title: [Dermatitis artifacta--psychiatric causes].
abstract: Dermatitis artifacta is a psychodermatological condition in which skin lesions are produced or inflicted by the patient's own actions. Patients present with lesions of various forms and bizarre shapes, which are difficult to recognize. Lesions can mimic many different dermatological diseases, but they mostly resemble superficial erosion, hyperpigmented maculae, excoriation or ulcerations. Patients often deny responsibility, so the direct confrontation will mostly lead to withdrawal and seeking help somewhere else. An effective therapeutic relationship requires a nonjudgemental, empathic and supportive environment in order to encourage return to follow up, and eventually talk about the possible psychological basis of the disease. Dermatitis artifacta is difficult to diagnose and is rarely recognized, but it is estimated that 0.2%-0.5% of dermatological patients suffer from this disease. There is generally considered to be a female preponderance, but estimates vary from 1:3 to 1:20 male to female ratio. Most affected patients are in their teens or early adulthood. Many patients suffer from a psychiatric illness, mostly borderline personality disorder. Patients may suffer from anxiety, depression or somatoform disorders. There is strong association with eating disorders; it is estimated that dermatitis artifacta occurs in approximately one-third of patients with anorexia or bulimia. Patients may have subconscious compulsion based on psychological or emotional need to elicit care; the illness often serves as an extreme form of nonverbal communication. Dermatitis artifacta occurs in patients with poor coping skills and often represents a maladaptive response to psychological stressor. Treatment is very difficult and with variable outcomes. Dermatitis artifacta is a challenging condition that requires both dermatological and psychiatric expertise, but unfortunately psychiatric treatment is rarely conducted since patients deny their responsibility and refuse psychiatric help.
authors.affiliation: University Department of Dermatovenereology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia. maja_vurnek@yahoo.com
authors.forename: Maja Vurnek
authors.initials: MV
authors.lastname: Zivković
authors.forename: Mirna
authors.initials: M
authors.lastname: Situm
mesh_terms: D005162:Factitious Disorders / Q000175:diagnosis*; D006801:Humans; D011602:Psychophysiologic Disorders / Q000175:diagnosis*; D012652:Self Mutilation / Q000175:diagnosis*; D012871:Skin Diseases / Q000523:psychology*