Factitious dermatitis

Factitious Dermatitis (also known as Dermatitis Artefacta or Self-inflicted Skin Lesions) is a condition characterized by skin lesions that are deliberately produced or feigned by a person for various psychological reasons. The condition falls under the spectrum of Factitious Disorder Imposed on Self, previously known as Munchausen Syndrome by Proxy when applied to oneself. Patients with Factitious Dermatitis often seek medical attention for lesions that they have intentionally created or exacerbated. The diagnosis and management of this condition pose a significant challenge to healthcare providers due to the complex interplay of psychological factors involved.

Etiology and Pathophysiology

The exact cause of Factitious Dermatitis is not well understood, but it is believed to be associated with psychological distress or psychiatric disorders. Individuals may inflict harm upon their skin through various methods such as cutting, burning, or applying irritants, driven by an unconscious need to assume the sick role and receive medical care or sympathy. The condition is considered a psychiatric disorder, and it may coexist with other mental health disorders such as depression, anxiety disorders, and borderline personality disorder.

Clinical Features

Factitious Dermatitis presents with a wide variety of skin lesions, which can include erosions, ulcers, bruises, or burns. The lesions typically appear on accessible parts of the body that the patient can easily reach, such as the arms, legs, or abdomen. The distribution and appearance of the lesions are often unusual, lacking a clear medical or dermatological cause. Patients may have a history of frequent visits to healthcare providers, unsuccessful treatments, and vague or inconsistent explanations for their injuries.

Diagnosis

Diagnosing Factitious Dermatitis requires a high index of suspicion and a thorough clinical evaluation. Important diagnostic criteria include:

• Exclusion of other dermatological or medical conditions that could explain the lesions.
• Evidence or admission of self-infliction.
• Presence of psychological factors contributing to the behavior.

A multidisciplinary approach involving dermatologists, psychiatrists, and other healthcare professionals is often necessary to assess and manage the condition effectively.

Management

The management of Factitious Dermatitis is challenging and focuses on addressing both the physical and psychological aspects of the condition. Treatment strategies may include:

• Establishing a supportive and nonjudgmental therapeutic relationship.
• Referral to psychiatric or psychological services for assessment and therapy.
• Use of medications to treat any coexisting psychiatric disorders.
• Limiting unnecessary medical interventions or procedures that could reinforce the behavior.

Prognosis

The prognosis of Factitious Dermatitis varies widely. Some individuals may only exhibit the behavior for a short period, while others may have chronic, recurrent episodes. The success of treatment largely depends on the patient's willingness to engage in psychiatric or psychological care and the underlying reasons for the behavior.

See Also

• Munchausen Syndrome
• Self-harm
• Psychodermatology