Factitial dermatitis in Adult
Clinical appearance depends on the method of self-injury. Dermatitis-like lesions, panniculitis, ecchymosis, ulcers, and vasculitis-like lesions are all possible. The diagnosis tends to occur more frequently in women and in those working in health care. It can be seen in the setting of acute stressors but is predominantly seen in patients with an underlying psychiatric ailment (eg, borderline personality disorder).
The patients' typical lack of concern for how disfiguring their lesions appear is out of proportion to the reality of their presentation. The patient history tends not to corroborate the unusual cutaneous findings. This so-called "hollow history" is a characteristic of the disease. The lesions may be produced by scratching, picking, biting, cutting, burning, injecting, and puncturing and may be produced by hand, instruments, or topical or injectable chemicals. More serious wounds can be complicated by gangrene, abscess formation, or other life-threatening infections. Treatment is often challenging and multidisciplinary.
Related topics: factitious disorders, medical child abuse
L98.1 – Factitial dermatitis
27720003 – Factitious dermatitis
Differential Diagnosis & Pitfalls
- Neurotic excoriations – The patient has a conscious desire to pick and manipulate the lesions.
- Acne excoriée – Can be a subtype of neurotic excoriations.
- Malingering – Motivated by secondary gain.
- Factitious disorders – The intentional self-infliction or feigning of physical or psychological signs or symptoms without an apparent gain or motivation.
- Medical child abuse – The intentional production or feigning of physical or psychological signs or symptoms by a patient's caregiver.
- Pyoderma gangrenosum
- Postherpetic neuralgia or pruritus (see herpes zoster)
- Allergic contact dermatitis
- Irritant contact dermatitis
- Arthropod reaction
- Delusions of parasitosis
- Lesch-Nyhan syndrome – Self-mutilation by biting the lips, fingertips, and shoulders.
- Medical causes of pruritus (see pruritus without rash)
- Neuropathic (eg, trigeminal trophic syndrome)