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THROUGH THE LENS
Year : 2019  |  Volume : 10  |  Issue : 4  |  Page : 496-497  

Munchausen syndrome by proxy


1 Department of Dermatology, Aster Medcity, Kochi, Kerala, India
2 Department of Pediatric Neurology, Aster Medcity, Kochi, Kerala, India
3 Department of Psychiatry, Aster Medcity, Kochi, Kerala, India

Date of Web Publication28-Jun-2019

Correspondence Address:
Anuradha Kakkanatt Babu
Department of Dermatology, Aster Medcity, Kochi - 682 027, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/idoj.IDOJ_250_18

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How to cite this article:
Babu AK, Mohamed A, Das N. Munchausen syndrome by proxy. Indian Dermatol Online J 2019;10:496-7

How to cite this URL:
Babu AK, Mohamed A, Das N. Munchausen syndrome by proxy. Indian Dermatol Online J [serial online] 2019 [cited 2019 Jul 21];10:496-7. Available from: http://www.idoj.in/text.asp?2019/10/4/496/255536



A 5-year-old girl was brought by her parents with a 2-day history of fluid-filled and crusted skin lesions. While admitted in the hospital, the number of lesions increased day by day. On examination, the child was drowsy, and multiple hyperpigmented crusted plaques and vesicles were seen on face, trunk, and limbs [Figure 1]. Most of the lesions showed a peculiarly similar morphology which could be matched to have been made using a cigarette lighter [Figure 2]. Blood sample of the child which was sent for toxicology screening showed significant levels of alcohol. On further interrogation, the parents subtly admitted to have been intoxicating the child with alcohol to make her drowsy and fabricated the skin lesions using hot metallic rim of a cigarette lighter. On further inquiry, the parents admitted that they used to get money from their local religious organization on the claim of having a sick child. A diagnosis of Munchausen syndrome by proxy (MSBP) was made. Child welfare society was informed about this case who did the needful for the protection of the child. Parents were referred to psychiatry department for expert management.
Figure 1: Multiple hyperpigmented crusted plaques and vesicles on face, trunk, andlimbs

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Figure 2: Lesions with a peculiarly similar morphology which could be matched to have been made using a cigarette lighter

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MSBP was named after Baron von Munchausen, an 18th-century German dignitary known for making up stories about his travels and experiences to get attention.

MSBP is characterized by four important features: (i) fabrication of illness by caretaker or giver, (ii) child subjected to multiple diagnostic procedures and characterized by persistent illness, (iii) the perpetrator denies the cause of child illness, and (iv) theseparation of the child from the perpetrator stops the symptoms and signs presented by the child.[1]

In a review of 451 victims of MSBP by Sheridan, a majority of the perpetrators were biological mothers (76.5%) or fathers (6.7%).[2]

MSBP is a mental illness and may require treatment. Reduction of harm to the child remains to be the main aim. The golden rule is to try to build a strong rapport with the perpetrator and motivate to begin psychopharmacotherapy.[3] If there is an acute threat and if there is no motivation for therapy, the help of child protection services and legal services may be sought.

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.
Brown P, Tierney C. Munchausen syndrome by proxy. Pediatr Rev 2009;30:414-5.  Back to cited text no. 1
    
2.
Sheridan MS. The deceit continues: An updated literature review of Munchausen Syndrome by Proxy. Child Abuse Negl 2003;27:431-51.  Back to cited text no. 2
    
3.
Narang T, Kanwar AJ, Kumaran MS, Singh SM. Munchausen by proxy in a family. Indian J Dermatol Venereol Leprol 2012;78:748-50.  Back to cited text no. 3
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