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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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Singh S, Chikhalkar S, Kabbannavar YR. Dermatitis artefacta: A diagnostic dilemma. Indian J Psychiatry 2023; 65:703-705. [PMID: 37485414 PMCID: PMC10358812 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_54_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/23/2023] [Indexed: 07/25/2023] Open
Abstract
Dermatitis artefacta (DA) is a rare psychological disorder in which patients self-inflict cutaneous lesions to satisfy an emotional need. Here, we describe a case of DA initially misdiagnosed as pemphigus. This case represents the importance of the timely recognition and treatment of DA to prevent its progression like in our case scarring alopecia.
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Affiliation(s)
- Surender Singh
- Department of Dermatology, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Siddhi Chikhalkar
- Department of Dermatology, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Yallappa R. Kabbannavar
- Department of Dermatology, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
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3
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Rahman SM, Abduelmula A, Jafferany M. Psychopathological symptoms in dermatology: A basic approach toward psychocutaneous disorders. Int J Dermatol 2023; 62:346-356. [PMID: 35816285 DOI: 10.1111/ijd.16344] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/01/2022] [Accepted: 06/17/2022] [Indexed: 11/28/2022]
Abstract
Dermatological conditions impact not only an individual's physical body but also their psychological health. Similar to how cutaneous conditions can affect one's psychological health, worsening psychological conditions can exacerbate or even induce dermatological conditions. There are four common psychiatric pathologies typically found in dermatology practices: depressive symptoms, anxiety symptoms, obsessive-compulsive disorder behaviors, and psychosis. Common cutaneous disorders associated with these psychopathological symptoms include, but are not limited to, psoriasis, acne vulgaris, atopic dermatitis, urticaria, trichotillomania, excoriation disorder, and delusions of parasitosis. The goal of this review is to examine the relationship between these four psychopathological symptoms with common psychodermatological conditions and to help providers better diagnose and implement appropriate psychological support to treat their patients.
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Affiliation(s)
- Syed Minhaj Rahman
- College of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Abrahim Abduelmula
- Faculty of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Mohammad Jafferany
- Department of Psychiatry, Central Michigan University, Saginaw, Michigan, USA
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4
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Guleria S, Gamalero L, Cimaz R, Giani T. Artifactual Skin Lesions: A Trap for Rheumatologists. J Clin Rheumatol 2021; 27:e26-e27. [PMID: 31804250 DOI: 10.1097/rhu.0000000000001219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Sandesh Guleria
- From the Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lisa Gamalero
- Department of Pediatric Rheumatology, Meyer Children Hospital, University of Florence, Florence, Italy
| | - Rolando Cimaz
- Department of Pediatric Rheumatology, Meyer Children Hospital, University of Florence, Florence, Italy
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Adebanjo GAR, Parisella FR, Cittadini A, Luzi F, Tammaro A. A case of dermatitis artefacta during a pandemic. Dermatol Ther 2020; 33:e14235. [PMID: 32851742 PMCID: PMC7460987 DOI: 10.1111/dth.14235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Andrea Cittadini
- Consultation Liaison Psychiatric Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Fabiola Luzi
- NESMOS, Dermatology Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonella Tammaro
- NESMOS, Dermatology Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Fatima F, Das A, Jafferany M, Gharami RC. A 37‐year‐old woman with dermatitis artefacta: A case report. Dermatol Ther 2020; 33:e14139. [PMID: 32770620 DOI: 10.1111/dth.14139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/25/2020] [Accepted: 08/01/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Farhat Fatima
- Department of Dermatology Medical College and Hospital Kolkata West Bengal India
| | - Anupam Das
- Department of Dermatology KPC Medical College and Hospital Kolkata West Bengal India
| | | | - Ramesh Chandra Gharami
- Dermatology, Department of Dermatology Medical College and Hospital Kolkata West Bengal India
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7
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Dermatitis artefacta mimicking cutaneous vasculitis: case report and literature overview. Reumatologia 2019; 57:106-108. [PMID: 31130749 PMCID: PMC6532111 DOI: 10.5114/reum.2019.84816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 04/12/2019] [Indexed: 11/17/2022] Open
Abstract
A 31-year-old Caucasian woman with a history of anxiety disorder presented with chronic ulcerative lesions of the skin in arms and legs, treated initially as cutaneous vasculitis, evolving with relapsing during corticosteroid tapering, was diagnosed, after thorough investigation and no organic disease found, with dermatitis artefacta – a self-inflicted harm due to psychological disorders. Dermatitis artefacta is a rare condition, more frequent in women, in which traumatic skin lesions are caused by the patient him/herself, over accessible parts of the body, due to personality disorders. Clinicians should be aware of this alternative aetiology, especially as a differential diagnosis for refractory cutaneous vasculitis.
