title: Dermatitis artefacta.
abstract: BACKGROUND
  Dermatitis artefacta (DA) is difficult to diagnose by clinical findings alone. Histopathologic analysis may rule out organic disorders and in some cases establish, in conjunction with microanalytic techniques, a definite diagnosis.
  
  
  OBJECTIVE
  We report a young woman with DA in the form of recurrent abscesses whose diagnosis was aided by the identification of subcutaneous foreign material through histologic and microanalytic methods.
  
  
  METHODS
  Histologic examination showed foreign body giant cell reaction with polarizable material, which was identified as cellulose by energy dispersive x-ray analysis and Fourier transform infrared spectrometry.
  
  
  RESULTS
  Self-injection of exogenous matter was suspected. Referral to an expert in psychodermatology resulted in the diagnosis of multiple psychiatric comorbidities commonly associated with DA. Initiation of antidepressants resulted in marked improvement in her skin disease, as well as her mood and affect.
  
  
  CONCLUSIONS
  We emphasize the importance of interdisciplinary collaboration between dermatologists, dermatopathologists, and mental health professionals in the management of DA.
authors.affiliation: Department of Dermatology, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors.forename: Eun Ji
authors.initials: EJ
authors.lastname: Kwon
authors.forename: Michael
authors.initials: M
authors.lastname: Dans
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Koblenzer
authors.forename: Rosalie
authors.initials: R
authors.lastname: Elenitsas
authors.forename: William D
authors.initials: WD
authors.lastname: James
mesh_terms: D003872:Dermatitis / Q000175:diagnosis* / Q000523:psychology; D003937:Diagnosis, Differential; D005162:Factitious Disorders / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D015745:Granuloma, Foreign-Body / Q000175:diagnosis* / Q000523:psychology; D006801:Humans; D012008:Recurrence; D016728:Self-Injurious Behavior / Q000175:diagnosis* / Q000523:psychology