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Dermatitis Artefacta Treatment & Management

  • Author: John YM Koo, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Jan 06, 2016
 

Approach Considerations

Dermatitis artefacta is a challenging condition whose management requires dermatologic and, often, psychiatric expertise.[7, 17, 18] A detailed assessment of the patient history for chronic dermatoses, chronic medical conditions, psychiatric illnesses, and psychosocial problems is necessary. General dermatologic care measures include baths, debridement, emollients, and topical antimicrobials. Any underlying psychiatric disorder that may be present should be addressed.

No surgical care is required for dermatitis artefacta. Hospitalization may be required for some patients, depending on the severity of the skin lesions and the risk of suicide. Consultation with a psychiatrist is recommended.

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Psychiatric and Other Nonpharmacologic Therapies

An effective therapeutic relationship in dermatitis artefacta patients requires a nonjudgmental, empathetic, and supportive environment. Every effort should be made to avoid discussing the etiology of the condition or confronting the patient regarding the behavior. Developing a good rapport with the patient and encouraging the patient to return for follow-up appointments are important.

A psychiatric evaluation is warranted in dermatitis artefacta patients if severe self-mutilation is noted or if there is any evidence of psychiatric illness, psychosis, suicide risk, or need for hospitalization.

Complementary adjuvant therapies in dermatitis artefacta patients may include acupuncture, cognitive-behavioral therapy (eg, aversion therapy, systemic desensitization, or operant conditioning), biofeedback and relaxation therapy (eg, for anxiety-related dermatitis artefacta), and hypnosis.[19]

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Pharmacologic Therapy

Topical antimicrobials are the medications most commonly prescribed for dermatitis artefacta; however, these agents are of limited efficacy when used alone. Oral antibiotics may be given for impetiginized lesions.

In many instances, treating the underlying psychiatric disorder with antidepressants, antianxiety drugs, and antipsychotic agents is necessary.[20, 21] Analgesics should be avoided because of the high probability for dependence and addiction.

Selective serotonin reuptake inhibitors (SSRIs; eg, paroxetine, sertraline, citalopram, and fluoxetine) are first-line therapy for depression. A tricyclic antidepressant (TCA) with antihistamine, antipruritic, and antidepressant properties (eg, doxepin) is recommended for depression with or without agitation and with pruritus as the primary symptom. A TCA with analgesic properties (eg, amitriptyline) is appropriate for depression with pain sensations (eg, burning, chafing, or stinging) as the primary symptom.

Typical (eg, pimozide) and atypical antipsychotics (eg, risperidone, olanzapine,[22] quetiapine) may be considered for short-term use, particularly if skin lesions are associated with psychotic or delusional symptoms.

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Long-Term Monitoring

Frequent follow-up visits with a dermatologist, a psychiatrist, or both are recommended for dermatitis artefacta patients. It should be kept in mind that such patients are often lost to follow-up.

In cases of Münchausen syndrome by proxy, removal of the child to a safe environment is mandatory.

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Contributor Information and Disclosures
Author

John YM Koo, MD Professor and Vice Chairman, Department of Dermatology, University of California, San Francisco, School of Medicine; Director, UCSF Psoriasis Treatment Center

John YM Koo, MD is a member of the following medical societies: American Academy of Dermatology, American Psychiatric Association, National Psoriasis Foundation

Disclosure: Nothing to disclose.

Coauthor(s)

Patricia T Ting, MD, MSc, FRCPC, LMCC(Canada) Clinical Assistant Professor, University of Calgary Faculty of Medicine, Canada

Patricia T Ting, MD, MSc, FRCPC, LMCC(Canada) is a member of the following medical societies: Alberta Medical Association, American Academy of Dermatology, American Society for Dermatologic Surgery, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Canadian Dermatology Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Galderma; Janssen Inc.<br/>Received income in an amount equal to or greater than $250 from: Galderma; Janssen Inc.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Acknowledgements

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.

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

References
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