1
|
Gu Y, He R, Zhang B. A girl with circular erythema on the forearm. BMJ 2024; 385:e078449. [PMID: 38636968 DOI: 10.1136/bmj-2023-078449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
- Ying Gu
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Rui He
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Bin Zhang
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| |
Collapse
|
2
|
Sun CF, Singh N, Tenzer MM, Kablinger AS. Factitious dermatitis in children and adolescents is highly comorbid with psychiatric disorders. J Psychosom Res 2023; 166:111170. [PMID: 36724627 DOI: 10.1016/j.jpsychores.2023.111170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 01/19/2023] [Accepted: 01/22/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Factitious dermatitis (FD) is a psychocutaneous disorder characterized by self-induced skin lesions. FD is related to mental illness, but the correlation is poorly defined in the pediatric population. Our study aims to investigate the risk of psychiatric disorders diagnosed after the FD diagnosis in children and adolescents. METHODS We conducted a retrospective cohort study over a seven-year period (2016-2022) to measure the incidence and risk ratio of psychiatric disorders in patients under age 19 years. The FD cohort was defined as patients with FD (International Classification of Diseases, ICD-10-CM: L98.1); the control cohort was defined as patients who attended a regular dermatology visit by applying a diagnostic code of disease of the skin and subcutaneous tissue (ICD-10-CM: L00-99). RESULTS A total of 453 patients were identified for analysis. We found that FD patients were more likely to be diagnosed with anxiety disorder (Relative risk [RR] 7.63; P < 0.001), obsessive-compulsive disorder (RR 6.20; P < 0.001), attention-deficit hyperactivity disorder (RR 4.90, P < 0.001), depression (RR 2.27; p = 0.02), sleep disorder (RR 2.23; P = 0.01), impulse disorder (RR 2.20; P = 0.04), and conduct disorder (RR 2.14; P = 0.04) within 1 year following the diagnosis of FD. CONCLUSION FD is highly comorbid with psychiatric disorders. Though some practitioners believe FD could result from experimental or recreational behavior in children and adolescents, possible underlying psychiatric disorders should never be overlooked.
Collapse
Affiliation(s)
- Ching-Fang Sun
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Neha Singh
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Martha M Tenzer
- Health Analytics Research Team (HART), Carilion Clinic, Roanoke, VA,USA
| | - Anita S Kablinger
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Mosca M, Martin K, Hong J, Hadeler E, Brownstone N, Koo J. A review of the diagnosis and management of pediatric psychodermatologic conditions: Part II. Pediatr Dermatol 2022; 39:12-16. [PMID: 34964183 DOI: 10.1111/pde.14885] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/29/2021] [Accepted: 11/21/2021] [Indexed: 12/14/2022]
Abstract
Pediatric psychodermatologic conditions encompass both primary dermatologic conditions with psychiatric comorbidities and primary psychiatric conditions with self-induced dermatologic manifestations. Detection, diagnosis, and management of primary psychiatric conditions with dermatologic manifestations are challenging due to patient-perceived stigma and lack of educational opportunities for dermatology providers. This two-part series highlights the most up-to-date evidence-based data and management techniques of some of the more common dermatoses of primary psychiatric conditions in children. Part I includes trichotillomania, skin picking disorder, and onychophagia, and part II covers dermatitis artefacta, body dysmorphic disorder, and delusions of parasitosis by proxy, with special considerations for family dynamics.
