title: Factitial dermatoses in children.
abstract: OBJECTIVE
  Factitial skin diseases are characterized by unusual patterns of skin lesions that do not conform to any known dermatologic condition and that are consciously or subconsciously fabricated by the patient. This review summarizes the current literature regarding the diagnosis and management of factitial dermatoses in children.
  
  
  RESULTS
  Neurotic excoriations, acne excoriee and trichotillomania are the most common factitial skin diseases seen in children. Dermatitis artefacta is also seen in children, but is less common. In many cases, the development of factitial skin disease is associated with a comorbid psychiatric condition or identifiable psychosocial stressor. With regard to the management of factitial dermatoses in children, it is of paramount importance for the clinician to establish an appropriate physician-patient-family relationship. Although controlled studies in children are lacking, pharmacologic and/or nonpharmacologic adjunctive therapy can be helpful in the treatment of these difficult conditions.
  
  
  CONCLUSIONS
  The diagnosis and management of factitial skin diseases in children is a challenge. Clinicians caring for children should be able to recognize the common factitial dermatoses that are seen in the pediatric population. The conveyance of support and acceptance by the physician is essential to the treatment process. Both psychotherapy and psychopharmacology can be important adjunctive treatments.
authors.affiliation: Section of Pediatric Dermatology, Children's Hospital of Philadelphia, PA 19104, USA. shahk@E-Mail.chop.edu
authors.forename: Kara N
authors.initials: KN
authors.lastname: Shah
authors.forename: Richard G
authors.initials: RG
authors.lastname: Fried
mesh_terms: D000293:Adolescent; D002648:Child; D006801:Humans; D010817:Physician-Patient Relations; D011613:Psychotherapy; D012871:Skin Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D014256:Trichotillomania / Q000175:diagnosis / Q000628:therapy