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Kimchi N, Bernstein JA. Clinical Conditions that Masquerade as Urticaria. EUROPEAN MEDICAL JOURNAL 2019. [DOI: 10.33590/emj/10313955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Chronic urticaria is one of the most commonly diagnosed dermatoses. Following diagnosis, correct identification and proper treatment significantly reduces disease activity, thereby improving the patient’s quality of life. However, there is an extensive differential diagnosis for chronic urticaria that, if missed, can lead to life-threatening sequelae. Many of the diseases that masquerade as urticaria are rare and often have a significant delay in diagnosis. This paper aims to fill the gap in the literature by clearly characterising the cutaneous eruptions and atypical findings in many of the most common mimickers of chronic urticaria. Conditions such as erythema marginatum seen in conjunction with hereditary angioedema, urticaria vasculitis, autoinflammatory cryopyrin-associated periodic syndromes, adult-onset Still’s disease and systemic onset juvenile arthritis, Schnitzler syndrome, erythema multiforme, and cutaneous mastocytosis will be discussed.
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Affiliation(s)
| | - Jonathan A. Bernstein
- Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Marzouki-Zerouali A, Schoeffler A, Liegeon AL, Le Vaou P, Truchetet F. [Self-inflicted lesions in the context of hidradenitis suppurativa: Pathomimicry]. Ann Dermatol Venereol 2018; 146:135-140. [PMID: 30361163 DOI: 10.1016/j.annder.2018.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/15/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Factitious disorders constitute a complex pathology for the dermatologist. Although a diagnosis is often indicated, it is difficult to confirm and treatment is complicated. Dermatitis artefacta is the somatic expression of an often serious psychiatric disorder consciously created by patients on their own cutaneous-mucosal surfaces but the motivation is unconscious and no secondary benefits are sought (in contrast to simulation). Pathomimicry represent a specific entity: the provocation of outbreaks of a known disease, triggered by voluntary exposure to a causative agent. Herein we report on a case of pathomimicry in a context of hidradenitis suppurativa. PATIENTS AND METHODS A teenage girl whose main previous medical history consisted of grade-2 obesity and an episode of pubic abscess was seen at our clinic for axillary lesions. She presented in a state of negligence, was suspicious and aggressive, and refused to undress. After gaining her trust, clinical examination revealed prominent ulcerations (each with a granulated base) at a distance from the folds in the axillary areas, as well as typical hidradenitis lesions of Hurley Grade 2 with purulent openings and rope-like scars from the inguinal folds. Hospitalization was recommended and a positive outcome was achieved under antibiotic therapy with doxycycline, topical alginate and hydrocellular dressings. A psychiatric evaluation concluded that the patient was presenting dysmorphophobic narcissistic weakness, probably in reaction to recurrent harassment at school since childhood. Once she developed trust with us, which was difficult to establish, the patient admitted to having caused the lesions herself. Given the history and clinical data, as well as the negative laboratory tests, a diagnosis of pathomimicry was made. DISCUSSION Several cases of dermatological pathomimicry (sustainment by the patient of an ulcer with a known cause, contact with an allergen found in eczema, or renewed use of a medication implicated in toxiderma) or systemic disease (insulin injection in a diabetic patient) have been reported. To the best of our knowledge, this is the first description of pathomimicry associated with hidradenitis suppurativa. Regarding therapy, aftercare should be multidisciplinary. Confessions should not be forced and confrontations, which risk serious psychiatric collapse, should be avoided. A reassuring attitude enables psychiatry to be applied once trust has been sustainably established, hence the crucial role of the dermatologist.