Collapse
Affiliation(s)
- Megan Mosca
- Psoriasis and Skin Treatment Center, Department of Dermatology, University of California, San Francisco, California, USA
| | - Kari Martin
- Department of Dermatology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Julie Hong
- Psoriasis and Skin Treatment Center, Department of Dermatology, University of California, San Francisco, California, USA
| | - Edward Hadeler
- Psoriasis and Skin Treatment Center, Department of Dermatology, University of California, San Francisco, California, USA
| | - Nicholas Brownstone
- Psoriasis and Skin Treatment Center, Department of Dermatology, University of California, San Francisco, California, USA
| | - John Koo
- Psoriasis and Skin Treatment Center, Department of Dermatology, University of California, San Francisco, California, USA
| |
Collapse
|
5
|
Isiyel E, Ersoy Evans S, Akar HT, Gurbanov A, Karaduman A, Foto-Ozdemir D, Teksam O. Challenging diagnosis and rare disease in children: Dermatitis artefacta. J Paediatr Child Health 2021; 57:1710-1712. [PMID: 33538364 DOI: 10.1111/jpc.15373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 12/14/2020] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Emel Isiyel
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sibel Ersoy Evans
- Department of Dermatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Halil Tuna Akar
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Anar Gurbanov
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Aysen Karaduman
- Department of Dermatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dilsad Foto-Ozdemir
- Department of Child and Adolescent Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ozlem Teksam
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
6
|
Patel A, Jafferany M. Multidisciplinary and Holistic Models of Care for Patients With Dermatologic Disease and Psychosocial Comorbidity: A Systematic Review. JAMA Dermatol 2021; 156:686-694. [PMID: 32347896 DOI: 10.1001/jamadermatol.2020.0394] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Psychocutaneous disease affects an underrecognized patient population facing misdiagnosis and a reduced quality of life due to knowledge gaps and insufficient awareness. Clinicians worldwide serve as pioneers in offering specialized care for affected patients through the development of combined clinics. Results yield a framework needed to expand availability and ultimately improve patient outcomes. Objectives To report key findings generated from an in-depth analysis of available literature, highlight the importance and benefits of providing multidisciplinary care, and provide structural evidence of existing liaison clinics for more widespread future application. Evidence Review To identify data from inception to November 12, 2019, a search was conducted in PubMed and Google Scholar using the following search strategy: psychodermatology clinic OR psychodermatology liaison OR psychodermatology combined OR psychocutaneous clinic OR psychocutaneous liaison OR psychocutaneous combined OR psychiatry dermatology combined OR psychiatry dermatology clinic. Studies were excluded if they were single-patient case reports; if information regarding the number of patients, clinic setup, and presenting conditions was not provided; and if the reports were published in a language other than English. Findings A total of 932 studies were screened, and 23 were retained after removal of duplicates and application of inclusion criteria. The combined clinics, varying in structure, design, and setting, provided collective data from 1677 patients in 12 countries worldwide. Results indicate that patients experience barriers in gaining access to care and clinicians lack appropriate knowledge and resources for proper diagnosis and treatment. The implementation of combined clinics provides a cost-reducing avenue in the management of dermatologic disease and psychosocial comorbidity by limiting inaccurate diagnoses, ineffective treatments, unnecessary referrals, and "doctor shopping." Increased patient satisfaction or improved patient outcomes after the use of holistic treatment with pharmacologic and nonpharmacologic therapies was reported by 20 included studies (87%). Conclusions and Relevance Examined data from the included clinics illuminate the increased need and demand for specialized care. The ability to provide high-quality integrative patient care, potential utility in medical education, and findings of reduced health care expenditures reflect the need for health care leaders to expand specialized care as key for moving forward. Practical clinic models consist of a well-informed dermatologist for identification of psychocutaneous disease, referral if needed, and treatment based on the physician's individual comfort level. Involvement of multiple specialists, including psychiatrists, psychologists, and residents and preferably within teaching institutions, in consultations and management-related discussions is recommended.
Collapse
Affiliation(s)
- Arsh Patel
- Currently a medical student at Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mohammad Jafferany
- Division of Psychodermatology, Department of Psychiatry, Central Michigan University College of Medicine, Saginaw, Michigan
| |
Collapse
|
7
|
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Saha A, Seth J, Gorai S, Bindal A. Dermatitis Artefacta: A Review of Five Cases: A Diagnostic and Therapeutic Challenge. Indian J Dermatol 2015; 60:613-5. [PMID: 26677280 PMCID: PMC4681205 DOI: 10.4103/0019-5154.169139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Dermatitis artefacta (DA) is a self-inflicted dermatological condition where the underlying motive is to assume a sick role. The act of self-harm is to discharge the inner sense of isolation and emotional distress, which is too great to endure. We, hereby, report five interesting cases of DA with varied presentations, using diverse and innovative means for inflicting injury/injuries. Rarity may be attributed to masquerading presentation, leading to misdiagnosis and paucity of awareness among the physicians. Lack of proper identification of the underlying psychiatric disturbances may be the major cause of the loss of follow-ups. Here, we were fortunate enough to identify the emotional need of most of the patients. A flexible, nonconfrontational yet strong therapeutic rapport is required to improve the therapeutic outcomes.
