Am J Dermatopathol 2017 Jan 31. Epub 2017 Jan 31.

*Department of Dermatology, University of Cincinnati, Cincinnati, OH;†Miraca Life Sciences Research Institute, Irving, TX; and‡Department of Dermatology, University of Florida College of Medicine, Gainesville, FL.

Factitious dermatitis (FD) (dermatitis artefacta) is rare and often difficult to diagnose because of conflicting history and nonspecific clinical and histologic findings. It can present with varied clinical features including geometric ulcers, erosions, and less commonly bullae secondary to external trauma from chemicals, electric burns, heat, and suction. Herein, we describe a case of bullous FD due to thermal burn with histologic features demonstrating overlap with fixed drug eruption. Read More

Clin Dermatol 2017 May - Jun;35(3):273-280. Epub 2017 Jan 22.

Department of Dermatology and Itch Center, Miller School of Medicine, University of Miami Medical Center, Miami, Florida. Electronic address:

The skin and psyche are intimately related with various skin diseases caused by or resulting in psychiatric disturbances. Pruritus is a commonly reported symptom in psychiatric patients, and likewise psychiatric co-morbidities, including anxiety and depression, are frequently seen in chronic pruritus patients. Primary psychodermatologic conditions, such as somatic symptom disorder, dermatitis artefacta, obsessive-compulsive and related disorders (excoriation disorder and prurigo nodularis), delusional infestation, and substance use disorder, can all induce significant pruritus in patients, severely affecting their quality of life. Read More

Clin Dermatol 2017 May - Jun;35(3):267-272. Epub 2017 Jan 21.

Department of Medicine, Faculty of Medicine, University of Toronto, Ontario, Canada.

Dissociation and conversion (defined as the somatic component of dissociation) can play an important mediating role in the exacerbation of the stress-reactive dermatoses (eg, psoriasis, idiopathic urticaria, atopic dermatitis), dermatoses that are exacerbated by excessive scratching (eg, lichen simplex chronicus, prurigo nodularis) and koebnerization, and the self-induced dermatoses (dermatitis artefacta, acne excoriée, skin picking disorder, trichotillomania, onychotillomania/onychophagia). Dissociative symptoms often coexist with obsessive-compulsive symptoms in the more severe cases of the self-induced dermatoses. Dissociation can play an important role in cutaneous sensory disorder (eg, scalp dysesthesia syndrome, stomatodynia/glossodynia, vulvodynia/scrotodynia, medically unexplained anesthesia). Read More

Clin Dermatol 2017 May - Jun;35(3):260-266. Epub 2017 Jan 22.

Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Dermatologic symptoms can be associated with posttraumatic stress disorder (PTSD) in several situations: (1) as features of some core PTSD symptoms, such as intrusion symptoms manifesting as cutaneous sensory flashbacks, as autonomic arousal manifesting as night sweats and idiopathic urticaria, and as dissociation manifesting as numbness and dermatitis artefacta; (2) the cutaneous psychosomatic effects of emotional and physical neglect and sexual abuse (eg, infantile eczema, cutaneous self-injury, and body-focused repetitive behaviors such as trichotillomania and skin picking disorder) and eating disorders, which can have dermatologic effects; (3) the direct effect of physical or sexual abuse or catastrophic life events (eg, earthquakes) on the skin; and (4) as a result of significant alterations in hypothalamic-pituitary-adrenal and sympatho-adrenal medullary axes, which can affect neuroendocrine and immune functions, and can lead to exacerbations of stress-reactive inflammatory dermatoses such as psoriasis, chronic urticaria, and atopic dermatitis. Elevated levels of inflammatory biomarkers and impaired epidermal barrier function have been reported in situations involving sustained psychologic stress and sleep deprivation. Some PTSD patients show hypothalamic-pituitary-adrenal axis hyporesponsiveness and higher circulating T lymphocytes, which can exacerbate immune-mediated dermatologic disorders. Read More

J Dermatolog Treat 2017 Jun 24;28(4):342-346. Epub 2016 Oct 24.

b Department of Dermatology, Psoriasis and Skin Treatment Center , University of California San Francisco , San Francisco , CA , USA.