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Affiliation(s)
- A Marzouki-Zerouali
- Département de dermatologie et vénéréologie, hôpital Bel-Air, CHR Metz-Thionville, 57000 Thionville, France.
| | - A Schoeffler
- Département de dermatologie et vénéréologie, hôpital Bel-Air, CHR Metz-Thionville, 57000 Thionville, France
| | - A-L Liegeon
- Département de dermatologie et vénéréologie, hôpital Bel-Air, CHR Metz-Thionville, 57000 Thionville, France
| | - P Le Vaou
- Département de psychiatrie, hôpital Bel-Air, CHR Metz-Thionville, 57000 Thionville, France
| | - F Truchetet
- Département de dermatologie et vénéréologie, hôpital Bel-Air, CHR Metz-Thionville, 57000 Thionville, France
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Krooks JA, Weatherall AG, Holland PJ. Review of epidemiology, clinical presentation, diagnosis, and treatment of common primary psychiatric causes of cutaneous disease. J DERMATOL TREAT 2017; 29:418-427. [DOI: 10.1080/09546634.2017.1395389] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- J. A. Krooks
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - A. G. Weatherall
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
- ClearlyDerm Center for Dermatology, Boca Raton, FL, USA
| | - P. J. Holland
- Psychiatry and Neurology Department, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
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11
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Mavrogiorgou P, Bader A, Stockfleth E, Juckel G. Obsessive-compulsive disorder in dermatology. J Dtsch Dermatol Ges 2016; 13:991-9. [PMID: 26408459 DOI: 10.1111/ddg.12781] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients with obsessive-compulsive (OCD) and related disorders - primarily trichotillomania, body dysmorphic disorder, and skin picking disorder - frequently present to dermatologists due to associated hair and skin symptoms. It is therefore crucial that dermatologists be familiar with these disorders. In this review article, we provide an update on clinical features, neurobiology factors, and treatment options for OCD spectrum disorders. Employing PubMed and Cochrane Library databases, a selective literature search was conducted using keywords related to dermatological disorders within the OCD spectrum. OCD and its related disorders share several phenomenological as well as pathophysiological similarities, thus warranting their classification within a separate nosological category of psychiatric disorders. Another similarity of OCD spectrum disorders is the frequent concurrence of hair and skin diseases. Besides symptomatic dermatological treatment, the combination of psychotherapy (behavioral therapy) and psychopharmacotherapy (SSRIs) may be helpful. Although recent insights into OCD have contributed to a better understanding and treatment thereof, more research is required, especially with respect to OCD spectrum disorders, for which large controlled treatment studies are still lacking.
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Affiliation(s)
- Paraskevi Mavrogiorgou
- LWL University Medical Center of the Ruhr University Bochum, Department of Psychiatry, Psychotherapy, and Preventive Medicine, Bochum, Germany
| | - Armin Bader
- Department of Dermatology, Venereology, and Allergology, St. Joseph Hospital, Medical Center of the Ruhr University Bochum, Germany
| | - Eggert Stockfleth
- Department of Dermatology, Venereology, and Allergology, St. Joseph Hospital, Medical Center of the Ruhr University Bochum, Germany
| | - Georg Juckel
- LWL University Medical Center of the Ruhr University Bochum, Department of Psychiatry, Psychotherapy, and Preventive Medicine, Bochum, Germany
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12
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Abstract
Many mental and emotional disorders have some variations of physical manifestations that are often the first definitive sign of disease. One such disorder is excoriation (skin-picking) disorder, also known as dermatillomania, acne excoriée, neurotic excoriation, or psychogenic excoriation. First identified in the dermatologic literature in 1920, excoriation disorder involves repetitive scratching behavior that sometimes accompanies pruritus and is often associated with depression, anxiety, and obsessive-compulsive disorder. In the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, the Diagnostic and Statistical Manual of Mental Disorders fifth edition, excoriation or skin-picking disorder is listed as a stand-alone disorder associated with obsessive-compulsive disorder. In certain patients, the skin lesions are shallow and have adherent crusts that can be mistaken for acne. These lesions, once healed, may appear white and partially atrophic. Because these patients often initially present to dermatologists or plastic surgeons for their skin conditions rather than to psychiatric professionals, it is important to recognize the salient diagnostic features and to acknowledge the importance of a multidisciplinary approach to patient care and management. We present a case of a 51-year-old woman with excoriation disorder who required medical management by dermatology, neurosurgery, psychiatry, and plastic surgery for a definitive surgical treatment.
