Treatment of Self-Harm Scars: A Scoping Review

BACKGROUND

Self-harm scars are a consequence of deliberate self-injury, serving as a visual reminder for involved individuals. Patients often reach out to their providers seeking treatment for their scars. However, there is currently no standard for treating self-harm scars, because multiple options are being explored.

OBJECTIVE

A scoping review was conducted to identify and characterize the body of literature on different treatments for self-harm scars, including surgical, laser, and vitamin A management.

METHODS

Thorough literature searches were conducted in PubMed/MEDLINE, EMBASE, and CINAHL Complete. The search strategy was designed and implemented by a medical librarian.

RESULTS

Of 510 retrieved articles, 4 described laser treatments, 8 described surgical treatments, and 2 described vitamin A treatments.

CONCLUSION

A multidisciplinary approach is critical for the selection and outcome of the treatment of self-harm scars.

Dermatitis artefacta in a patient affected by impulse control disorder: case report

Dermatitis artefacta is a disease characterized by self-inflicted skin lesions in fully aware patients. Mechanical and chemical devices are most commonly used to produce such injuries. Several psychological disorders like depression, obsessive compulsive disorders, hysteria, etc. are associated with this kind of disease. Most of the patients are young females aged between 15 and 30, but the diagnosis of dermatitis artefacta may even be made in pediatric patients or elderly people. Because of its rarity and the polymorphism of lesions, dermatitis artefacta is often a challenge for the clinicians. More difficulties might be due to the lack of cooperation in these patients, who usually refuse the dialogue with doctors and deny their primary role in damaging their skin. We present a case of an elderly woman who showed a peculiar pattern of deep excoriating lesions disseminated on the upper part of her body, with an evident state of depression. Diagnostic and therapeutic procedure, that is often long lasting and difficult in such cases, was made by teamwork of dermatologists, psychiatrists and psychologists, leading to steady control of impulses and full remission of cutaneous symptoms.

[Biodegradable stent as treatment of refractory benign esophageal stricture (RBES)]

A 26-year-old female patient, from La Paz-Bolivia. She came with a disease period of 15 months characterized by progressive dysphagia. One month before the onset of the symptomatology she ingested bleach with autolytic intentions. In the study of diagnostic upper gastrointestinal endoscopy at 25 centimeters of the dental arch was evidenced a stenosis of about 3 mm in diameter, central and with adjacent esophageal epithelium of a preserved appearance. In the x-ray of contrasted esophagus at the level of the middle third of the esophagus was evidenced a stenosis, short tubular, with a smooth border, of approximately 2 cm in length. Treatment was initiated using axial mechanical dilatations with Savary Guilliard bougies with an interval between sessions of 2 to 3 weeks and with 8 sessions in total. In the last session the largest bougie used was 12.8 mm. It is then that taking into account the diagnostic criteria of Kochman, the diagnosis of refractory caustic esophageal stenosis was made. During the period of realization of the dilations with bougies the patient became pregnant, which made difficult the accomplishment of the procedures for the routine use of fluoroscopic control. At 14 weeks of pregnancy, a SX-ELLA uncovered biodegradable esophageal stent of 10 cm length was implanted. We present the case as an alternative and novel management for this type of pathology.

Characteristics of children and adolescents with mental retardation and frequent outwardly directed aggressive behavior

Two interrelated cross-sectional studies were conducted to expand earlier findings about correlates of outwardly directed aggressive behavior in children with mental retardation. In Study 1 we compared children with mental retardation, 27 with and 23 without aggression. Aggression was best predicted by concurrent self-injurious behavior (SIB). In Study 2 we examined the likelihood that aggression was predicted by concurrent SIB and other nondestructive maladaptive behaviors in an archival cohort of 701 children younger than 21 with IQs below 70. Self-injurious behavior significantly predicted outwardly directed aggression for all children regardless of age. Additional predictors besides SIB showed only minimal improvements in model R2 values. Results were discussed in light of recent research proposing a common basis for aggression and SIB.

Case report: tooth wear associated with an unusual habit

Pathological tooth wear is an increasing problem affecting a significant proportion of the population. Although different wear mechanisms have been described, most reports in the literature concentrate on cases in which the predominant mechanisms were erosion and attrition. This article presents an unusual case of abrasive tooth wear caused by a sand eating habit which the patient had adopted as a child. Different causes of "abrasive" wear are discussed and the difficulties in management of this case are also presented.

Fire-eater's pneumonia after aspiration of liquid paraffin

Fire-eater's pneumonia is a distinct type of chemical pneumonitis that results from aspiration of different types of hydrocarbons. This article describes a case of fire-eater's pneumonia due to accidental aspiration of liquid paraffin. The adolescent patient became febrile the day after the accident. The diagnosis of fire-eater's pneumonia was delayed because aspiration history was not divulged by the patient from the beginning. The most prominent chest X-ray finding was multiple pneumatoceles. He responded well to antibiotics and corticosteroids. Two months after the accident, the lesions had almost completely resolved and only minor scarring was evident. Diagnosis of fire-eater's pneumonia can be difficult, especially if key aspects of related history are not divulged by the patient. Corticosteroid therapy was thought to be beneficial in the rapid recovery of the present case together with broad spectrum antibiotics.

