title: [Bullous dermatitis self-induced].
abstract: In three patients, two women aged 37 and 20 years and a man aged 46 years, a blistering skin condition was observed. Histopathological examination of the skin lesions revealed a blister level just beneath the stratum granulosum, which is proof of a friction blister. The patients were suffering from bullous dermatitis artefacta or bullous pathomimia. This is a psychiatric disorder characterised by rubbing skin blisters but denying self-infliction. Early diagnosis is important to prevent unnecessary drug therapy and chronic morbidity. The typical histology supports the doctor in his suspected diagnosis. A supportive and empathic dual disciplinary approach (by somatic physician and psychosocial worker) is recommended, avoiding direct confrontation with the self-inflicted nature of the lesions, and using the 'narrow escape' strategy, avoiding loss of face of the patient.
authors.affiliation: Afd. Dermatologie, Academisch Ziekenhuis Groningen.
authors.forename: A
authors.initials: A
authors.lastname: van Rijssen
authors.forename: L
authors.initials: L
authors.lastname: Molier
authors.forename: A J
authors.initials: AJ
authors.lastname: Vrijlandt
authors.forename: M F
authors.initials: MF
authors.lastname: Jonkman
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D019468:Disease Management; D004820:Epidermolysis Bullosa / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D005162:Factitious Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000517:prevention & control / Q000523:psychology*; D012867:Skin / Q000293:injuries* / Q000473:pathology