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13
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Mavrogiorgou P, Bader A, Stockfleth E, Juckel G. [Obsessive-compulsive disorder in dermatology]. J Dtsch Dermatol Ges 2015; 13:991-1000. [PMID: 26408458 DOI: 10.1111/ddg.20_12781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Paraskevi Mavrogiorgou
- LWL-Universitätsklinikum der Ruhr-Universität Bochum, Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, Bochum
| | - Armin Bader
- Klinik für Dermatologie, Venerologie und Allergologie, St. Joseph-Hospital, Klinikum der Ruhr-Universität Bochum
| | - Eggert Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie, St. Joseph-Hospital, Klinikum der Ruhr-Universität Bochum
| | - Georg Juckel
- LWL-Universitätsklinikum der Ruhr-Universität Bochum, Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, Bochum
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14
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Zinoun M, Chiheb S, Marnissi F, Kadiri N, Benchikhi H. [Unilateral bullous and purpuric lesions: skin pathomimicry]. Pan Afr Med J 2015; 20:301. [PMID: 26161224 PMCID: PMC4489942 DOI: 10.11604/pamj.2015.20.301.5048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 03/10/2015] [Indexed: 12/01/2022] Open
Abstract
La pathomimie cutanée est une forme particulière de troubles factices relativement rare, et constitue l'un des problèmes les plus complexes pour le dermatologue. Nous rapportons un cas de pathomimie révélée par des lésions cutanées unilatérales, mimant une brûlure. Une jeune femme de 27 ans, était suivie depuis 4 ans pour une dépression. Elle a présenté 15j avant sa 1ère hospitalisation un placard inflammatoire du sein gauche compliqué de lésions bulleuses et d’érosions superficielles. La biopsie cutanée avait montré une dermite non spécifique. Une cicatrisation rapide sous traitement local a été notée. Elle a présenté 10 jours plus tard de nouvelles lésions similaires étagées au membre inférieur gauche, évoluant vers le décollement bulleux spontané. La biopsie cutanée avait montré un décollement bulleux jonctionnel et des foyers de nécrose ischémique. L'IFD était négative. Devant les données anamnestiques, cliniques, la négativité du bilan paraclinique, et la guérison des lésions sous pansements occlusifs seuls, le diagnostic de pathomimie a été évoqué et retenu. La patiente a été adressée en psychiatrie où une thérapie cognitivo-comportementale a été préconisée. Notre observation correspond à un tableau de pathomimie de présentation clinique particulière par sa localisation unilatérale et son caractère bulleux. Chez notre patiente qui est droitière, la localisation unilatérale gauche sur des zones accessibles, l'absence de lésions spécifiques à l'examen histologique, la cicatrisation rapide des lésions sous traitement local occlusif seul et leur récurrence malgré des soins adaptés étaient en faveur d'une pathologie factice. Néanmoins, la localisation au niveau des seins peut être très déroutante. Le caractère bulleux des lésions dans le cadre d'une pathomimie a été rarement rapporté. Dans notre cas, la pathomimie s'associe à des troubles anxieux et dépressifs très importants. Leur prise en charge demande un investissement pluridisciplinaire le plus précoce possible. La prise en charge des pathomimies est complexe. Le traitement médical associé à une prise en charge psychologique de type thérapie cognitivo-comportementale, qui est une première expérience, peut aider cette patiente à contrôler son comportement et éviter les récidives qui sont fréquentes dans ce type de pathologie.
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Affiliation(s)
- Mouna Zinoun
- Service de Dermatologie-Vénéréologie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Soumia Chiheb
- Service de Dermatologie-Vénéréologie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Farida Marnissi
- Service d'Anatomopathologie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Nadia Kadiri
- Service de Psychiatrie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Hakima Benchikhi
- Service de Dermatologie-Vénéréologie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
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Rodriguez-Vallecillo E, Woodbury-Fariña MA. Dermatological manifestations of stress in normal and psychiatric populations. Psychiatr Clin North Am 2014; 37:625-51. [PMID: 25455069 DOI: 10.1016/j.psc.2014.08.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This article explores the way stress affects the skin, both at the molecular level, where the skin has an intricate connection to the neurocutaneous and immune systems, and at the clinical level. The concept of psychodermatology is reviewed with regard to the way skin reacts to stress, how stress is a trigger for several common skin diseases, and how neuropsychiatric disorders may have skin manifestations. The article is directed at making the dermatologist, the psychiatrist, the psychologist, and the primary physician familiar with the brain-skin mechanisms involved in stress and the resultant clinical expressions on the skin.
