Dermatitis Artefacta

[Bullous dermatitis with multinucleated keratinocytes in dermatitis artefacta: A case report]

We report the case of a 13-year-old young lady with a one year reccuring bullous dermatitis history for which the diagnostic hypothesis of dermatitis arterfacta was made. This hypothesis was made by the pathologist, without it being suggested by the dermatologist, after observing singular histological lesions coresponding to a cutaneous blister associated with epidermic necrosis with multinucleated keratinocytes. When dermatitis artefacta is suspected, a biopsy is usually conducted to rule out differential diagnosis such as auto-immmune dermatitis when there is a blister. Confession from patients is rarely obtained. Therefore, having positive histogical clues for dermatitis artefacta would be of a great use to help making the diagnosis in difficult cases.

Dermatitis Artefacta in Childhood: A Retrospective Analysis of 44 Patients, 1976-2006

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.

Dermatitis neglecta -- a dirty dermatosis: report of three cases

Dermatitis neglecta is a condition that results from inadequate frictional cleansing leading to accumulation of corneocytes, sebum and sweat ultimately resulting in hyper-pigmented patch or verrucous plaque. Recognizing this condition avoids unnecessary, aggressive diagnostic and therapeutic procedures. Here we report three cases of dermatitis neglecta in whom the dermatitis developed as a result of intentional neglect of personal hygiene.

Dermatosis neglecta: a report of two cases

Few cases of dermatosis neglecta have been reported in the medical literature, although the diagnosis is well-known to dermatologists. Recognizing this condition avoids unnecessary, aggressive diagnostic and therapeutic procedures. This case report discusses two cases of this condition in female patients in whom the dermatosis developed as a result of deliberate or unconscious neglect of personal hygiene.