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28 September 2012

A cry for help, do not omit the signs. Dermatitis artefacta – psychiatric problems in dermatological diseases (a review of 5 cases)

Karolina WojewodaCDE, Jonas BrennerC, Monika KąkolB, Matilda NaesströmB, Wiesław Jerzy CubałaD, Dorota KozickaB, Roman NowickiF, Małgorzata Sokołowska-WojdyłoF, Wioletta Barańska-RybakAE

DOI: 10.12659/MSM.883474

Med Sci Monit 2012; 18(10): CS85-89

Abstract

Background: Dermatitis artefacta (DA) is a dermatologicopsychiatric illness that is a conscious self-infliction of lesions to accessible regions of the body. The lesions usually do not resemble those of any know skin disease and there are no specific diagnostic tests to recognize them. This makes dermatitis artefacta a very slow, challenging and expensive disease to diagnose.
Case Report: We present 5 different clinical cases of dermatitis artefacta treated in the Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk in 2011. Detailed anamnesis and physical examination were performed at the day of admission. All patients had biochemical and hematological blood tests, skin biopsies and swabs for bacteriological examination, and photographs were taken. Psychiatric consultation was recommended in all cases.
Clinical symptoms before diagnosis lasted from 1 to 10 years. The female-to-male ratio is 1:0.7, with age range of 57–62 years. Of our patients, only 2 refused a psychiatric consultation. Three out of 5 patients denied self-mutilation (2 of those 3 patients finally admitted to self-manipulations). Lesions were usually within the reach of the dominant hand. Two patients have other personality disorders. In 4/5 cases visible improvement after treatment with occlusive dressings were observed.
Conclusions: We discuss and attempt to depict issues associated with collaboration between dermatologists and psychiatrists, reasons for poor recognition of the disease, very long diagnosis and high costs. To conclude, we found that close collaboration between dermatologists and psychiatrists is important in diagnosing and treating DA patients.

Keywords: Dermatitis - psychology, Cicatrix - psychology, Ulcer - psychology

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750