An unusual case of acute periorbital swelling

Periorbital swelling is frequently encountered in ear, nose, and throat practices and, as it may be secondary to acute sinusitis, delayed diagnosis may lead to significant morbidity. We describe the case of a 24-year-old man with acute ethmoid-maxillary sinusitis and ipsilateral facial swelling particularly involving the periorbital area. We also discuss the workup that led to the formulation of an unusual diagnosis.

A Meta-Analysis of Treatment for Self-Injurious Behavior in Children and Adolescents With Intellectual and Developmental Disabilities

Self-injurious behavior (SIB) among children and youth with developmental disabilities has not diminished in prevalence despite the availability of effective interventions, and the impact on quality of life for people and their families is devastating. The current meta-analysis reviews SIB intervention research between 2011 and 2021 using single-case experimental designs with children and youth up to 21 years old and provides a quantitative synthesis of data from high-quality studies including moderator analyses to determine effects of participant and study characteristics on intervention outcomes. Encouraging findings include a high level of effectiveness across studies in the decrease of SIB (Tau-U = -0.90) and increase of positive behavior (Tau-U = 0.73), as well as an increase in studies (relative to prior reviews) reporting intervention fidelity, generalization, maintenance, and social validity. However, our findings shed limited light on potential moderating variables in the development of interventions for children and youth who exhibit SIB. Of the potential moderators of intervention effects, only implementer (researcher/therapist vs. parent/caregiver) and setting (clinic vs. home) were significantly associated with improved outcomes. We discuss the need for more robust involvement of natural communities of implementers in SIB intervention research to better equip them to effectively and sustainably meet the needs of people they care for. We also discuss the importance of creating systems enabling broad access for children with SIB to effective interventions in service of reducing burden for people, families, and society over time.

Transdiagnostic Study of Impulsivity and Self-Injurious Behaviour in Unstable and Impulsive Disorders

High comorbidity between borderline personality disorder (BPD) and eating disorders (ED) shows the necessity of developing transdiagnostic models, where impulsivity could play a relevant role in the manifestations of self-injurious behaviour.

[Genital autoaggression. An unusual presentation]

Self-injuries are relatively common and usually consist in incisive injuries on the penis and the scrotum. This paper presents one case of genital self-injury by injection of petrol on the back of the penis. A description is offered of the clinical form of presentation, as well as the good evolution following medical treatment. Finally, a revision of likely complications is included.

Another idea for the treatment of patients with borderline personality disorder

We are not suggesting that casting is appropriate for all patients with BPD, nor are we suggesting that patients need be casted for prolonged periods of time. In the 3 stated cases, the patients were desperate to have some behaviour modification introduced into their lives and welcomed the procedure. In all these cases, comorbidity existed. Because marked skin damage and open wounds often occur, other specialists with expertise in wound healing and joint mobility maintenance need to be involved. We were fortunate to have the services of a plastic surgeon with a special interest in psychiatric disorders. We believe that psychiatrists should be aware of this technique as a possible strategy to be used in very specific circumstances. It appears, in our short series of 3 cases, to have benefits in very specific cases. If it appears that casting may be helpful, our recommendations are as follows: 1. The behaviours should be thoroughly evaluated, and all alternative managements should be reviewed. 2. Reasonable rapport needs to be established between the patient and the major therapists so that compliance can be assured. 3. Other specialists should be consulted, such as plastic surgeons, who have the expertise to manage prolonged casting. 4. Along with casting, appropriate medications and psychotherapy must be in place for a balanced approach to management.

Cyanotic episodes in a male child with fragile X syndrome

A 9-year-old male with a diagnosis of fragile X syndrome (FXS) was evaluated for cyanotic episodes of unknown etiology. Clinical observation revealed frequent episodes of hyperventilation lasting several minutes, only while the patient was awake. This was followed by apnea associated with cyanosis and oxygen desaturation. Polysomnogram confirmed episodic central apnea temporally associated with hypocapnia, only during the awake state. Extensive evaluation failed to reveal other neurological, cardiac, gastrointestinal, or pulmonary etiologies for the events. The clinical observations and investigations allowed us to conclude that the patient's cyanotic episodes were caused by primary behavioral hyperventilation in the awake state. Similar behaviors have been reported in children with a variety of diagnoses but to our knowledge have not been previously reported in children with FXS. Treatment for this unusual behavior in FXS consists of reassurance and behavior modification to decrease the frequency and severity of the cyanotic episodes.

Unna sleeve for neurotic excoriations

Neurotic excoriations are self-induced skin lesions produced because of compulsive scratching or picking. We present the successful use of the venerable technique of an Unna boot used as an Unna sleeve for neurotic excoriations of the upper extremities.

[Reduction of dysfunctional self-injurious and self-stimulatory behaviors in autism disorders spectrum through occupational therapy]

Self-stimulatory and self-injurious behaviors are very frequent in neurodevelopmental disorders, being a source of anxiety and suffering for persons who have that behavior and their families. Sometimes these behaviors are so intense and frequent that it becomes a selfintegrity risk. A bibliographic review was conducted on the different approaches that have been developed until today; in addition, this article explains the methodology applied in our clinic, with a data collection on the effect of therapy on self-injurious and self-stimulatory behaviors in 20 cases, as a starting point for future research. The sensory integration model that complements pharmacological and behavioral cognitive treatment is highlighted, since it considers sensory needs relevant and trains the capacity for functional self-regulation.