engleski

Dermatitis Artefacta: Usual and Unusual Cases

Dermatitis artefacta is frequently seen in individuals with immature personalities when faced with a stressful life situation. The visible skin lesions can be interpreted as an attempt of non-verbal communaication, actually a silent appeal for help. Many of these patients display a rather neurotic emotional disorder, not psychosis. Since in more severely affected patients the recurrences are frequent, a long-term and intensive psychotherapy by experienced analytically oriented therapist is recommended. We followed 40 patients with usual and unusual clinical pictures of dermatitis artefacta (3 males and 37 females) during longer period of time. The skin lesions were different in configuration, shapes, single or multiple, and found on skin areas accessible to patient's hands, mostly face, chest, and limbs. All lesions healed rapidly under the occlusive dressing. The diagnosis of dermatitis artefacta was made on the basis of bizarre case history and quality of dermatological lesions. In 17 patients, histological analysis was also performed. Twenty-four patients firmly denied that they had caused the lesions, while others admitted to have caused the skin lesions by scratching, abrasions, burning, applying chemicals and plant extracts, and even injecting some ingredients under the skin (such as sawdust). All that provoked heavy irritative dermatitis with erythema, erosions, and sometomes ulcerations. The psychological profile of 9 of our patients was within normal limits, 3 had a low intelectual level, one had mental retardation, 19 had neurotic disorders, and 8 were borderline personality disorders.

dermatitis artefacta; diagnosis; treatment

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