are doing from their doctors. Dermatitis artefacta should be considered a possible diagnosis when dealing with skin conditions that are long-term, puzzling, and keep coming back.

What Causes Dermatitis Artefacta?

Unlike faking an illness for some gain, people producing their own skin lesions aren’t looking for a direct advantage. They create these wounds to meet a psychological need – often, a desire to be noticed or cared for. Several reasons could lead to this, including struggles with one’s personal life, emotional immaturity, subconscious drives, and poor relations with others.

Risk Factors and Frequency for Dermatitis Artefacta

In general, this condition tends to be more common in females, with ratios varying from 20:1 to 4:1 in comparison to males. This condition is usually seen at its peak from late teenage years to early adulthood. It’s important to note that no age group is immune from this condition. It has been recorded in people who are senior in age and even in children as young as 8 years old. In the past, it used to be diagnosed more frequently in individuals with medical knowledge. However, with society becoming more modern and well-informed, and with greater access to the internet and media, this bias is becoming less visible.

Signs and Symptoms of Dermatitis Artefacta

Dermatitis artefacta is a condition where individuals cause harm to their own skin, often resulting in skin lesions that resemble a wide array of known skin reactions. The explanation given by the affected individuals for the origin of these sudden, fully formed lesions is often incomplete. The focus tends to be more on the complications and lack of healing. Even though these patients seem unconcerned about their condition, their relatives often display feelings of anger and frustration.

The skin lesions can look different from one case to another. They could appear as circular blisters, wounds, burns from exposure to cold or heat, scratch marks, hives, bleeding, hardened skin or skin die-off. All of these could be self-inflicted using various objects or chemicals. This is usually noticeable when closely examining the raw inflammation of the skin. Any part of the body can be affected, however, it’s seen most frequently on the face, back of the hands, and forearm of the hand that is not dominant. Patients may even show non-healing wounds after a surgical procedure.

Below are the common areas affected by dermatitis artefacta:

  • Face, most common
  • Lower extremity, 2nd most common
  • Hands and forearm, 3rd most common
  • Trunk (body)
  • Upper arm and shoulder
  • Scalp
  • Neck

Here are the types of lesions one might observe in cases of dermatitis artefacta:

  • Abrasions or erosions
  • Hair loss
  • Crusted lesions
  • Discolored spots
  • Red bumps
  • Excoriations (scratch marks)
  • Nail deformation
  • Small, red or purple spots on the skin
  • Scars in chronic cases
  • Open sores

Most people with this condition display more than one type of skin lesion. During a physical examination, health care providers should distinguish this disorder from others with similar signs such as hair-pulling disorder, skin-picking disorder, and neglected dermatitis. In severe cases, the skin lesions might resemble conditions such as T cell lymphoma (a type of cancer), hemophilia (a bleeding disorder), and late skin porphyria (a type of porphyria affecting the skin).

Testing for Dermatitis Artefacta

The way a condition appears and presents itself can often help doctors make a diagnosis. If certain physical characteristics are present and the problem appears in a specific area or pattern, these cues can be almost enough to determine the condition. The usual signs differ greatly when comparing conditions like obsessive skin-picking, delusional disorders, faking sickness for no apparent gain, and frequent hospital visitors who feign illness.

For crusted or blistering skin problems, the potential causes include skin infections like ecthyma or herpes simplex. There are also other conditions that might look similar, such as a type of porphyria that mainly affects the skin, a rare skin disorder called epidermolysis bullosa acquisita, a buildup of certain proteins called amyloidosis, inflammation of blood vessels or vasculitis, a painful skin ulcer known as pyoderma gangrenosum, skin cancer, reactions to medication, or a spider bite causing skin damage and inflammation.

Treatment Options for Dermatitis Artefacta

Skin problems may require treatment with creams or ointments that contain antibiotics. However, if the infection is severe, prescription drugs might be necessary. It’s also crucial to treat any underlying mental health issues, which might call for medication such as antipsychotics, antidepressants, or calming medicines. Non-prescription pain medications may be suggested, but stronger, possibly addictive analgesics should be avoided.

If depression symptoms are present, certain medications like SSRIs are typically preferred. Tricyclic antidepressants can also be beneficial for those struggling with itching, sleep issues, pain, and depression. For patients experiencing delusions or psychosis, antipsychotics might be necessary, but they shouldn’t be used for a prolonged period due to possible side effects.

Managing this type of health issue can be challenging due to the patient’s denial of emotional distress and the complex feelings it can trigger in medical staff. The best approach is to be understanding, empathetic, and non-judgmental, and avoid any confrontational behavior. Closely observing and treating skin problems can help build a relationship with the patient, and may pave the way for discussions about mental health, and potentially psychiatric referral. If the patient refuses to see a psychiatrist, medication for mental health issues can be prescribed by a dermatologist.

SSRIs or low-dose antipsychotics can be effective. However, it’s important to note that in cases not triggered by immediate stress, the chances of a complete resolution are low. The condition tends to vary according to changes in the patient’s life. Although skin problems can be minimized and the patient can be protected from unnecessary invasive tests with careful monitoring, support and regular reviews.

