Indian Journal of Psychological Medicine
  Home | About Us | Editorial Board | Search | Ahead of print | Current Issue | Archives | Instructions | Contact | Advertise | Submission | Login 
Users Online: 239 
Wide layoutNarrow layoutFull screen layoutHome Print this page Email this page Small font sizeDefault font sizeIncrease font size


 
 Table of Contents    
LETTER TO EDITOR
Year : 2014  |  Volume : 36  |  Issue : 4  |  Page : 447-448  

Dermatitis artefacta: Growing awareness


1 Department of Dermatology, Subharti Medical College, Meerut, Uttar Pradesh, India
2 Department of Psychiatry, KMC Hospital, Meerut, Uttar Pradesh, India

Date of Web Publication15-Sep-2014

Correspondence Address:
Dr. Supriya Vaish
Department of Psychiatry, 134, Ram Sadan, Opposite Anurag Cinema, Baghpat Road, Meerut - 250 004, Uttar Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0253-7176.140760

Rights and Permissions

How to cite this article:
Bhardwaj A, Vaish S, Gupta S, Singh G. Dermatitis artefacta: Growing awareness. Indian J Psychol Med 2014;36:447-8

How to cite this URL:
Bhardwaj A, Vaish S, Gupta S, Singh G. Dermatitis artefacta: Growing awareness. Indian J Psychol Med [serial online] 2014 [cited 2019 Nov 12];36:447-8. Available from: http://www.ijpm.info/text.asp?2014/36/4/447/140760

Sir,

This article is regarding the current understanding and awareness about the multiple aspects of psychodermatology. [1] It is of extreme importance that adequate awareness and skills should be imparted to post-graduates and stress is laid upon the teaching of the psychodynamic aspects of the dermatological lesions, also regarding the primary psychiatric conditions like dermatitis artefacta that present to a dermatologist, which when present to the OPD are often missed, inadequately managed or lost to follow-up. In the same league, we wanted to discuss briefly a case of 14-year-old girl who presented to us with complaints of multiple circumferential and linear clearly demarcated, hyperpigmented scars over the forearms uniform in shape, which were slightly tapering towards the periphery, over the left leg, and on the thighs for 2 months [Figure 1] and [Figure 2]. The lesions were sudden in onset, recurring every few days and were in different stages of healing, were not associated with injury (as per patient), insect bite or intake of drugs; also, there was no history of fever, cold and cough, or any medical or surgical history of any kind. All her investigations including blood investigations - Human immunodeficiency virus antibodies test and venereal disease research laboratory test were non-reactive. Skin biopsy was done, which revealed traumatic pathology. Due to the unusual nature of her lesions as well as suggestive biopsy report, diagnosis of dermatitis artefacta was suspected; however, the patient denied any role in producing the lesions despite questioning. Although detailed psychological evaluation did not reveal any specific psychiatric disorder, the personality work up revealed attention-seeking behaviour, la belle indifference, poor impulse control, and poor coping styles in the patient. Patient was started on a holistic treatment approach and was followed up for observation. It appeared that the lesions had been caused by application of an abrasive substance. Occlusive bandage dressing was used to cover the affected limb. The cutaneous lesions healed within a week with no recurrence. The psychological interventions included psycho education to patient and more importantly her family members and were advised regular OPD review. Also, individual psychotherapy was planned for patient.
Figure 1: Dermatitis Artefacta - self-inflicted linear scar mark on the wrist

Click here to view
Figure 2: Multiple old and new linear burns with scarring over non-dominant hand

Click here to view


Increasingly, the psycho-dermatology is starting to get its due attention and is being called as an exciting field, which deals with the close relationship that exists between dermatological and psychiatric disorders. [2] Dermatitis artefacta, also known as factitial dermatitis, is a disorder of self-injurious behaviour and one of the primary psychiatric conditions to dermatologist with no exact prevalence known, but definite female predominance documented. [3],[4],[5] A number of case reports have been previously described with each emphasizing on the unusual and varied presentation of lesions. [6],[7],[8],[9] Unconscious motivating factors and psychological need or hypochondriacal tendencies drive the patient towards self-destructive behaviour, where the psychological needs are taken care of by assuming the role of the sick patient. [3],[10]

The most crucial and aspect of DA is managing or treating the case, where the recommended approach is bio-psycho-social approach, incorporating the thoughts and manipulations of the patients without being judgemental. [11]

With the growing knowledge and literature of psychocutaneous lesions and the basic underlying psychological cause for it, the current focus should be to create awareness and formulate better protocols of educating and dealing with the disorder.

 
   References Top

1.Yadav S, Narang T, Kumaran MS. Psychodermatology: A comprehensive review. Indian J Dermatol Venereol Leprol 2013;79:176-92.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Ghosh S, Behere RV, Sharma P, Sreejayan K. Psychiatric evaluation in dermatology: An overview. Indian J Dermatol 2013;58:39-43.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.Wong JW, Nguyen TV, Koo JY. Primary psychiatric conditions: Dermatitis artefacta, trichotillomania and neurotic excoriations. Indian J Dermatol 2013;58:44-8.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.Koblenzer CS. Neurotic excoriations and dermatitis artefacta. Dermatol Clin 1996;14:447-55.  Back to cited text no. 4
[PUBMED]    
5.Ostlere LS, Harris D, Denton C, Williams J, Black C, Rustin MH. Boxing-glove hand: An unusual presentation of dermatitis artefacta. J Am Acad Dermatol 1993;28:120-2.  Back to cited text no. 5
    
6.Walia NS. Dermatitis artefacta: Three case reports. Indian J Dermatol 2006;51:39-41.  Back to cited text no. 6
  Medknow Journal  
7.Obasi OE, Naguib M. Dermatitis artefacta: A review of 14 cases. Ann Saudi Med 1999;19:223-7.  Back to cited text no. 7
    
8.Tamakuwala B, Shah P, Dave K, Mehta R. Dermatitis artefacta. Indian J Psychiatry 2005;47:233-4.  Back to cited text no. 8
[PUBMED]  Medknow Journal  
9.Nayak S, Acharjya B, Debi B, Swain SP. Dermatitis artefacta. Indian J Psychiatry 2013;55:189-91.  Back to cited text no. 9
[PUBMED]  Medknow Journal  
10.Fabisch W. Psychiatric aspects of dermatitis artefacta. Br J Dermatol 1980;102:29-34.  Back to cited text no. 10
[PUBMED]    
11.Gould WM. Teaching psychocutaneous medicine: Time for a reappraisal. Arch Dermatol 2004;140:282-4.  Back to cited text no. 11
[PUBMED]    


    Figures

  [Figure 1], [Figure 2]



 

Top
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    References
    Article Figures

 Article Access Statistics
    Viewed835    
    Printed18    
    Emailed0    
    PDF Downloaded51    
    Comments [Add]    

Recommend this journal