Collapse
Affiliation(s)
- Abhijit Saha
- Department of Dermatology, STD and Leprosy, Burdwan Medical College, Burdwan, West Bengal, India
| | - Joly Seth
- Department of Dermatology, STD and Leprosy, Burdwan Medical College, Burdwan, West Bengal, India
| | - Surajit Gorai
- Department of Dermatology, STD and Leprosy, Burdwan Medical College, Burdwan, West Bengal, India
| | - Ayush Bindal
- Department of Dermatology, STD and Leprosy, Burdwan Medical College, Burdwan, West Bengal, India
| |
Collapse
|
10
|
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.
Collapse
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
| | | | | |
Collapse
|
11
|
Boyd AS, Dewan A. Dermatitis artefacta in an adolescent female. J Cutan Pathol 2015; 42:660-1. [PMID: 26011579 DOI: 10.1111/cup.12499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 04/06/2015] [Accepted: 04/18/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Alan S Boyd
- Department of Medicine (Dermatology), Vanderbilt University, Nashville, TN, USA. .,Department of Pathology, Vanderbilt University, Nashville, TN, USA.
| | - Anna Dewan
- Department of Medicine (Dermatology), Vanderbilt University, Nashville, TN, USA
| |
Collapse
|
12
|
|
13
|
Ring HC, Miller IM, Benfeldt E, Jemec GB. Artefactual skin lesions in children and adolescents: review of the literature and two cases of factitious purpura. Int J Dermatol 2014; 54:e27-32. [DOI: 10.1111/ijd.12493] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hans Christian Ring
- Department of Dermatology; Roskilde Hospital; Health Sciences Faculty; University of Copenhagen; Copenhagen Denmark
| | - Iben M. Miller
- Department of Dermatology; Roskilde Hospital; Health Sciences Faculty; University of Copenhagen; Copenhagen Denmark
| | - Eva Benfeldt
- Department of Dermatology; Roskilde Hospital; Health Sciences Faculty; University of Copenhagen; Copenhagen Denmark
| | - Gregor B.E. Jemec
- Department of Dermatology; Roskilde Hospital; Health Sciences Faculty; University of Copenhagen; Copenhagen Denmark
| |
Collapse
|
14
|
Dermatitis artefacta: revisión. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:854-66. [DOI: 10.1016/j.ad.2012.10.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 09/21/2012] [Accepted: 10/14/2012] [Indexed: 01/25/2023] Open
|
15
|
|
16
|
Mohandas P, Bewley A, Taylor R. Dermatitis artefacta and artefactual skin disease: the need for a psychodermatology multidisciplinary team to treat a difficult condition. Br J Dermatol 2013; 169:600-6. [DOI: 10.1111/bjd.12416] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2013] [Indexed: 12/01/2022]
Affiliation(s)
- P. Mohandas
- Whipps Cross University Hospital; London; U.K
| | | | - R. Taylor
- The Royal London Hospital; London; U.K
| |
Collapse
|
17
|
|
18
|
Trichotillomania and Dermatitis Artefacta: A Rare Coexistence. Case Rep Psychiatry 2012; 2012:674136. [PMID: 22934222 PMCID: PMC3420478 DOI: 10.1155/2012/674136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 11/14/2011] [Indexed: 11/23/2022] Open
Abstract
A 24-year-old pregnant female patient presented with complains of bilateral lower limb swelling and fever for 1 month. On examination, blood pressure was 144/94 mmHg along with pitting pedal edema. She had bizarre skin lesions, aligned longitudinally and distributed over the approachable site of the body with tapering ends and in various stages of healing. Lower limbs examination also revealed similar lesions with signs of cellulitis. Her scalp had short and distorted hair suggesting pulling and plucking. These skin lesions and the denial of self-infliction by the patient made us reach the diagnosis of dermatitis artefacta with trichotillomania. Psychotherapy was advocated along with conservative management of skin lesions. The patient improved and is under our follow up.
