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Kontoangelos K, Kousta F, Potouridou I, Chasapi V, Dikeos D, Stratigos A. Factitious Disorder as a Skin Ulcer: A Case Report. Cureus 2024; 16:e51642. [PMID: 38313954 PMCID: PMC10837820 DOI: 10.7759/cureus.51642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/06/2024] Open
Abstract
Dermatitis artefacta (factitious dermatitis) is a dermatological disease of different types; it could appear on various parts of the body. It is associated with severe difficulties, such as psychic distress and negative feelings aroused in healthcare personnel or borderline personality disorder, and the long-term possibility of patient self-harm to create more symptoms, resulting in unnecessary medical procedures. This is a case of a 17-year-old girl who was hospitalized with a skin ulcer on her right ankle that proved to be a factitious disorder. She was experiencing severe symptoms of anxiety, such as feeling nervous, having trouble sleeping and concentrating, and an inability to control worry due to her preparation for university studies. She refused to see a mental health professional since the onset of anxiety symptoms, i.e., the last four months. Patients who present with factitious disorder deliberately create clinical signs of a somatic disease because they need warmth and attention in a medical environment. Symptoms offer no significant benefit, and the pathophysiological mechanisms are mainly psychological. The primary treatment for factitious disorder is psychotherapy while the management of the ulcer requires dermatosurgical treatment.
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Affiliation(s)
- Konstantinos Kontoangelos
- 1st Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Fiori Kousta
- Department of Dermatology and Venereology, Andreas Syggros Hospital, Athens, GRC
| | - Irene Potouridou
- Department of Dermatology and Venereology, Andreas Syggros Hospital, Athens, GRC
| | - Vasiliki Chasapi
- Department of Dermatology and Venereology, Andreas Syggros Hospital, Athens, GRC
| | - Dimitris Dikeos
- 1st Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Alexander Stratigos
- 1st Department of Dermatology, Hospital of Venereal & Dermatological Diseases, National and Kapodistrian University of Athens, Athens, GRC
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Ramos-e-Silva M, Ramos-e-Silva S, Carneiro S. Acne in women. Br J Dermatol 2015; 172 Suppl 1:20-6. [DOI: 10.1111/bjd.13638] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2014] [Indexed: 11/29/2022]
Affiliation(s)
- M. Ramos-e-Silva
- Sector of Dermatology and Post-graduate Course; University Hospital and School of Medicine; Federal University of Rio de Janeiro; Rua Dona Mariana 143/C-32 22280-020 Botafogo Rio de Janeiro Brazil
| | - S. Ramos-e-Silva
- Sector of Dermatology and Post-graduate Course; University Hospital and School of Medicine; Federal University of Rio de Janeiro; Rua Dona Mariana 143/C-32 22280-020 Botafogo Rio de Janeiro Brazil
| | - S. Carneiro
- Sector of Dermatology and Post-graduate Course; University Hospital and School of Medicine; Federal University of Rio de Janeiro; Rua Dona Mariana 143/C-32 22280-020 Botafogo Rio de Janeiro Brazil
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Cheng CM, Hsu JW, Huang KL, Bai YM, Su TP, Li CT, Yang AC, Chang WH, Chen TJ, Tsai SJ, Chen MH. Risk of developing major depressive disorder and anxiety disorders among adolescents and adults with atopic dermatitis: a nationwide longitudinal study. J Affect Disord 2015; 178:60-5. [PMID: 25795537 DOI: 10.1016/j.jad.2015.02.025] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 02/25/2015] [Accepted: 02/25/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previous cross-sectional studies have suggested a comorbid association between atopic dermatitis (AD) and depressive disorder as well as anxiety disorders, but the temporal relationship was not determined. METHODS Using the Taiwan National Health Insurance Research Database, 8208 AD patients aged 12 and older without psychiatric history and age-/sex-matched (1:1) controls between 1998 and 2008 were enrolled in our study and followed to the end of 2011. Subjects who developed major depression, any depressive disorder, and anxiety disorders during the follow-up were identified. RESULTS The Cox regression analysis after adjusting for demographic data and atopic comorbidities demonstrated that patients with AD had an elevated risk of developing major depression (hazard ratio [HR]: 6.56, 95% confidence interval [CI]: 3.64-11.84), any depressive disorder (HR: 5.44, 95% CI: 3.99-7.44), and anxiety disorders (HR: 3.57, 95% CI: 2.55-4.98). Stratified by age group, both adolescents and adults with AD were prone to developing major depression (HR: 4.26, 95% CI: 1.39-13.13; HR: 7.56, 95% CI: 3.75-15.23), any depressive disorder (HR: 4.38, 95% CI: 2.09-9.18; HR: 5.66, 95% CI: 4.01-7.99), and anxiety disorders (HR: 5.40, 95% CI: 2.02-14.39; HR: 3.36, 95% CI: 2.38-4.80). CONCLUSIONS AD in both adolescence and adulthood increased the risk of developing major depression, any depressive disorder, and anxiety disorders in later life. Further studies would be required to clarify the possible underlying mechanism between AD and depression as well as anxiety disorders.
