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Factitial dermatitis in Adult
See also in: External and Internal Eye
Other Resources UpToDate PubMed

Factitial dermatitis in Adult

See also in: External and Internal Eye
Contributors: Erin X. Wei MD, Noah Craft MD, PhD, Lindy P. Fox MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Factitial dermatitis (dermatitis artefacta) is a psychiatric condition, characterized by skin lesions that are self-induced to satisfy an unconscious or conscious psychological need, which often is to assume the sick role. Patients will not admit to creating the lesions, which are usually more elaborate than simple excoriations. Factitial dermatitis should be differentiated from malingering, in which lesions are created deliberately for secondary gain, such as collecting disability or evading prosecution. Malingering is not a mental illness. Additionally, factitial dermatitis should be distinguished from neurotic excoriations, in which the patient is aware of, and will typically admit to, scratching or picking.

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: Munchausen syndrome, Munchausen syndrome by proxy

Codes

ICD10CM:
L98.1 – Factitial dermatitis

SNOMEDCT:
27720003 – Factitious dermatitis

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Last Reviewed:05/19/2021
Last Updated:06/06/2021
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Factitial dermatitis in Adult
See also in: External and Internal Eye
A medical illustration showing key findings of Factitial dermatitis : Erythema, Face, Lichenified plaque, Non-healing skin lesions, Skin erosion, Thick scaly plaque, Self-mutilation, Arms
Clinical image of Factitial dermatitis - imageId=383779. Click to open in gallery.  caption: 'Linear scaly plaques on the dorsal hand and fingers.'
Linear scaly plaques on the dorsal hand and fingers.
Copyright © 2022 VisualDx®. All rights reserved.