Collapse
|
19
|
Santhanam R, Fairley M, Rogers M. Is it trichotillomania? Hair pulling in childhood: a developmental perspective. Clin Child Psychol Psychiatry 2008; 13:409-18. [PMID: 18783123 DOI: 10.1177/1359104508090604] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A cohort of children with hair pulling as the presenting symptom was followed up to enhance clinical understanding of the nature of hair-pulling behaviour in childhood. Thirty-eight children were clinically assessed for a diagnosis of trichotillomania, co-morbidity, co-existing habits and other relevant factors. Intervention consisted of a combination of behavioural strategies, self-esteem work, supportive family approaches, attachment-focused parenting models and medication. In this group of children it was difficult to define their symptoms as a clinical diagnosis of trichotillomania, using ICD-1O/DSM-IV. This article concludes that hair pulling, as a symptom in children, is a heterogeneous condition. It is useful to approach this issue from a developmental perspective. Our data warrant reappraisal of the diagnosis of trichotillomania in childhood. We explore the framework of a developmental continuum to understand and manage the problem of hair pulling in childhood.
Collapse
|
20
|
Angus J, Affleck AG, Croft JCR, Leach IH, Slater DN, Millard LG. Dermatitis artefacta in a 12-year-old girl mimicking cutaneous T-cell lymphoma. Pediatr Dermatol 2007; 24:327-9. [PMID: 17542895 DOI: 10.1111/j.1525-1470.2007.00418.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Dermatitis artefacta or factitious disease may be unrecognized in children. We present a 12-year-old girl who had an unusual facial lesion on the chin, which was self-inflicted but histologically mimicked cutaneous T-cell lymphoma. Our report emphasizes both the potential diagnostic pitfalls and the importance of clinicopathologic correlation.
Collapse
Affiliation(s)
- Janet Angus
- Department of Dermatology, Queen's Medical Centre, Nottingham, UK.
| | | | | | | | | | | |
Collapse
|
21
|
Soong TKW, Soong V, Samsudin A, Soong F, Sharma V, O'Donnell N. Periocular dermatitis artefacta in a child. J AAPOS 2006; 10:585-6. [PMID: 17189158 DOI: 10.1016/j.jaapos.2006.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Revised: 08/23/2006] [Accepted: 08/23/2006] [Indexed: 10/24/2022]
Abstract
Dermatitis artifacta is a factitious dermatological disorder with many forms of presentation in any part of the body. It is commonly documented in dermatological cases but rarely presented as an ophthalmic condition. The diagnosis of dermatitis artifacta is often concluded after rigorous and repeated investigation. Histological sampling of skin lesions is usually required in these cases to exclude masquerading skin lesions such as basal cell carcinoma, vasculitis, or herpetic skin lesions.
Collapse
|
22
|
Abstract
PURPOSE OF REVIEW Factitial skin diseases are characterized by unusual patterns of skin lesions that do not conform to any known dermatologic condition and that are consciously or subconsciously fabricated by the patient. This review summarizes the current literature regarding the diagnosis and management of factitial dermatoses in children. RECENT FINDINGS Neurotic excoriations, acne excoriee and trichotillomania are the most common factitial skin diseases seen in children. Dermatitis artefacta is also seen in children, but is less common. In many cases, the development of factitial skin disease is associated with a comorbid psychiatric condition or identifiable psychosocial stressor. With regard to the management of factitial dermatoses in children, it is of paramount importance for the clinician to establish an appropriate physician-patient-family relationship. Although controlled studies in children are lacking, pharmacologic and/or nonpharmacologic adjunctive therapy can be helpful in the treatment of these difficult conditions. SUMMARY The diagnosis and management of factitial skin diseases in children is a challenge. Clinicians caring for children should be able to recognize the common factitial dermatoses that are seen in the pediatric population. The conveyance of support and acceptance by the physician is essential to the treatment process. Both psychotherapy and psychopharmacology can be important adjunctive treatments.
