title: A cry for help, do not omit the signs. Dermatitis artefacta--psychiatric problems in dermatological diseases (a review of 5 cases).
abstract: BACKGROUND
  Dermatitis artefacta (DA) is a dermatologicopsychiatric illness that is a conscious self-infliction of lesions to accessible regions of the body. The lesions usually do not resemble those of any know skin disease and there are no specific diagnostic tests to recognize them. This makes dermatitis artefacta a very slow, challenging and expensive disease to diagnose.
  
  
  METHODS
  We present 5 different clinical cases of dermatitis artefacta treated in the Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk in 2011. Detailed anamnesis and physical examination were performed at the day of admission. All patients had biochemical and hematological blood tests, skin biopsies and swabs for bacteriological examination, and photographs were taken. Psychiatric consultation was recommended in all cases. Clinical symptoms before diagnosis lasted from 1 to 10 years. The female-to-male ratio is 1:0.7, with age range of 57-62 years. Of our patients, only 2 refused a psychiatric consultation. Three out of 5 patients denied self-mutilation (2 of those 3 patients finally admitted to self-manipulations). Lesions were usually within the reach of the dominant hand. Two patients have other personality disorders. In 4/5 cases visible improvement after treatment with occlusive dressings were observed.
  
  
  CONCLUSIONS
  We discuss and attempt to depict issues associated with collaboration between dermatologists and psychiatrists, reasons for poor recognition of the disease, very long diagnosis and high costs. To conclude, we found that close collaboration between dermatologists and psychiatrists is important in diagnosing and treating DA patients.
authors.affiliation: Student Scientific Association in Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland. karolina.wojewoda@hotmail.com
authors.forename: Karolina
authors.initials: K
authors.lastname: Wojewoda
authors.forename: Jonas
authors.initials: J
authors.lastname: Brenner
authors.forename: Monika
authors.initials: M
authors.lastname: Kąkol
authors.forename: Matilda
authors.initials: M
authors.lastname: Naesström
authors.forename: Wiesław Jerzy
authors.initials: WJ
authors.lastname: Cubała
authors.forename: Dorota
authors.initials: D
authors.lastname: Kozicka
authors.forename: Roman
authors.initials: R
authors.lastname: Nowicki
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Sokołowska-Wojdyło
authors.forename: Wioletta
authors.initials: W
authors.lastname: Barańska-Rybak
mesh_terms: D002921:Cicatrix / Q000473:pathology / Q000523:psychology; D003872:Dermatitis / Q000473:pathology / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014456:Ulcer / Q000473:pathology / Q000523:psychology