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Affiliation(s)
- Chih-Ming Cheng
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Albert C Yang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Han Chang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Klokk M, Stansfeld S, Overland S, Wilhelmsen I, Gotestam KG, Steinshamn S, Mykletun A. Somatization: the under-recognized factor in nonspecific eczema. The Hordaland Health Study (HUSK). Br J Dermatol 2011; 164:593-601. [PMID: 21114476 DOI: 10.1111/j.1365-2133.2010.10150.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psychodermatology has focused primarily on depression and anxiety in eczema. Skin symptoms are listed among many others for the ICD-10 diagnosis of somatization disorder. Somatization (unexplained somatic symptoms) is highly prevalent in the general population, but its association with eczema is yet to be empirically investigated. OBJECTIVES We therefore explored the association between somatization and eczema by examining the extent of somatization in eczema compared with allergic rhinitis, and by examining if eczema was more strongly associated with somatization than with anxiety and depression. Finally, we aimed to examine the relationship between the site of eczema and somatization for individual somatic symptoms and for somatic symptoms as a whole. METHODS For this population-based cross-sectional study we employed data from the Hordaland Health Study (HUSK) with 15,225 participants aged 41-48 years. Information on nonspecific eczema, allergic rhinitis, somatization, anxiety, depression and other covariates was obtained by self-report. RESULTS The association between nonspecific eczema and somatization was strong and followed a dose-response pattern, as did all somatic symptoms in our index of somatization when analysed separately. The association between nonspecific eczema and somatization was stronger than that between rhinitis and somatization, and also the association between nonspecific eczema and anxiety and depression. In multivariate models, somatization accounted for most of the association between nonspecific eczema and anxiety/depression. In contrast, the association between nonspecific eczema and somatization was robust for adjustment for anxiety/depression. CONCLUSIONS Somatization was strongly associated with nonspecific eczema. This applies to a whole range of somatic symptoms constituting the construct of somatization. There is hardly any mention of somatization in leading dermatological journals, in contrast to anxiety and depression which are frequently reported in eczema. We speculate that this under-recognition of somatization in the dermatological literature may correspond to under-recognition of this factor also in clinical practice.
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Affiliation(s)
- M Klokk
- Department of Physical Medicine and Rehabilitation, Aalesund Hospital, Norway.
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Yang YW, Tseng KC, Chen YH, Yang JY. Associations among eczema, asthma, serum immunoglobulin E and depression in adults: a population-based study. Allergy 2010; 65:801-2. [PMID: 19886915 DOI: 10.1111/j.1398-9995.2009.02249.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Y-W Yang
- School of Public Health, Taipei Medical University, 250 Wusing St., Sinyi District, Taipei, Taiwan
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Klokk M, Gotestam KG, Mykletun A. Factors accounting for the association between anxiety and depression, and eczema: the Hordaland health study (HUSK). BMC DERMATOLOGY 2010; 10:3. [PMID: 20412596 PMCID: PMC2876073 DOI: 10.1186/1471-5945-10-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 04/22/2010] [Indexed: 12/03/2022]
Abstract
Background The association between anxiety and depression, and eczema is well known in the literature, but factors underlying this association remain unclear. Low levels of omega-3 fatty acids and female gender have been found to be associated with both depression and eczema. Somatization and health anxiety are known to be associated with anxiety and depression, further, somatization symptoms and health anxiety have also been found in several dermatological conditions. Accordingly, omega-3 fatty acid supplement, female gender, somatization and health anxiety are possible contributing factors in the association between anxiety and depression, and eczema. The aim of the study is to examine the relevance of proposed contributing factors for the association between anxiety and depression, and eczema, including, omega-3 fatty acid supplement, female gender, health anxiety and somatization. Methods Anxiety and depression was measured in the general population (n = 15715) employing the Hospital Anxiety and Depression Scale (HADS). Information on eczema, female gender, omega-3 fatty acid supplement, health anxiety and somatization was obtained by self-report. Results Somatization and health anxiety accounted for more than half of the association between anxiety/depression, and eczema, while the other factors examined were of minor relevance for the association of interest. Conclusions We found no support for female gender and omega-3 fatty acid supplement as contributing factors in the association between anxiety/depression, and eczema. Somatization and health anxiety accounted for about half of the association between anxiety/depression, and eczema, somatization contributed most. The association between anxiety/depression, and eczema was insignificant after adjustment for somatization and health anxiety. Biological mechanisms underlying the mediating effect of somatization are yet to be revealed.