Collapse
Affiliation(s)
- Kara N Shah
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, PA 19104, USA.
| | | |
Collapse
|
23
|
Abstract
Children with cerebral palsy are at greater risk of a whole range of oral conditions than their peers. These include bruxism (tooth grinding), oral skill dysfunction, gross malocclusion due to effects of the abnormal orofacial muscle tone on tooth eruption, drooling of saliva, and poor oral hygiene. A challenging case of a painful buccal lesion in a 2 year old girl with cerebral palsy (CP) that did not respond to antifungal, antiviral or antibiotic treatment is presented as a factitious lesion. The recognition and significance of self-injurious behaviour and factitious lesions in children are discussed.
Collapse
Affiliation(s)
- D Harris
- Department of Paediatric Emergency Medicine, St Mary's Hospital, London, UK.
| |
Collapse
|
24
|
Saez-de-Ocariz M, Duran-McKinster C, Orozo-Covarrubias L, Ruiz-Maldonado R. Dermatitis artefacta in a teenager after awareness of his HIV-positive diagnosis. Clin Exp Dermatol 2005; 30:92-3. [PMID: 15663518 DOI: 10.1111/j.1365-2230.2004.01665.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
25
|
Harth W, Mayer K, Linse R. The borderline syndrome in psychosomatic dermatology Overview and case report. J Eur Acad Dermatol Venereol 2004; 18:503-7. [PMID: 15196174 DOI: 10.1111/j.1468-3083.2004.00965.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The borderline syndrome is one of the most severe disturbances of psychosomatic dermatology. Patients with borderline syndrome are situated 'on the border' of psychosis, neurosis and personality disorders. The skin as a borderline organ carries a symbolic role. The clinical picture includes artefactual skin diseases due to self-mutilation by conscious or unconscious cutting, and rubbing, scratching or para-artefactual manipulations of pre-existing dermatoses. Leading symptoms of the borderline syndrome are poor impulse control, emotional instability and poor ego strength with low frustration tolerance and unstable personal relationships. We present the case of a 38-year-old female patient with borderline syndrome suffering from para-artefactual skin diseases of the face and a massive hyperhidrosis of the hands and feet. Within 9 months she was treated in four acute psychiatric hospitals and by 12 psychiatrists and psychotherapists. Early and accurate diagnosis and high-quality, sophisticated long-term therapy are necessary.
Collapse
Affiliation(s)
- W Harth
- Clinic for Skin Diseases, Erfurt Hautklinik, Helios Klinikum Erfurt, Nordhäuserstrasse 74, 99089 Erfurt, Germany.
| | | | | |
Collapse
|
26
|
Affiliation(s)
- Maureen Rogers
- Children's Hospital Medical Center, Westmead, NSW, Australia
| |
Collapse
|
27
|
Saez-de-Ocariz M, Orozco-Covarrubias L, Mora-Magaña I, Duran-McKinster C, Tamayo-Sanchez L, Gutierrez-Castrellon P, Ruiz-Maldonado R. Dermatitis artefacta in pediatric patients: experience at the national institute of pediatrics. Pediatr Dermatol 2004; 21:205-11. [PMID: 15165196 DOI: 10.1111/j.0736-8046.2004.21303.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Dermatitis artefacta is a factitious disorder in which there is deliberate conscious production of skin lesions. There are only a few reports that evaluate instances of dermatitis artefacta in the pediatric population. The aim of this retrospective study was to assess the characteristics of patients with this disorder who were seen at the National Institute of Pediatrics in Mexico City. The records of all patients diagnosed with dermatitis artefacta from January 1980 to December 1999 were analyzed. There were 29 patients (25 females, 4 males). The upper limbs and the face were the most commonly involved areas. Superficial erosions were the most frequent initial event, and residual lesions consisted of scars and crusts. Time taken to diagnosis was on average 10 months. Half of the patients were lost to follow-up. No correlation was found between the length of time from the disease onset to diagnosis, the type of lesions, and the clinical outcome. Twelve patients had an associated systemic disorder. The possible association with chronic disease has not been sufficiently stressed and demonstrates the importance of providing psychological support for these patients. Psychiatric diagnoses were anxiety, depression, and personality disorder. No correlation was found between the psychiatric diagnosis and the outcome of dermatitis artefacta. A young age at presentation, which has been considered important as a favorable prognostic sign, could not be demonstrated in our patients.
Collapse
|