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Affiliation(s)
- Edgardo Rodriguez-Vallecillo
- Private Practice, 29 Washington Street, Suite 507, San Juan, PR 00907, USA; Dermatology, HIMA San Pablo Hospital, Sta. Cruz Street, Bayamon, PR 00961, USA.
| | - Michel A Woodbury-Fariña
- Department of Psychiatry, University of Puerto Rico School of Medicine, 307 Calle Eleonor Roosevelt, San Juan, PR 00918-2720, USA
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16
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Affiliation(s)
- Abhishek Bhardwaj
- Department of Dermatology, Subharti Medical College, Meerut, Uttar Pradesh, India
| | - Supriya Vaish
- Department of Psychiatry, KMC Hospital, Meerut, Uttar Pradesh, India
| | - Sonal Gupta
- Department of Dermatology, Subharti Medical College, Meerut, Uttar Pradesh, India
| | - Garima Singh
- Department of Dermatology, Subharti Medical College, Meerut, Uttar Pradesh, India
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17
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Abstract
Trichotillomania (TTM) is a type of impulse control disorder, characterized by recurrent pulling of hair. The etiology of TTM is complex, but a genetic contribution to this condition was advocated based on a limited number of reports on familial TTM. We report a 13-year-old male with history of focal hair loss in the scalp. Examination showed a patchy area of hair loss, with several short broken hairs of varying lengths. Dermoscopy and pathology examinations were consistent with TTM. Upon further questioning, his father admitted repeated pulling of his beard. The paternal grandfather also suffers from severe hair pulling of his beard since puberty. To our knowledge, this is the first report of TTM in a 3 generation family. This report strengthens the possibility that TTM is a genetic disease, probably with a complex inheritance pattern. It also highlights the importance of appropriate family history taking when examining a TTM patient.
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Affiliation(s)
- Yuval Ramot
- Department of Dermatology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Alexander Maly
- Department of Pathology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Liran Horev
- Department of Dermatology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Abraham Zlotogorski
- Department of Dermatology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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18
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Turner GA, Sutton S, Sharma A. Augmentation of Venlafaxine with Aripiprazole in a Case of Treatment-resistant Excoriation Disorder. INNOVATIONS IN CLINICAL NEUROSCIENCE 2014; 11:29-31. [PMID: 24653940 PMCID: PMC3960782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We present a case of a 21-year-old woman with excoriation disorder that was resistant to currently reported treatment options. Severe lesions were present on multiple sites of her body. The skin picking appeared to be associated with anxiety surrounding her current medical stay and medical condition. The addition of aripiprazole to the venlafaxine she was already taking resulted in resolution of her unconscious picking. This medication combination may be considered by clinicians in the future for treatment-resistant excoriation disorder as its side effect profile is favorable for patients who have failed first-line treatment options. Large-scale studies investigating the use of second generation antipsychotics combined with selective serotonin reuptake inhibitors/serotonin norepinephrine reuptake inhibitors for the treatment of excoriation disorder is recommended.
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Affiliation(s)
- Grant A Turner
- Mr. Turner is a third year medical student, Ms. Sutton is a fourth year medical student, and Dr. Sharma is Associate Professor of Consult/Liaison Psychiatry; all from University of Nebraska Medical Center, Psychiatry Department, Omaha, Nebraska
| | - Stephanie Sutton
- Mr. Turner is a third year medical student, Ms. Sutton is a fourth year medical student, and Dr. Sharma is Associate Professor of Consult/Liaison Psychiatry; all from University of Nebraska Medical Center, Psychiatry Department, Omaha, Nebraska
| | - Ashish Sharma
- Mr. Turner is a third year medical student, Ms. Sutton is a fourth year medical student, and Dr. Sharma is Associate Professor of Consult/Liaison Psychiatry; all from University of Nebraska Medical Center, Psychiatry Department, Omaha, Nebraska
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Emer J, Luber A, Gropper J, Sidhu H, Phelps R. A patch of hair loss on the scalp. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2013; 6:45-49. [PMID: 23882315 PMCID: PMC3718756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Jason Emer
- The authors are from Mount Sinai School of Medicine, Departments of Dermatology and Dermatopathology, New York, New York
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