Artefacts

Dermatitis artefacta, dermatitis factitia, pathomimia, automutilation, hysterical skin gangrene, self inflicted skin injuries.

Self-induced skin lesions due to a mental disorder.

• Mostly women
• 2% of all patients in dermatology practice
• Age peak 20th-40th year of life

• Simulations: Deliberately caused skin lesions in order to gain certain advantages, i.e. secondary gain of illness (sick leave, pity)
• For example: Munchausen syndrome
• Paraartefacts: self-inflicted injuries, without intent to deceive, due to mental illness
• Real artefacts: Arising from a progressive, internal tension, which is eradicated by skin manipulation

Different mental disorders.

Only skin locations that can be easily reached by the hands are affected. There is usually a side preference (always ask the patient if he is right- or left-handed). Manipulations are usually performed on the contralateral side. Primary efflorescences are not visible. Both hands, nails, knives or even toxic substances can be used.

Diagnoses of exclusion.

If suspected, perform a biopsy to exclude pyogderma gangraenosum.

• Occlusion of manipulation sites so the patients can't manipulate.
• Psychotherapy

1. Koblenzer CS. NEUROTIC EXCORIATIONS AND DERMATITIS ARTEFACTA. Dermatologic Clinics 1996;14:447-56.

2. Michael J. Lavery et al.  Dermatitis artefacta. Clin Dermatol Nov-Dec 2018;36(6):719-722.