title: Epidermal multinucleated keratinocytes: a histopathologic clue to dermatitis artefacta.
abstract: Dermatitis artefacta is a psycho-cutaneous disorder characterized by self-inflicted cutaneous injuries, often in association with an underlying psychiatric disorder or as a response to external stressors. Cutaneous lesions suggestive of dermatitis artefacta are dependent on the means of injury and thus may be morphologically variable, but typically have geometric shapes, spare hard-to-reach anatomic areas, and are present in variable stages of evolution at any specific time. Although a dermatologist may be suspicious of dermatitis artefacta in a given patient, making a definitive diagnosis is extremely challenging. Patients often clinically evade questioning and deny creating skin lesions, and histopathologic evaluation of lesional biopsies usually reveals non-specific epidermal and dermal changes and inflammation. Thus, identification of clues that lend support to a diagnosis of dermatitis artefacta would be welcomed by both clinicians and pathologists. Here we present a case of dermatitis artefacta with a unique, yet previously reported, histopathological finding of multinucleated keratinocytes within the epidermis. Although probably uncommon and dependent on the etiology of cutaneous injury, we believe this finding is important for dermatopathologists to be aware of as a potential diagnostic clue when evaluating biopsies in patients suspected to have dermatitis artefacta.
authors.affiliation: School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gutierrez
authors.affiliation: Department of Dermatology, Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Schowalter
authors.affiliation: Department of Dermatology, Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.|Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Melissa P
authors.initials: MP
authors.lastname: Piliang
authors.affiliation: Department of Dermatology, Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, USA. fernana6@ccf.org.|Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA. fernana6@ccf.org.
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Fernandez
mesh_terms: D000328:Adult; D003872:Dermatitis / Q000473:pathology*; D004817:Epidermis / Q000473:pathology*; D005260:Female; D015726:Giant Cells / Q000473:pathology*; D006801:Humans; D015603:Keratinocytes / Q000473:pathology*
keywords: dermatitis artefacta; keratinocytes; multinucleated giant cells