Dermatitis Artefacta Treatment & Management

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

Medical Care

Dermatitis artefacta is a challenging condition that requires dermatologic and, often, psychiatric expertise.[6, 15]

  • General dermatological care measures include baths, debridement, emollients, and topical antimicrobials.
  • A detailed assessment of the patient history for chronic dermatoses, chronic medical conditions, psychiatric illnesses, and psychosocial problems is necessary in the care of dermatitis artefacta.
  • An effective therapeutic relationship in dermatitis artefacta patients requires a nonjudgmental, empathetic, and supportive environment. Avoid etiology issues and confrontation. Developing a good rapport with the patient and encouraging the patient to return for follow-up appointments are important.
  • A psychiatric evaluation is warranted for severe self-mutilation and any evidence of psychiatric illness, psychosis, risk of suicide, and/or need for hospitalization in dermatitis artefacta patients.
  • Complementary adjuvant therapies in dermatitis artefacta patients may include acupuncture, cognitive behavioral therapy (ie, aversion therapy, systemic desensitization, operant conditioning), biofeedback and relaxation therapy (ie, anxiety-related dermatitis artefacta), and hypnosis.[16]
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Surgical Care

No surgical care is required for dermatitis artefacta.

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Consultations

Consultation with a psychiatrist is recommended.

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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, 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].

 
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