Individuals with obsessive-compulsive features frequently visit dermatologists for complaints of the skin, hair or nails, and often progress towards a chronic relapsing course due to the challenge associated with accurate diagnosis and management of their psychiatric symptoms. The current DSM-5 formally recognizes body dysmorphic disorder, trichotillomania, neurotic excoriation and body focused repetitive behavior disorder as psychodermatological disorders belonging to the category of Obsessive-Compulsive and Related Disorders. However there is evidence that other relevant skin diseases such as delusions of parasitosis, dermatitis artefacta, contamination dermatitis, AIDS phobia, trichotemnomania and even lichen simplex chronicus possess prominent obsessive-compulsive characteristics that do not necessarily fit the full diagnostic criteria of the DSM-5. Read More

J Eur Acad Dermatol Venereol 2016 Oct 15;30(10):e101-e102. Epub 2015 Sep 15.

Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.

Clin Psychopharmacol Neurosci 2016 Aug;14(3):311-3

Consultant Psychiatrist, Kolkata, India.

Dermatitis artefacta lies in a gray zone, between the specialities of psychiatry and dermatology. The condition could mimic a number of other lesions and therefore is a source of much confusion in clinical practice. Here, we describe a case of dermatitis artefacta in an 11-years old girl, which resembled self-harming behavior in Borderline personality disorder. Read More

Acta Derm Venereol 2016 Aug;96(217):64-8

Department of Psychiatry and Psychosomatics, I.M.Sechenov First Moscow State Medical University, Moscow, Russia.

The article is devoted to a psychodermatological disorder with self-destructive behavior - hypochondriasis circumscripta. Presented data are based on a clinical analysis of 22 consecutive cases (15 female; mean age - 56.1 ± 12. Read More

J Pediatr 2016 Aug 2;175:237-237.e1. Epub 2016 Jun 2.

Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom.

J Cutan Pathol 2016 Oct 27;43(10):880-3. Epub 2016 Jun 27.

Department of Dermatology, Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.

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. Read More

J Pediatr Neurosci 2016 Jan-Mar;11(1):80-2

Department of Dermatology, AIIMS, Bhubaneswar, Odisha, India.

Dermatitis artefacta, a self-inflicted intentional dermatosis is a very rare diagnosis in childhood. In a large proportion, the underlying psychiatric disorders go unidentified due to lack of collaboration between dermatologist and psychiatrist. The underlying psychological reasons for childhood dermatitis artefacta include emotional distress and interpersonal conflicts. Read More

Int J Trichology 2016 Jan-Mar;8(1):26-8

Department of Dermatology and Venereology, Government Medical College, Thrissur, Kerala, India.

Dermatitis artefacta (DA) and trichotemnomania are self-inflicted dermatoses often preceded by psychosocial stressful events. A 38-year-old female presented with sudden loss of hair in the right frontal area along with discoloration and edema of skin. On examination, there was complete loss of hair involving the right frontal area and the lateral half of right eyebrow with skin over that area appearing scalded, edematous, bruised, and discolored. Read More

Indian J Dermatol 2016 Mar-Apr;61(2):193-5

Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India.

Patients presenting with unusual symptoms are uncommon. Unusual symptoms often catch the attention of the public including the health professionals. Atypicality in the symptoms is usually seen in patients with factitious disorder. Read More

Wounds 2016 Feb;28(2):63-7

Hospital Infanta Leonor, Madrid, Spain.

Dermatitis artefacta may represent a real challenge for the clinician. As the patient does not admit self-inflicting the lesions, misdiagnosis with other diseases, such as pyoderma gangrenosum, is common. Consequently, these patients normally go through unnecessary tests and receive potentially harmful treatments as clinicians determine their diagnosis. Read More

Ugeskr Laeger 2016 Feb;178(6):V10150786

Dermatitis artefacta is a self-inflicted skin disease with a multifactorial aetiology. The condition can be a symptom of an underlying psychiatric condition or a sign of psycho-social stressors. This paper gives an updated view on dermatitis artefacta. Read More

Indian J Dermatol 2015 Nov-Dec;60(6):613-5

Department of Dermatology, STD and Leprosy, Burdwan Medical College, Burdwan, West Bengal, India.

Dermatitis artefacta (DA) is a self-inflicted dermatological condition where the underlying motive is to assume a sick role. The act of self-harm is to discharge the inner sense of isolation and emotional distress, which is too great to endure. We, hereby, report five interesting cases of DA with varied presentations, using diverse and innovative means for inflicting injury/injuries. Read More

Acta Neurochir (Wien) 2015 Dec 15;157(12):2227-8. Epub 2015 Oct 15.

Division of Neurosurgery, University of Cambridge, Cambridge, UK.

