Dermatitis artefacta: a retrospective analysis.

BACKGROUND: Factitial dermatitis describes self-produced and consciously made skin lesions usually intended to win sympathy, avoid responsibilities and even gain disability insurance. Dermatitis artefacta belongs to an extensive spectrum of self-inflicted diseases termed factitious diseases.

OBJECTIVES: The study is retrospective, and the patients were seen in our department from 2002 to 2012.

MATERIALS AND METHODS: For patients with skin lesions, the demographic features and clinical descriptive characteristics of their lesions were ascertained. Patient files and photographs were reviewed and the patients were called for follow-up.

RESULTS: A total of 25 patients were recorded. Mean age of the patients was 25.64 ± 11.80. With the exception of two cases, all patients were females. With regard to location, 27% of the patients showed facial localization, whereas the lesions have been localized on the extremities in 44%. The most common clinical appearance of DA was crusted eroded lesions (24%) and excoriations (24%) followed by ulcers (12%), superficial erosion (12%), acute eczematous lesions (8%), purpuric lesions (8%), pigment application (8%), diffuse erythema (8%), hyperpigmentation (8%), blister (4%), hair cutting (4%), hypopigmentation (4%) and cellulitis (4%). Forty percent of the patients had multiple lesions. There were eight children with dermatitis artefacta whose mean age was 14.50. The predominant lesion in these cases was superficial eroded plaque (37.5%). While patients with mild lesions limited in number receive ambulatory care, almost half of the patients require hospitalization. In this study, all patients were referred to psychiatric consultation, but most of them either refused treatment or did not receive medications.

CONCLUSION: Although it is primarily a psychiatric disease, dermatitis artefacta is frequently diagnosed by dermatologists. Detailed history and physical examination are key factors because it imitates an extensive spectrum of diseases.