Factitial Dermatitis

Key Points
Skin condition in which the affected person deliberately injures the skin
Often attributed to psychological or interpersonal issues, including depression
Appearance of lesions may vary according to the method of injury, but will generally not resemble conventional Dermatitis

Factitial Dermatitis, also known as Dermatitis Artefacta, is a skin condition in which the affected person deliberately injures the skin. Lesions may take on many forms, dependent on the method of injury, but in any case are hard to recognize as they do not resemble those found in convential dermatitis. Lesions may be linear or geometric in form and patter, with irregular outlines which are well defined from surrounding skin. Lesions may appear as redness, blisters, areas devoid of skin, crusting areas, burns, or cuts, and can be produced by a variety of methods. The condition will not appear gradually, instead developing very quickly and in areas of the skin which are readily accessible. Lesions may appear to be chronic or episodic.

Factitial Dermatitis can develop in any gender or age group. Affected persons will often be of at least average intelligence, and may have some medical knowledge. Factitial Dermatitis is often attributed to a psychological or interpersonal problem, including depression, anxiety, personality and delusional disorders.

Differential Diagnosis (Other conditions with similar appearance)

Impetigo
Insect Bites
Atopic Dermatitis
Neurotic excoriations
Bedbug Bites
Contact Dermatitis
Pruritus and Systemic Disease
Delusions of parasitosis
Friction Blisters

Diagnosis
Key Points
Diagnosis based on skin appearance in conjunction with clinical psychological observation
Skin Biopsy or other testing may be performed to rule out other conditions

Factitial Dermatitis is primarily a psychological disorder. In some cases a skin biopsy may be performed to rule out other conditions. Most diagnoses are based on appearance of lesions in conjunction with clinical psychological observation.

Treatment
Symptomatic treatment of lesions in conjunction with close observation by health care professionals is the standard form of treatment
Goal of treatment is to eventually resolve the underlying psychological condition
Condition may be episodic depending on the affected person and underlying condition

If Factitial Dermatitis is suspected, the affected person should not be confronted, and will deny injuring themselves when/if they are. Instead, standard practice is symptomatic treatment of lesions in conjunction with close supervision by health care professionals, with the hope that professionals may slowly draw out the psychological aspects of the condition and begin treatment of them. The condition may be episodic throughout the affected person's life, and it is recommended that those affected continue to see health care professionals even when there are no lesions present to maintain supervision of the person's mental and physical health.