Acta Dermatovenerol Croat 2015 ;23(2):87-95

Professor Aleksandra Basta-Juzbašić, MD, PhD, Department of Dermatology and Venereology, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Šalata 4, 10000 Zagreb, Croatia;

Primary psychiatric disorders where skin changes appear most frequently include: delusions of parasitosis, body dysmorphic disorder, neurotic excoriations, dermatitis artefacta, and trichotillomania. In all these diseases the primary pathologic condition is of psychiatric nature, and the skin changes are secondary and self-induced. In this review we wanted to present the epidemiology, clinical pictures, and treatment options for these disorders. Read More

Ann Dermatol 2015 Jun 29;27(3):322-5. Epub 2015 May 29.

Department of Dermatology, Korea University College of Medicine, Seoul, Korea.

Tinea incognito is a dermatophytic infection induced by immunosuppressive agents that lacks the classic features of a typical fungal infection. Although the treatment of tinea incognito is simple and relatively easy, its clinical manifestation varies and can masquerade as various skin disorders, causing misdiagnosis and thus preventing prompt and appropriate treatment. Here, we report an interesting case of tinea incognito occurring after topical steroid administration in an immunosuppressed patient with dermatitis artefacta. Read More

Pediatr Dermatol 2015 Sep-Oct;32(5):604-8. Epub 2015 Jun 8.

Department of Dermatology, Hospital Universitario Virgen Macarena, Sevilla, Spain.

Background: Dermatitis artefacta (DA) consists of self-inflicted skin lesions that the patient denies having produced.

Objectives: To conduct a single-center retrospective clinical review of children and adolescents diagnosed with DA.

Methods: From 1976 to 2006, data were collected on children diagnosed with DA who were seen in the Department of Dermatology in our hospital. Read More

J Cutan Pathol 2015 Sep 26;42(9):660-1. Epub 2015 May 26.

Department of Medicine (Dermatology), Vanderbilt University, Nashville, TN, USA.

Int Wound J 2016 Oct 14;13(5):860-2. Epub 2015 Jan 14.

Department of Pathology, Dental School, University of São Paulo, São Paulo, Brazil.

Obsessive-compulsive-related cutaneous disease most often includes trichotillomania, neurotic excoriations and nail biting. In this report, we present two cases of self-inflicted severe wounds that were diagnosed as secondary to obsessive-compulsive behaviour. Patients were middle-aged females who presented with deep cutaneous ulcers that were acknowledgedly maintained through repetitive manipulation. Read More

Indian J Psychol Med 2014 Oct;36(4):447-8

Department of Dermatology, Subharti Medical College, Meerut, Uttar Pradesh, India.

J Dermatol Case Rep 2014 Sep 30;8(3):81-3. Epub 2014 Sep 30.

Department of Dermatology and Venereology, Government Medical College and Hospital, Sector 32 B, Chandigarh, India.

A 22-year-old female presented to the dermatology department with a 8-month history of blistering lesions over the left forearm and face. Most of the bullae and erosions were perfectly round and of nearly the same size. In absence of any obvious etiological, precipitating or aggravating factor, a provisional diagnosis of dermatitis artefacta (self-inflicted dermatological lesions) was made. Read More

Postepy Dermatol Alergol 2014 Aug 8;31(4):277-9. Epub 2014 Sep 8.

Psychodermatology Department, Medical University of Lodz, Poland. Head of Department: Prof. Anna Zalewska-Janowska MD, PhD.

Dermatitis artefacta is a disease that occurs as a result of a self-inflicted injury of the skin. The skin lesions are most often located on the areas within easy reach of the patient's dominant hand sparing the middle part of the back. Dermatitis artefacta may coexist with psychiatric disorders and imitate many dermatologic diseases. Read More

Compr Psychiatry 2014 Oct 7;55(7):1614-9. Epub 2014 Jul 7.

Department of Psychiatry, Farhat Hached hospital, Tunisia.

Background: If the severity of dermatitis artefacta (DA) is accepted by most authors, few published studies have sought to clarify its etiology and impact. It is in this context that this work aimed to compare Life Events (LE) and quality of life (QoL) scores in patients with DA, in their siblings and in control patients with other chronic dermatological diseases.

Methods: This is a descriptive and comparative cross-sectional study carried out in the dermatology department of Farhat Hached hospital in Sousse, Tunisia. Read More

Clin Ter 2014 ;165(3):e223-4

Dermatology Unit, S. Andrea Hospital, NESMOS Department, University of Rome 'Sapienza', Italy.

Int J Dermatol 2015 Jan 16;54(1):e27-32. Epub 2014 Apr 16.

Department of Dermatology, Roskilde Hospital, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark.

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. Read More

Iran Red Crescent Med J 2013 Sep 5;15(9):862-4. Epub 2013 Sep 5.

