engleski

Dermatitis artefacta as a variant of irritant contact dermatitis

28 patients with dermatitis artefacta have been investigated by a dermatologist and a psychiatrist. The diagnosis was made on the basis of bizzare case history and dermatological lesions. The lesions were unusual in configuration, single or multiple, confined to area accessible to patients’hands. All skin lesions healed under the occlusive dressing. There was strenuous denial by 18 patients that took part in provoking the lesions, while others admitted to have produced skin lesions by scratching, abrasions, burning, applying chemicals and plants, and injecting some ingredients under the skin. All that provoked heavy irritant dermatitis with erythema, erosions and somethimes ulcerations. Histological analysis was made in 11 patients: in 3 we found epidermal necrosis suspected to be an artefact, in 1 intraepidermal blister without acantholysis, in 1 acantholytical intraepidermal blister (DIF and IIF were negative), in 5 unspecific inflammatory reaction, and in 1 cicatricial keloid type reaction. The visible skin lesions can be interpreted as an attempt of nonverbal communication, actually a silent appeal for help. Many of these patients displayed a rather neurotic emotional disorder and not psychosis. In 6 of our patients, the psychical structure was within normal limits, 2 exhibited a low intelectual level, 1 mental retardation, 13 displayed neurotic disorders, and only 6 were borderline cases where a longterm and intensive psychotherapy was recommended.

irritant contact dermatitis; dermatitis artefacta; neurotic disorders

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