Dermatitis Artefacta : Case Report and Review of Literature
Abstract
Dermatitis artefacta is a self-inflicted dermatologic injury with underlying primary psychiatric condition. Precipitating factors ranges from simple anxiety to interpersonal conflicts and several personality disorders including obsessive compulsive disorder, depression and psychotic disturbances. The diagnosis of this entity is often missed. Herein, we are reporting a case of dermatitis artefacta with description of its various manifestations.
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Introduction
Psychodermatology encompasses a group of disorders prevailing on the boundary between psychiatry and dermatology. Although there is no universally accepted classification, the most accepted system is that devised by Koo and Lee in the year 20031 comprising of:
1) Psycho physiological disorders: psoriasis, atopic dermatitis, acne excoriee, hyperhidrosis, urticaria, herpes simplex virus infections, seborrheic dermatitis, aphthosis, rosacea, pruritus.
2) Psychiatric disorders with dermatological manifestations (primary psychiatric): dermatitis artefacta, delusion of parasitosis, trichotillomania, obsessive compulsive disorders, phobic disorders, dysmorphophobia, eating disorders, neurotic excoriation, psychogenic pruritus.
3) Dermatological disorders with psychiatric symptoms (primary dermatologic): alopecia areata, vitiligo, generalized psoriasis, chronic eczema, ichthyosiform syndromes, rhinophyma, neurofibroma, albinism.
4) Miscellaneous: a) cutaneous sensory syndromes: glossodynia, vulvodynia, chronic itching in scalp, b) psychogenic purpura syndrome, c) pseudo-psycho dermatologic disease, d) suicide in dermatology patients.
Herein we are reporting a case of dermatitis artefacta along with obsessive compulsive disorder as a primary psychiatry disorder.
Conclusion
Dermatitis artefacta remains a challenging psychodermatological condition due to its deceptive clinical presentation, frequent denial by patients and close overlap with several dermatological and psychiatric disorders. This case highlights the importance of maintaining a high index of suspicion when encountering atypical, bizarre and symmetrically distributed lesions confined to accessible areas, especially in patients with an underlying psychiatric history such as obsessive compulsive disorder. Early recognition through careful clinical evaluation and exclusion of organic causes is essential to prevent unnecessary investigations and prolonged morbidity. Effective management requires a non-confrontational approach and close collaboration between dermatologists, psychiatrists and family physicians. A combined strategy of appropriate wound care, pharmacotherapy and psychotherapy can lead to better outcomes, reduced recurrence and improved quality of life for affected patients.