Department of Psychiatry, Rafsanjan University of Medical Sciences, Rafsanjan, IR Iran.

Dermatitis artifacta is a factitious dermatological disorder with many forms of presentation of self inflicted skin lesions in any part of the body. Dermatitis artefacta is a rare and difficult condition for diagnosis and treatment mostly because of the patient's denial. The liaison among primary care physicians, psychiatrists and dermatologists can be important in the management of these patients. Read More

Cutan Ocul Toxicol 2014 Mar 13;33(1):22-7. Epub 2013 May 13.

Faculty of Medicine, Dermatology, Dicle University , Diyarbakir , Turkey.

Background: Factitial dermatitis describes self-produced and consciously made skin lesions usually intended to win sympathy, avoid responsibilities and even gain disability insurance. Dermatitis artefacta belongs to an extensive spectrum of self-inflicted diseases termed factitious diseases.

Objectives: The study is retrospective, and the patients were seen in our department from 2002 to 2012. Read More

Australas J Dermatol 2014 Feb;55(1):90

Royal Melbourne Hospital, Parkville, Melbourne, Victoria, Australia.

J Eur Acad Dermatol Venereol 2014 Sep 12;28(9):1262-3. Epub 2013 Dec 12.

Duke-NUS Graduate Medical School, Singapore.

Indian Pediatr 2013 Sep;50(9):897-8

Department of Dermatology and STD, University College of Medical Sciences and Guru Tegh Bahadur Hospital, University of Delhi, Delhi, India.

Acta Clin Croat 2013 Jun;52(2):247-50

Clinical Department of Dermatovenereology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia.

Automutilating behavior is becoming ever more frequent in patients seeking dermatologic care. Psychocutaneous disorders encompass a wide range of dermatologic conditions, all of which have in common the important role of psychological factors. Dermatitis artefacta syndrome is characterized by unconscious self-injury behavior, while dermatitis para-artefacta syndrome is labeled with manipulation of an existing specific dermatosis. Read More

Semin Cutan Med Surg 2013 Jun;32(2):95-100

Keck School of Medicine, University of Southern California, Los Angeles, USA.

Neurotic Excoriations is a psychocutaneous disorder that is characterized by an uncontrollable urge to pick at normal skin or skin with mild irregularities. Dermatitis Artefacta is another psychocutaneous disorder that consists of self-induced skin lesions often involving a more elaborate method for damaging the skin, such as the use of a sharp instrument. Both neurotic excoriations and dermatitis artefacta cause significant disfigurement and anxiety for the patient. Read More

J Craniofac Surg 2013 Jul;24(4):e432-4

Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Krishna Institute of Medical Sciences, Deemed University, Karad, Maharashta, India.

Numbness and ulceration of the face, particularly erosion of ala of the nose, sometimes occur after sensory denervation in the territory of the divisions of the trigeminal nerve. The incidence is uncertain and usually follows surgical treatments for trigeminal neuralgia. Such condition is known as trigeminal trophic syndrome (TTS), although some authors believe it to be a special form of dermatitis artefacta. Read More

Indian J Psychiatry 2013 Apr;55(2):189-91

Department of Skin and VD, MKCG Medical College and Hospital, Berhampur, India.

A 27-year old lady presented to our department with multiple erosive lesions over extremities, which had a very bizarre pattern and was only over accessible parts of body. A thorough history was taken and a diagnosis of dermatitis artefacta was made. We present this interesting case for its rarity and future reference. Read More

Clin Exp Dermatol 2013 Dec 13;38(8):921-3. Epub 2013 Jun 13.

Department of Dermatology, Barts Health NHS Trust, Royal London Hospital, London, UK.

Dermatitis artefacta (DA), a factitious skin disorder, often occurs as a response to traumatic life events or as a factitious behaviour, which may result in secondary gain. It can be difficult to get patients to engage with health services, and they seldom admit to causing the lesions themselves. The possibility of DA lesions occurring in dissociative states is less well known. Read More

Br J Dermatol 2013 Sep;169(3):600-6

Whipps Cross University Hospital, London, U.K.

Background: Dermatitis artefacta (DA) is a factitious skin disorder caused by the deliberate production of skin lesions by patients with a history of underlying psychological problems. The patient may not be fully aware of this, and the true extent of this disorder, especially in children, is currently unknown. Management of these patients is challenging as many fail to engage effectively with their dermatologist. Read More

J Vis Commun Med 2013 Jun;36(1-2):31-4

Welsh Institute of Dermatology, University Hospital of Wales, Cardiff, UK.

