Dermatitis Artefacta Follow-up

  • Author: John YM Koo, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 25, 2012
 

Further Inpatient Care

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

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.
Previous
Next

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.
Previous
Next

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.
Previous
Next

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.[19]
  • Regularly assess the risk of self-harm (suicide) or harm towards others.
Previous
 
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, MD, MSc  Resident Physician, Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Canada

Patricia T Ting, MD, MSc is a member of the following medical societies: Alberta Medical Association, Canadian Dermatology Association, and Canadian Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

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 GSK Company Salary Employment; Orfagen Consulting fee Consulting; Maruho Consulting fee Consulting; Astellas Consulting fee Consulting; Abbott Consulting fee Consulting; Leo Pharma Consulting fee Consulting

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.

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.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M 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, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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. Sambhi R, Lepping P. Psychiatric treatments in dermatology: an update. Clin Exp Dermatol. Mar 2010;35(2):120-5. [Medline].

  7. Baranska-Rybak W, Cubala WJ, Kozicka D, Sokolowska-Wojdylo M, Nowicki R, Roszkiewicz J. Dermatitis artefacta--a long way from the first clinical symptoms to diagnosis. Psychiatr Danub. Mar 2011;23(1):73-5. [Medline].

  8. 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].

  9. 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].

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

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

  12. 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].

  13. 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].

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

  15. Koblenzer CS. The current management of delusional parasitosis and dermatitis artefacta. Skin Therapy Lett. Oct 2010;15(9):1-3. [Medline].

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

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

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

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

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.