This condition, known as Dermatitis artefacta, is a long-term disorder that requires ongoing check-ups with both a dermatologist and psychiatrist, as relapses are common. Unfortunately, many patients fail to adhere to their treatment or even attend their follow-up appointments.

When diagnosing dermatitis artefacta, a skin condition often caused by self-harm, doctors need to consider and exclude other conditions that might have similar symptoms. These may include:

  • Alopecia Areata (hair loss in small patches)
  • Anagen Effluvium (abrupt hair loss)
  • Bedbug bites
  • Delusions of Parasitosis (false belief of being infested with parasites)
  • Friction Blisters (blisters caused due to friction)
  • Impetigo (bacterial skin infection)
  • Insect bites
  • Irritant contact dermatitis (skin inflammation caused by contact with some substances)
  • Onycholysis (separation of a nail from the nail bed)
  • Telogen Effluvium (a temporary hair loss condition)

By considering these possibilities and doing the necessary tests, doctors can reach an accurate diagnosis.

What to expect with Dermatitis Artefacta

People with mild cases of dermatitis artefacta, a skin condition often linked with stress, anxiety, or depression, usually have good outcomes. However, if the condition is chronic and is associated with other medical problems or persistent skin damage, the prognosis is less optimistic. People in such cases often can’t be completely cured, and the condition tends to recur frequently.

If dermatitis artefacta is not treated, it can result in severe self-damage and unsightly scarring. In the most severe cases, there is even a risk of suicide. Therefore, it’s important to recognize and treat this condition early to avoid these serious outcomes.

Frequently asked questions

Dermatitis Artefacta is a skin-related psychological condition where patients deliberately harm their own skin, hair, nails, or moist tissues to meet a psychological need, draw attention, or avoid responsibility.

This condition tends to be more common in females, with ratios varying from 20:1 to 4:1 in comparison to males.

The signs and symptoms of Dermatitis Artefacta include: - Circular blisters - Wounds - Burns from exposure to cold or heat - Scratch marks - Hives - Bleeding - Hardened skin or skin die-off - Non-healing wounds after a surgical procedure - Abrasions or erosions - Hair loss - Crusted lesions - Discolored spots - Red bumps - Excoriations (scratch marks) - Nail deformation - Small, red or purple spots on the skin - Scars in chronic cases - Open sores It is important for healthcare providers to distinguish Dermatitis Artefacta from other disorders with similar signs, such as hair-pulling disorder, skin-picking disorder, and neglected dermatitis. In severe cases, the skin lesions might resemble conditions such as T cell lymphoma, hemophilia, and late skin porphyria.

Dermatitis Artefacta is a condition where individuals cause harm to their own skin, often resulting in skin lesions that resemble a wide array of known skin reactions. The skin lesions can be self-inflicted using various objects or chemicals.

Alopecia Areata, Anagen Effluvium, Bedbug bites, Delusions of Parasitosis, Friction Blisters, Impetigo, Insect bites, Irritant contact dermatitis, Onycholysis, Telogen Effluvium.

There are no specific tests mentioned in the text for diagnosing Dermatitis Artefacta. However, the text does mention the importance of closely observing and treating skin problems, as well as managing any underlying mental health issues. Therefore, the types of tests that a doctor might order to properly diagnose this condition could include: - Physical examination of the skin to assess the appearance and pattern of the skin problems - Blood tests to check for any underlying infections or conditions that might be contributing to the skin problems - Psychological evaluation to assess any underlying mental health issues that might be present - Dermatological tests, such as skin biopsies or patch testing, to rule out other possible causes of the skin problems.

Dermatitis Artefacta can be treated with creams or ointments containing antibiotics for skin problems. In severe cases, prescription drugs may be necessary. Treatment of underlying mental health issues may also be required, which can involve medication such as antipsychotics, antidepressants, or calming medicines. Non-prescription pain medications may be suggested, but stronger analgesics should be avoided to prevent addiction. Regular check-ups with both a dermatologist and psychiatrist are necessary for ongoing management of this long-term disorder.

When treating Dermatitis Artefacta, there can be possible side effects depending on the medications used. Some potential side effects include: - Side effects from antibiotics creams or ointments - Possible side effects from prescription drugs, especially if the infection is severe - Side effects from antipsychotics, such as those used for delusions or psychosis - Side effects from antidepressants, such as SSRIs or tricyclic antidepressants - Potential addictive side effects from stronger analgesics, which should be avoided - The condition itself may vary according to changes in the patient's life, and relapses are common, requiring ongoing check-ups with both a dermatologist and psychiatrist.

The prognosis for Dermatitis Artefacta depends on the severity of the condition and whether it is associated with other medical problems or persistent skin damage. People with mild cases usually have good outcomes, while those with chronic and more severe cases may not be completely cured and the condition tends to recur frequently. If left untreated, Dermatitis Artefacta can result in severe self-damage, unsightly scarring, and even a risk of suicide.

A dermatologist and a psychiatrist.

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