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Chen Y, Li L, Lu J. Purpura with regular shape in an adolescent: Beware of dermatitis artefacta. Front Pediatr 2022; 10:959064. [PMID: 36405818 PMCID: PMC9671281 DOI: 10.3389/fped.2022.959064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Purpura is common in pediatric patients, mostly diagnosed as IgA-related vasculitis (Henoch-Schönlein purpura), idiopathic thrombocytopenic purpura (ITP), and thrombotic thrombocytopenic purpura (TTP). However, in some cases, for example, cases with dermatitis artefacta, it could puzzle a physician or pediatrician for a long time, with great challenges in diagnosis. CASE PRESENTATION We present the case of a 13-year-old boy with recurrent painful purpura on both upper limbs. The physical exam was unremarkable, except for right blepharoptosis and scars from burns. The diagnostic tests were normal. Through repeated communication, the patient was finally diagnosed as having dermatitis artefacta, accompanied by underlying psychological problems. CONCLUSIONS Before dermatitis artefacta was diagnosed, we spent a lot of money and effort on the diagnosis. Therefore, in order to determine the diagnosis as soon as possible and save on unnecessary medical expenses, we propose a rapid process for the diagnosis of purpura of dermatitis artefacta in children.
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Affiliation(s)
- Yuhao Chen
- Department of Pediatrics, West China Second Hospital of Sichuan University, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Sichuan, China
| | - Lin Li
- Pathology Department, West China Hospital of Sichuan University, Sichuan, China
| | - Jing Lu
- Department of Pediatrics, West China Second Hospital of Sichuan University, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Sichuan, China
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Sarkar S, Ghosh SK, Sil A. Stereotypical linear purpura of the upper limbs: A report of three cases of a rare psychocutaneous disorder and review of the literature. Indian J Psychiatry 2020; 62:212-216. [PMID: 32382185 PMCID: PMC7197830 DOI: 10.4103/psychiatry.indianjpsychiatry_356_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/02/2019] [Accepted: 12/25/2019] [Indexed: 11/09/2022] Open
Abstract
Mechanically induced purpura with its varied clinical presentations may often pose a great diagnostic challenge to the treating physician. In this report, we seek to familiarize clinicians with a relatively new and rarely diagnosed psychocutaneous disorder, stereotypical linear mechanically induced purpura of the upper limbs, which we had the chance to detect in three teenage girls from Eastern India. A review of the PubMed and Medline database reveals a paucity of information on this subject, especially in the English language literature. Only a handful of reports have been described worldwide till date. However, it is probably hitherto unreported from India.
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Affiliation(s)
- Sharmila Sarkar
- Department of Psychiatry, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Sudip Kumar Ghosh
- Department of Dermatology, Venereology, and Leprosy, R.G. Kar Medical College, Kolkata, West Bengal, India
| | - Abheek Sil
- Department of Dermatology, Venereology, and Leprosy, R.G. Kar Medical College, Kolkata, West Bengal, India
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Hosteing S, Uthurriague C, Boralevi F, Mazereeuw-Hautier J. [A stereotypical clinical presentation of childhood linear purpura of the arms: Analysis of six cases]. Arch Pediatr 2016; 24:45-51. [PMID: 27956314 DOI: 10.1016/j.arcped.2016.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 06/14/2016] [Accepted: 10/27/2016] [Indexed: 11/17/2022]
Abstract
Among causes of childhood purpura, other- or self-induced mechanical purpura, such as factitious purpura, needs to be considered. This cause is unfamiliar to pediatricians, usually compromising early diagnosis. We report on the cases of six children, seen between 1998 and 2014 at the Toulouse and Bordeaux Departments of Dermatology, presenting with a stereotypical linear purpura on the arms. All were females, aged 6-14 years. One patient had a psychiatric history, whereas the others were undergoing a stressful time period. All had several relapses and diagnosis was delayed in all. The patients presented with multiple oval or square purpuric macules, forming a discontinuous linear band. Some patients reported functional discomfort such as pain or pruritus. Lesions were always located on the arms and sometimes on other areas of the body. Biological assessments were normal and there was no vasculitis at skin histology. We retained the diagnosis of induced mechanical purpura. Psychological support was offered to four patients. One of them declared that the lesions were induced by classmates using suction. Another child declared that she caused the lesions herself, without explaining the mechanism. Outcome was favorable in five children (one was lost to follow-up), 1-4 years after diagnosis. In conclusion, induced mechanical purpura in children, although rarely described in the medical literature, must be kept in mind. Investigations should be carried out in cases with uncertain diagnosis. Underlying psychological distress should be sought.
