Self-induced dermatosis: a diagnostic problem at the intersection of two specialties

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详细

Self-induced dermatoses is a group of artificial skin injuries and its appendages caused by self-injuring by the patient in order to get rid of negative emotions and painful sensations or to simulate a well-known dermatitis because of the pathological desire to be hospitalized to meet emotional or financial needs.

A significant similarity of clinical manifestations of self-induced dermatoses and oorganic dermatoses (vasculitis, cystic medicine, gangrenous pyoderma, drug reactions, etc.), the inefficiency of dermatological treatment with the sudden appearance of new lesions, as well as the deliberate concealment by the patient the real causes of skin lesions and giving false anamnesis lead to difficulties in diagnosis of self-induced dermatoses. The article presents current data on the main diagnostic criteria and effective methods of treatment of this disease based on several foreign and russian publications; own clinical cases’ descriptions are also provided.

Self-induced dermatoses must be considered as a possible differential diagnosis in cases when no well-known dermatoses can explain the clinical picture and anamnesis does not match it; new destructive lesions appear spontaneously, despite the ongoing treatment.

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作者简介

Olga Olisova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: olisovaolga@mail.ru
ORCID iD: 0000-0003-2482-1754
SPIN 代码: 2500-7989

Dr. Sci. (Med.), Professor

俄罗斯联邦, 8-2, Trubetskaya street, Moscow, 119992

Natalia Teplyuk

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: teplyukn@gmail.com
ORCID iD: 0000-0002-5800-4800
SPIN 代码: 8013-3256

Dr. Sci. (Med.), Professor

俄罗斯联邦, 8-2, Trubetskaya street, Moscow, 119992

Lyailya Kayumova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: mika20-04@mail.ru
ORCID iD: 0000-0003-0301-737X

Cand. Sci. (Med.), Assistant

俄罗斯联邦, 8-2, Trubetskaya street, Moscow, 119992

Lyudmila Smirnova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: slm@mma.ru
ORCID iD: 0000-0002-6581-4529
SPIN 代码: 8355-4040

Cand. Sci. (Med.), Assistant Professor

俄罗斯联邦, 8-2, Trubetskaya street, Moscow, 119992

Ekaterina Anpilogova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

编辑信件的主要联系方式.
Email: truelass@hotmail.com
ORCID iD: 0000-0001-9478-5838

MD, Assistant

俄罗斯联邦, 8-2, Trubetskaya street, Moscow, 119992

Alena Nikulina

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: a.niku@mail.ru
ORCID iD: 0000-0002-0736-8022

MD

俄罗斯联邦, 8-2, Trubetskaya street, Moscow, 119992

参考

  1. Ivanov OL. Skin and venereal diseases: manual. Мoscow: Мedicine; 2007. Р. 190–191. (In Russ).
  2. Pashinyan AG, Subbotina RA, Akopyan AN, et al. Psychoemotional features of patients with self-destructive dermatosis. Lechebnoe delo. Russian Journal. 2018;(3):26–28. (In Russ).
  3. Lvov AN. Pathomimia in dermatology practice. Continuing Postgraduate Eeducation. Russian Journal. 2010;(5):71–78. (In Russ).
  4. Kansal NK. Dermatitis artefacta: an update. Skinmed. 2019;17(5):311–316.
  5. Rodriguez-Pichardo A, Hoffner MV, Garcia-Bravo B, Camacho FM. Dermatitis artefacta of the breast: a retrospective analysis of 27 patients (1976–2006). J Eur Acad Dermatol Venereol. 2010;24(3):270–274. doi: 10.1111/j.1468-3083.2009.03403.x
  6. Gupta MA, Gupta AK. Self-induced dermatoses: a great imitator. Clin Dermatol. 2019;37(3):268–277. doi: 10.1016/j.clindermatol.2019.01.006
  7. Fatima F, Das A, Jafferany M, Gharami RC. A 37-year-old woman with dermatitis artefacta: A case report. Dermatol Ther. 2020;33(6):e14139. doi: 10.1111/dth.14139
  8. Lee HG, Stull C, Yosipovitch G. Psychiatric disorders and pruritus. Clin Dermatol. 2017;35(3):273–280. doi: 10.1016/j.clindermatol.2017.01.008
  9. Goulding JM, Mughal F. Self-induced skin conditions: differential diagnosis and management. Br J Gen Pract. 2019;69(686):464–465. doi: 10.3399/bjgp19X705449
  10. Mohandas P, Bewley A, Taylor R. Dermatitis artefacta and artefactual skin disease: the need for a psychodermatology multidisciplinary team to treat a difficult condition. Br J Dermatol. 2013;169(3):600–606. doi: 10.1111/bjd.12416
  11. Tammaro A, Magri F, Chello C, et al. Occupational dermatitis artefacta: a clinical case in a flight attendant. Clin Ter. 2020;171(4):e288–e290. doi: 10.7417/CT.2020.2229
  12. Brkic J, Gunaric A, Tomic I, et al. Report of two psychodermatological cases: neurotic excoriation and dermatitis artefacta. Psychiatr. Danub. 2020;32(Suppl 2):298–301.
  13. Adebanjo GA, Parisella FR, Cittadini A, et al. A case of dermatitis artefacta during a pandemic. Dermatol Ther. 2020;33(6):e14235. doi: 10.1111/dth.14235
  14. Laughter MR, Florek AG, Wisell J, Newman S. Dermatitis artefacta, a form of factitial disorder imposed on self, misdiagnosed as pyoderma gangrenosum for eight years. Cureus. 2020;12(7):e9054. doi: 10.7759/cureus.9054
  15. Raizada A, Panda M, Dixit N, Hassanandani T. Dermatitis artefacta presenting as dermatomyositis: a diagnostic conundrum. Indian Dermatol Online J. 2020;11(4):629–631. doi: 10.4103/idoj.IDOJ_594_19

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2. Fig. 1. Artifical dermatitis in a patient with Alzheimer's disease: а ― cheeks and chin; б ― on the back.

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3. Fig. 2. Artifical dermatitis within the limited hypochondria, which developed against the background of the loss of a close relative: а ― on the upper eyelid and the bridge of the nose; б, в ― on the back.

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4. Fig. 3. Artifical dermatitis within the limited hypochondria in a patient with schizophrenia: а ― on the forehead; б ― on the lower leg; в ― on the knee.

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5. Fig. 4. Neurotic excoriation, developed against the background of a severe divorce process: а ― on the forehead; б ― on the cheek.

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6. Fig. 5. Excoriated acne.

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7. Fig. 6. Patient D., 29 years old. Rash on the skin of the abdomen before treatment.

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8. Fig. 7. The same patient. Scars after stab cuts in the left forearm.

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9. Fig. 8. The same patient. The histological picture of pathomymia.

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10. Fig. 9. The same patient. Rash on the skin of the abdomen during

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11. Fig. 10. Patient S. Ulcerative defect before treatment.

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12. Fig. 11. The same patient. Pathomymia during treatment: а ― 8th day; б ― 12th day; в ― 20th day; г ― 27th day

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13. Fig. 12. The same patient. After treatment: 36th day

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