A patient is described with dermatitis artefacta, which is a common psychocutaneous disorder whereby a fully-aware patient self-inflicts injury to their skin. The motives for their behaviour can vary and the patient always tries to hide the responsibilities for their actions. In this case report, serial use of standardised photography provided strong evidence to support the diagnosis of dermatitis artefacta. Read More

Aust N Z J Psychiatry 2013 Oct 29;47(10):974-5. Epub 2013 Apr 29.

1Adult Mental Health Unit Team, Toowoomba Base Hospital, Darling Downs Health Service District, Toowoomba, Australia.

Clin Exp Dermatol 2013 Jul 23;38(5):504-6. Epub 2013 Apr 23.

Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK.

A 69-year-old woman presented with a nonhealing ulcer on her right cheek. On histological examination of a biopsy, no evidence of granuloma formation or malignancy was found, and the overall picture was felt to be consistent with dermatitis artefacta (DA). The patient was referred to a joint psychodermatology clinic, where treatment with risperidone was started. Read More

Pan Afr Med J 2013 16;14:23. Epub 2013 Jan 16.

Service de pédiatrie, Hôpital Militaire d'Instruction Mohamed V, Rabat, Morocco.

Indian J Dermatol 2013 Jan;58(1):44-8

School of Medicine, University of Utah, Salt Lake City, UT, San Francisco, California ; Department of Dermatology, University of California, San Francisco, California, USA.

Primary psychiatric conditions encountered in dermatology include dermatitis artefacta, trichotillomania (TTM) and neurotic excoriations. For these disorders, the primary pathologic condition involves the psyche; therefore, any cutaneous findings are self-induced. Herein, we review common primary psychiatric conditions in dermatology - dermatitis artefacta, neurotic excoriations and TTM - and examine their epidemiology, clinical presentation, differential diagnosis and treatment strategies. Read More

Acta Derm Venereol 2013 Jan;93(1):4-12

Department of Psychosomatic Medicine, Justus Liebig University, Giessen, Germany.

The terminology, classification, diagnosis and treatment of self-inflicted dermatological lesions are subjects of open debate. The present study is the result of various meetings of a task force of dermatologists, psychiatrists and psychologists, all active in the field of psychodermatology, aimed at clarifying the terminology related to these disorders. A flow chart and glossary of terms and definitions are presented to facilitate the classification and management of self-inflicted skin lesions. Read More

Singapore Med J 2012 Dec;53(12):789-93

Department of Dermatology, Changi General Hospital,Singapore.

Introduction: Recognising and appropriately treating psychosomatic factors in dermatological conditions can have a significant positive impact on the outcomes of patients. Treatment of psychodermatological patients requires a multidisciplinary approach that involves dermatologists, psychiatrists and allied health professionals.

Methods: This was a retrospective case series of patients seen in our psychodermatology liaison conferences from November 2009 to July 2011. Read More

Actas Dermosifiliogr 2013 Dec 22;104(10):854-66. Epub 2012 Dec 22.

Departamento de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España. Electronic address:

Dermatitis artefacta is a rarely diagnosed disorder that is often a source of perplexity and anxiety for dermatologists because they know less about the cause of this self-inflicted condition than the patients themselves. It differs from other skin disorders in that diagnosis is made by exclusion rather than on the basis of histologic and biochemical findings and therefore involves a considerable investment of time and resources. Based on the findings of a study of 201 patients diagnosed with dermatitis artefacta between 1976 and 2006, we review the different clinical presentations of this skin disorder and discuss its diagnosis and treatment. Read More

Clin Dermatol 2013 Jan-Feb;31(1):110-7

Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, 585 Springbank Dr, Suite 101, London, ON, N6J 1H3, Canada.

The self-induced dermatoses (such as trichotillomania, pathologic skin picking or neurotic excoriations, dermatitis artefacta, onychophagia and onychotillomania), which are caused as a result of excessive manipulation of the skin, hair, and nails by the patient, can contribute to significant morbidity and can even complicate the course of a primary dermatologic condition such as acne (eg, in acne excoriée) and some pruritic dermatoses. Reports on the self-induced dermatoses in the past decade have tended to focus upon the specific motor behaviors involved in self-inducing the lesions (ie, skin picking or hair pulling) rather than address the common psychopathologic factors underlying the self-injurious behaviors. In the current psychiatric nosology (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) the self-induced dermatoses are classified as Impulse Control Disorders and Stereotypic Movement Disorders, and this classification does not adequately consider the fact that in most patients with self-induced dermatoses, the frequency and severity of the self-injurious behaviors are directly related to acute or chronic problems with emotional regulation and dissociation. Read More