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Affiliation(s)
- S Hosteing
- Service de dermatologie, hôpital Larrey, université Paul-Sabatier, CHU de Toulouse, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France.
| | - C Uthurriague
- Service de dermatologie, hôpital Larrey, université Paul-Sabatier, CHU de Toulouse, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France
| | - F Boralevi
- Service de dermatologie pédiatrique, groupe hospitalier Pellegrin, CHU Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - J Mazereeuw-Hautier
- Service de dermatologie, hôpital Larrey, université Paul-Sabatier, CHU de Toulouse, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France
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Weston K, Tappin A, Bolton K. Dermatitis Artefacta Presenting as Recurrent Periorbital Cellulitis. J Pediatr 2016; 175:237-237.e1. [PMID: 27263401 DOI: 10.1016/j.jpeds.2016.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Kelly Weston
- Department of Ophthalmology, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Alison Tappin
- Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
| | - Kate Bolton
- Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
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Alcántara Luna S, García Bravo B, Rodríguez Pichardo A, Camacho Martínez FM. Dermatitis Artefacta in Childhood: A Retrospective Analysis of 44 Patients, 1976-2006. Pediatr Dermatol 2015; 32:604-8. [PMID: 26058478 DOI: 10.1111/pde.12625] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dermatitis artefacta (DA) consists of self-inflicted skin lesions that the patient denies having produced. OBJECTIVES To conduct a single-center retrospective clinical review of children and adolescents diagnosed with DA. METHODS From 1976 to 2006, data were collected on children diagnosed with DA who were seen in the Department of Dermatology in our hospital. Clinical and epidemiologic features are described. Forty-four children (mean age 12.9 yrs) were selected, representing 21.9% of the total patients with DA recorded (n = 201) during this period. RESULTS The most frequent clinical forms were excoriations (16 [36.4%]) and ulcers (10 [22.7%]), followed by blisters (7 [15.9%]), burns (3 [6.8%]), contact dermatitis (3 [6.8%]), hematomas (2 [4.5%]), panniculitis (1 [2.3%]), cheilitis (1 [2.3%]), and hyperpigmentation (1 [2.3%]). Sixteen were located exclusively on the face and neck, whereas 28 also had other locations (upper limbs, n = 10; lower limbs, n = 9; thorax, n = 5; abdomen, n = 4). Cutaneous lesions were treated with occlusive bandages using zinc paste or a plaster splint when necessary. CONCLUSION To our knowledge, this is the largest reported series of DA in childhood. This complicated psychodermatologic condition requires correct diagnosis, appropriate management, and psychiatric assessment.
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Affiliation(s)
- Sara Alcántara Luna
- Department of Dermatology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Begoña García Bravo
- Department of Dermatology, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Hlal H, Barrimi M, Kettani N, Rammouz I, Aalouane R. ["Factitious disorder and skin picking: Clinical approach". A case report]. Encephale 2013; 40:197-201. [PMID: 24091067 DOI: 10.1016/j.encep.2013.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 03/04/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The number of patients requiring primary and secondary care for factitious disorder unexplained by any known medical condition is high. We report a case illustrating the clinical and psychopathological features of factitious disorder. The treatment difficulties encountered in the association of this disorder with dermatillomania are discussed. CASE REPORT The patient was a 22-year old girl with abrasions on the face and forearms with ingested epidermal layer of the skin. She also had multiple somatic complaints, the authenticity of which was difficult to confirm. The diagnosis of comorbid factitious disorder with dermatillomania was retained. In view of reducing self-harm acts, we prescribed a mood stabilizer associated with an anxiolytic for 6 months. The self-harming acts have regressed, while the hypochondriacal complaints remain with a tendency of overstatement. DISCUSSION Factitious disorder (FD) is a mental disorder occurring in patients acting intentionally similar to a physically or mentally sick person with no apparent benefits. The reported cases often show FD comorbidity with other psychiatric disorders such as substance abuse, somatoform disorders, dysthymia, borderline personality disorder and sexual disorders. Comorbidity of factitious disorder with neurotic excoriation is exceptional, and rarely described in the literature. Pathological skin picking (PSP) is a disabling disorder characterized by repetitive skin picking, which causes tissue damage. It was estimated to affect 2% of the population. PSP is currently listed as an impulse control disorder not otherwise specified, it is associated with a high rate of psychiatric comorbidity like borderline personality disorder. CONCLUSION The comorbidity of factitious disorder and dermatillomania makes diagnosis very difficult. The limit between the two disorders is sometimes unclear.
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Affiliation(s)
- H Hlal
- Service de psychiatrie, CHU Hassan II, Fès, Maroc; Université Sidi Mohamed Ben Abdellah, faculté de médecine et de pharmacie de Fès, Fès, Maroc.
| | - M Barrimi
- Service de psychiatrie, CHU Hassan II, Fès, Maroc; Université Sidi Mohamed Ben Abdellah, faculté de médecine et de pharmacie de Fès, Fès, Maroc
| | - N Kettani
- Service de psychiatrie, CHU Hassan II, Fès, Maroc; Université Sidi Mohamed Ben Abdellah, faculté de médecine et de pharmacie de Fès, Fès, Maroc
| | - I Rammouz
- Service de psychiatrie, CHU Hassan II, Fès, Maroc; Université Sidi Mohamed Ben Abdellah, faculté de médecine et de pharmacie de Fès, Fès, Maroc
| | - R Aalouane
- Service de psychiatrie, CHU Hassan II, Fès, Maroc; Université Sidi Mohamed Ben Abdellah, faculté de médecine et de pharmacie de Fès, Fès, Maroc
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