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CONSICE COMMUNICATION
Year : 2019  |  Volume : 10  |  Issue : 1  |  Page : 72  

Dermatitis artefacta in a child: An interesting morphological presentation


1 Department of Dermatology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
2 Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Date of Web Publication14-Jan-2019

Correspondence Address:
Gaurav Dash
Department of Dermatology, All India Institute of Medical Sciences, Bhubaneswar, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/idoj.IDOJ_132_18

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How to cite this article:
Pradhan S, Sirka CS, Dash G, Mohapatra D. Dermatitis artefacta in a child: An interesting morphological presentation. Indian Dermatol Online J 2019;10:72

How to cite this URL:
Pradhan S, Sirka CS, Dash G, Mohapatra D. Dermatitis artefacta in a child: An interesting morphological presentation. Indian Dermatol Online J [serial online] 2019 [cited 2019 Feb 17];10:72. Available from: http://www.idoj.in/text.asp?2019/10/1/72/250065



Sir,

A 10-year-old boy presented with recurrent painful skin lesions over body since 2 years, appearing at an interval of 5–6 days. Examination revealed square-shaped erosions with crusting and hypopigmented and hyperpigmented scars over approachable areas of body [Figure 1]. The lesions were of two different sizes indicating two types of square-shaped instruments used for inflicting injuries. On the basis of pattern of lesions and their distribution, diagnosis of dermatitis artefacta was made. Psychiatric evaluation revealed separation from father, getting less attention of parents, and patient's anxiety being the cause of the disease condition. The patient and parents were counselled separately, family therapy was given, and stressors were addressed. The child was given cognitive behavioral therapy and he did not develop any new skin lesions during the 4 months of follow-up.
Figure 1: Square-shaped scars of two different sizes on approachable areas

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Dermatitis artefacta is characterized by self-inflicted skin lesions over accessible areas of the body to satisfy a psychological need of which he or she is not completely aware.[1] It is mostly found in prepubertal and adolescent age groups.[2] The lesions are symmetrical, bizarre-shaped, and monomorphic at variable stages of healing. Several causes such as delayed developmental milestones, loss of close relatives in the recent past, separation from parents/close relatives, disturbed parent–child relationship, domestic violence, gender bias, pressure to do well in exam, bullying in school, conflict with siblings have been implicated as the precipitating factors for dermatitis artefacta.[3],[4],[5] In our case, separation from the father and getting less attention from the mother was the cause of dermatitis artefacta in the child; he was injuring himself with square-shaped wooden stamp and some irritant to gain the attention of parents. The child was given cognitive behavior therapy along with identification of cognitive errors and correction of maladaptive cognition.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Gregurek-Novak T, Novak-Billic G, Vucic M. Dermatitis artefacta: Unusual appearance in an older woman. J Eur Acad Dermatol Venereol 2005;19:223-5.  Back to cited text no. 1
    
2.
Sneddon I, Sneddon J. Self-inflicted injury: A follow-up study of 43 patients. Br Med J 1975;3:527-30.  Back to cited text no. 2
    
3.
Rogers M, Fairley M, Santhanam R. Artefactual skin disease in children and adolescents. Australas J Dermatol 2001;42:264-70.  Back to cited text no. 3
    
4.
Kumaresan M, Rai R, Raj A. Dermatitis artefacta. Indian Dermatol Online J 2012;3:141-3.  Back to cited text no. 4
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5.
Obasi OE, Naguib M. Dermatitis artefacta: A review of 14 cases. Ann SaudiMed 1999;19:223-7.  Back to cited text no. 5
    


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