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Affiliation(s)
- Marianne Klokk
- Department of Adult Psychiatry, Aalesund Hospital, Helse Sunnmore HF, N-6026 Aalesund, Norway.
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Childhood traumatic experiences, dissociation and thought suppression in patients with ‘Psychosomatic’ skin diseases. Stress Health 2009. [DOI: 10.1002/smi.1224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Moss K. Contact at the borderline: psychoanalytic psychotherapy with EB patients. ACTA ACUST UNITED AC 2008; 17:449-55. [DOI: 10.12968/bjon.2008.17.7.29065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kate Moss
- EB Service, St John’s Institute of Dermatology, St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London
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Kakihara T, Tanaka A, Imai C, Ikarashi Y, Uchiyama M, Emura I. Psychosomatic reaction exhibiting hemorrhagic erythema and motorsensory disturbance. Pediatr Int 2003; 45:472-4. [PMID: 12911488 DOI: 10.1046/j.1442-200x.2003.01765.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Toshio Kakihara
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical, Niigata, Japan.
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Gutiérrez JV, Gutiérrez JV, Romero AM. Valoración del daño corporal en Dermatología. Estudio jurisprudencial. ACTAS DERMO-SIFILIOGRAFICAS 2002. [DOI: 10.1016/s0001-7310(02)76558-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
UNLABELLED Depression is a common and serious psychiatric disorder, more common in women than in men. It can be triggered by abrupt hormonal changes, life events, or nothing at all. It causes enormous debility and significant mortality, and it costs the American economy hundreds of millions of dollars a year. Depression can be readily diagnosed and treated, but, more often than not, it is neither diagnosed nor effectively treated in the primary care setting. The stigma of mental illness and misconceptions about depression in particular, hinder recognition. The signs and symptoms of clinical depression as outlined in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, are valid and reliable. Both psychotherapeutic and psychopharmacologic treatments are effective. The obstetrician/gynecologist plays a crucial role in identifying depression, helping the patient, and sometimes her family, to understand the nature of the problem, suggesting treatment, and facilitating either referral or treatment within the Ob-Gyn setting. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES After completion of this article, the reader will be able to understand the stigmata and misconceptions associated with a depression, to be aware of the various etiologies of depression and typical and atypical presentations, as well as the various management strategies for depression, and have a better understanding of which patients should be referred.
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Affiliation(s)
- N L Stotland
- Rush University Medical College, Chicago, Illinois, USA
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Abstract
PURPOSE To describe the clinical appearance of factitious (or self-inflicted) lesions on periocular skin and face. METHODS All patients with factitious cutaneous disease who were examined at Mayo Clinic, Rochester, Minnesota, between 1985 and 1997 were identified. For patients with lesions on the face and periocular skin, the demographic features, clinical descriptive characteristics of their lesions, associated psychopathology, and treatments were ascertained. RESULTS Of 38 patients with factitious dermatitis, 18 (47%) had facial lesions. Of these 18 patients, 15 (83%) were female. The mean age (+/- SD) of the patients with facial lesions was 35.2 +/- 15.7 years (range, 9 to 66 years). Eight patients (44%) had neurotic excoriations, nine (50%) had dermatitis artefacta, and one (6%) had trichotillomania. The working diagnoses of five patients cared for initially in the Department of Ophthalmology were corneal epithelial and facial desquamation associated with severe pain of unknown cause, medial cicatricial ectropion of probable vasculitic cause, basal cell carcinoma of the nasojugal fold, recurrent preseptal cellulitis resistant to medical treatment, and madarosis of the upper eyelids of unknown cause. CONCLUSION Cutaneous factitious disease may masquerade as numerous clinical entities and should be included in the differential diagnosis of lesions of the periocular skin.
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Affiliation(s)
- S Ugurlu
- Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
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Affiliation(s)
- T S Barfod
- Institute of General Practice, University of Aarhus Høegh Guldbergsgade Arhus, Denmark
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Affiliation(s)
- C S Koblenzer
- Department of Dermatology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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