eMedicine Specialties > Dermatology > Psychocutaneous Diseases

Dermatitis Artefacta: Follow-up

Author: John YM Koo, MD, Vice Chair, Department of Dermatology, University of California San Francisco Medical Center; Professor, Clinical Dermatology, Department of Dermatology, University of California at San Francisco School of Medicine
Coauthor(s): Patricia T Ting, MSc, MD, Dermatology Resident, Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta
Contributor Information and Disclosures

Updated: Jul 8, 2009

Follow-up

Further Inpatient Care

  • Hospitalization may be required for dermatitis artefacta patients, depending on the severity of the skin lesions and the risk of suicide.

Further Outpatient Care

  • Frequent follow-up visits with a dermatologist and/or psychiatrist are recommended for dermatitis artefacta patients.
  • Note that many dermatitis artefacta patients are often lost to follow-up.
  • With Münchhausen syndrome by proxy, removal of the child to a safe environment is mandatory.

Inpatient & Outpatient Medications

  • Selective serotonin reuptake inhibitors (eg, paroxetine, sertraline, citalopram, fluoxetine) are first-line therapy for depression.
  • A tricyclic antidepressant with antihistamine, antipruritic, and antidepressant properties (eg, doxepin) is recommended for depression with or without agitation and the primary symptom of pruritus.
  • A tricyclic antidepressant with analgesic properties (eg, amitriptyline) is appropriate for depression with a primary symptom of pain sensations (eg, burning, chafing, stinging).
  • Typical (eg, pimozide) and atypical antipsychotics (eg, risperidone, olanzapine, quetiapine) are for short-term use, particularly if skin lesions are associated with psychotic or delusional symptoms.

Prognosis

  • Mild cases of dermatitis artefacta secondary to identifiable psychosocial stressors usually have a good outcome; cure is possible.
  • Chronic cases of dermatitis artefacta with associated chronic dermatological or medical issues usually have a poor outcome, and cure is usually not possible.

Patient Education

  • The unique presentation and appearance of skin lesions may be a cause of significant concern to the patient and the parents or caregivers.
  • Avoid confrontational issues regarding the etiology of lesions during initial patient visits.
  • Gradually introduce the role of psychosocial factors and/or psychiatric issues that may contribute to the self-inflicted skin lesions.16
  • Regularly assess the risk of self-harm (suicide) or harm towards others.

Miscellaneous

Medicolegal Pitfalls

  • Identify any risk factors for suicide and a need for hospitalization, as well as the potential for harm to others.
  • In cases of Münchhausen syndrome by proxy, the victim (usually a child younger than 5 y) must be removed from the offender (usually a female caregiver or the mother) and placed in a safe, protected environment.
 


More on Dermatitis Artefacta

Overview: Dermatitis Artefacta
Differential Diagnoses & Workup: Dermatitis Artefacta
Treatment & Medication: Dermatitis Artefacta
Follow-up: Dermatitis Artefacta
References
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References

  1. Shah KN, Fried RG. Factitial dermatoses in children. Curr Opin Pediatr. Aug 2006;18(4):403-9. [Medline].

  2. Gupta MA, Gupta AK, Ellis CN, Koblenzer CS. Psychiatric evaluation of the dermatology patient. Dermatol Clin. Oct 2005;23(4):591-9. [Medline].

  3. Saez-de-Ocariz M, Orozco-Covarrubias L, Mora-Magana I, et al. Dermatitis artefacta in pediatric patients: experience at the national institute of pediatrics. Pediatr Dermatol. May-Jun 2004;21(3):205-11. [Medline].

  4. Ozmen M, Erdogan A, Aydemir EH, Oguz O. Dissociative identity disorder presenting as dermatitis artefacta. Int J Dermatol. Jun 2006;45(6):770-1. [Medline].

  5. Urpe M, Pallanti S, Lotti T. Psychosomatic factors in dermatology. Dermatol Clin. Oct 2005;23(4):601-8. [Medline].

  6. Ehsani AH, Toosi S, Shahshahani MM, Arbabi M, Noormohammadpour P. Psycho-cutaneous disorders: an epidemiologic study. J Eur Acad Dermatol Venereol. Mar 11 2009;[Medline].

  7. Ilter N, Adisen E, Gurer MA, Kevlekci C, Tekin O, Sayin A. Dermatitis artefacta masquerading as pyoderma gangrenosum. Int J Dermatol. Sep 2008;47(9):975-7. [Medline].

  8. Harries MJ, McMullen E, Griffiths CE. Pyoderma gangrenosum masquerading as dermatitis artefacta. Arch Dermatol. Nov 2006;142(11):1509-10. [Medline].

  9. Brod CS, Garbe C, Schleicher J, Rocken M, Schilling M. Acquired haemophilia mimicking dermatitis artefacta. Acta Derm Venereol. 2009;89(2):194-5. [Medline].

  10. Angus J, Affleck AG, Croft JC, Leach IH, Slater DN, Millard LG. Dermatitis artefacta in a 12-year-old girl mimicking cutaneous T-cell lymphoma. Pediatr Dermatol. May-Jun 2007;24(3):327-9. [Medline].

  11. Giunta A, Demin F, Campione E, Chimenti S, Bianchi L. Dermatitis artefacta in sporadic sclerodermoid hepatitis C virus-associated porphyria cutanea tarda. J Eur Acad Dermatol Venereol. Dec 22 2008;[Medline].

  12. Cohen AD, Vardy DA. Dermatitis artefacta in soldiers. Mil Med. Jun 2006;171(6):497-9. [Medline].

  13. Shenefelt PD. Complementary psychocutaneous therapies in dermatology. Dermatol Clin. Oct 2005;23(4):723-34. [Medline].

  14. Gupta MA, Guptat AK. The use of antidepressant drugs in dermatology. J Eur Acad Dermatol Venereol. Nov 2001;15(6):512-8. [Medline].

  15. Lee CS, Koo J. Psychopharmacologic therapies in dermatology: an update. Dermatol Clin. Oct 2005;23(4):735-44. [Medline].

  16. Koblenzer CS. Dermatitis artefacta. Clinical features and approaches to treatment. Am J Clin Dermatol. Jan-Feb 2000;1(1):47-55. [Medline].

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Further Reading

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Keywords

dermatitis artefacta, factitious disorder, Munchhausen's syndrome by proxy, Münchhausen syndrome by proxy, Munchhausen syndrome by proxy, Munchausen syndrome by proxy, acne excoriee, picker's nodules, picker nodules, psychocutaneous disease, psychosomatic dermatoses, self-injurious behaviors, obsessive-compulsive behavior, attention-seeking behavior, self injury, self-induced excoriations

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Contributor Information and Disclosures

Author

John YM Koo, MD, Vice Chair, Department of Dermatology, University of California San Francisco Medical Center; Professor, Clinical Dermatology, Department of Dermatology, University of California at San Francisco School of Medicine
John YM Koo, MD is a member of the following medical societies: American Academy of Dermatology, American Psychiatric Association, and National Psoriasis Foundation
Disclosure: Nothing to disclose.

Coauthor(s)

Patricia T Ting, MSc, MD, Dermatology Resident, Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta
Patricia T Ting, MSc, MD is a member of the following medical societies: Alberta Medical Association, Canadian Dermatology Association, and Canadian Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Jacek C Szepietowski, MD, PhD, Professor, Vice-Head, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University; Director of the Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Poland
Disclosure: Stiefel Salary Employment; Orfagen Consulting fee Consulting; Maruho Consulting fee Consulting; Astellas Consulting fee Consulting

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Edward F Chan, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine
Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

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