title: Artefactual skin lesions in children and adolescents: review of the literature and two cases of factitious purpura.
abstract: BACKGROUND
  Self harm is a great diagnostic and treatment challenge. In addition, psychocutaneous conditions are rare in the pediatric population and may therefore be misdiagnosed. Dermatitis artefacta is a psychocutaneous syndrome, which is a subgroup of the general spectrum of self-inflicted skin lesions. Dermatitis artefacta encompasses an array of different clinical manifestations, including purpura. Factitious purpura has rarely been reported in children.
  
  
  METHODS
  Case report and review of the literature.
  
  
  RESULTS
  We describe two Caucasian patients (9-year-old boy and 10-year-old girl) with striking purpuric lesions diagnosed as factitious purpura. The clinical lesions were similar, but the underlying psychological problems differed significantly (depression and stress). The current state of knowledge of dermatitis artefacta in children and adolescents was reviewed.
  
  
  CONCLUSIONS
  The presence of purpura in children and adolescents typically causes extensive intervention programs due to the possible serious pathological consequences. The two cases demonstrate a need for a high degree of attention to psychological disturbances, lesional evolution, and distribution once the suspicion is established.
authors.affiliation: Department of Dermatology, Roskilde Hospital, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Hans Christian
authors.initials: HC
authors.lastname: Ring
authors.forename: Iben M
authors.initials: IM
authors.lastname: Miller
authors.forename: Eva
authors.initials: E
authors.lastname: Benfeldt
authors.forename: Gregor B E
authors.initials: GB
authors.lastname: Jemec
mesh_terms: D002648:Child; D003863:Depression / Q000523:psychology*; D005162:Factitious Disorders / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D011693:Purpura / Q000209:etiology*; D016728:Self-Injurious Behavior / Q000523:psychology; D013315:Stress, Psychological / Q000523:psychology*