The major advantages of histopathology are speed, low cost and the ability to provide a presumptive identification of the infecting fungus as well as demonstrating the tissue reaction. Dermatitis artefacta da is an intentional selfinflicted dermatitis produced by patients for unconscious psychological gain. The term eczema, which formerly referred to the blistered, oozing state of inflamed skin, has by common usage come to have the same meaning as dermatitis. Dermatitis artefacta is a rare pathology for which. We conducted a pubmed search without time frame using the terms dermatitis artefacta, factitiousfactitial dermatitis, artefactual skin in combination with histology or pathology. Histopathological pattern caused by chronic rubbingscratching. The cracks are 1 mm to 8 mm deep and bleeding continues for 2 to 3 hours then the cracks get healed in a week leaving marks on the skin. Dermatitis artefacta is a disease that occurs as a result of a selfinflicted injury of the skin. Factitious dermatitis due to thermal burn with histologic features simulating fixed drug eruption leah persad, do, sadia salim, md, and kiran motaparthi, md abstract. Dermatitis artefacta da is a rare selfinduced psychocutaneous disorder where the patient denies hisher role in its causation. Stasis dermatitis can be prevented if steps are taken early to improve the blood circulation. Patients with this condition require both dermatologic assessment and psychosocial support. The act of selfharm is to discharge the inner sense of isolation and emotional distress, which is too great to endure. Characteristically, patients deny the responsibility for their creation.
To satisfy her psychological or emotional need, it is the deliberate and conscious. The patient has full insight, but hides the responsibility for their actions. Pathology of skin introduction linkedin slideshare. The clinical presentation is characteristic, and differs from that of neurotic excoriations, delusional disorders, malingering, and munchausens syndrome. Dermatitis artefacta primary care dermatology society uk. If allergic contact dermatitis involves extensive areas of the skin greater than 20 percent, systemic steroid therapy is often required and offers relief within 12 to 24 hours. Histopathological patterns in dermatitis artefacta. It encompasses a large heterogeneous group of skin lesions and may form part of a braod spectrum of artefactual disease which can affect any organ and present to any discipline. The tissue undergoes a series of steps before it reaches the examiners desk to be thoroughly examined microscopically to arrive at a particular diagnosis. Dermatitis artefacta is a relevant and frequently unrecognized clinical condition associated with self.
The condition is caused by chronic poor blood flow in the veins and particularly by varicose veins. From the department of dermatology, university hospital, queens medical centre, nottingham, england. Dermatitis artefacta, a factitious dermatitis from selfinflicted injury, is a diagnosis of exclusion and when there is evidence of an artifactual cause. Dermatitis artefacta is thought to account for between 1 in 200 to 1 in 2,000 dermatological consultations. General dermatologic care measures include baths, debridement, emollients, and topical. The characteristic atopic reaction to patch tests with human dander and the naturally occurring lesions of the disease atopic dermatitis resemble each other grossly in the occurrence of papules, papulovesicles, redness and slight desquamation and in their chronologic development and retrogression. Keloids and foreign body granuloma due to overvalued ideation of acupuncture. The disease, unfortunately, shows a strong tendency to relapse upon cessation of fig. Chapter 1 introducton histopathology definition it is a branch of pathology which deals with the study of disease in a tissue section. Without additionally using the latter two terms, we found a little more than 200 publications. Summary background dermatitis artefacta is a relevant and frequently. Alcohol penetrates rapidly in presence of other fixative hence incombination e. Dense clusters of neutrophils and scattered eosinophils fill the papillary dermis forming microabscesses figure 4.
By occlusive bandaging dressing lesions healed without recurrence. Request pdf on apr 24, 2018, jorg tittelbach and others published histopathological patterns in dermatitis artefacta find, read and cite all the research you. Infective dermatitis is also referred to as chronic infantile. Stasis dermatitis is a skin inflammation affecting the ankles and lower legs. Dermatitis artefacta then develops as an emotional escape valve or an appeal for help in an attempt to fill a need of which the patient is not aware. Factitious dermatitis due to thermal burn with histologic. The methods used to injure the skin include deep excoriations with a sharp instrument, scarification with a knife, the application of caustic.
The characteristic atopic reaction to patch tests with human dander and the naturally occurring lesions of the disease atopic dermatitis resemble each other grossly in the occurrence of papules, papulovesicles, redness and slight desquamation and in. Three cases of dermatitis artefacta are reported for their varied presentation, diagnostic indicators and complex management. Oct 09, 2018 dermatitis artefacta is a challenging condition whose management requires dermatologic and, often, psychiatric expertise. Infective dermatitis should by definition respond to appropriate antibiotic therapy. Dermatitis artefacta medigoo health tests and medical. The tissue undergoes a series of steps before it reaches the diagnosis. Table 1 criteria for diagnosis of infective dermatitisa four major criteria required for diagnosisb major criteria 1. Histopathology the pathogenesis of infective dermatitis is unknown. The poor blood flow brings about swelling and a progressively more acute irritation of the skin that may lead to ulceration. Aug 12, 2014 dermatitis artefacta is thought to account for between 1 in 200 to 1 in 2,000 dermatological consultations. In women, it is regarded as a cry for help, especially when the patient is faced with psychosocial stress.
Skin lesions are very variable, depending on the methods they choose to. Aug 22, 2012 in dermatitis artefacta, the patient creates skin lesions to satisfy an internal psychological need, usually a need to be taken care of. Scanning power view of dermatitis herpetiformis shows vesicular reaction pattern figure 1, characterized by foci or small zones of subepidermal separation figures 2 and 3. Dermatitis artefacta da is a deliberate and conscious selfinflicted cutaneous injury. Chronic infective dermatitis is associated with an increased risk of malignant transformation and may be an early sign of. Munchausens syndrome by proxy is a form of dermatitis artefacta. Factitious dermatitis fd dermatitis artefacta is rare and often dif. Dermatitis artefacta da is a factitious disorder in which dermatological signs and symptoms are the predominant feature. Dermatitis artefacta as a symptom of schizophrenia. Svirsky department of oral pathology box 566, mcv station richmond, va 23298 bound volumes available to subscribers bound volumes of oral surgery, oral medicine and oral pathology are available to subscribers only for the 1987 issues from the publisher, at a cost of. The cracks are very sharp and it looks that they are made by a sharp knife or blade.
Lack of clinical and histopathologic correlation can raise suspicion, as in this case. The term is derived from the greek histos meaning web or tissue, and refers to the science of tissues. Histopathology remains one of the major tools of diagnosis in mycology20 table 3. Microscopy reveals a subacute or chronic inflammatory. It is characterized by a vast spectrum of geometrical or linear shape lesions such as. Postinflammatory hyperpigmentation in the skin of the buttocks. It is a poorly understood condition and, in most cases, goes on for a. The current management of delusional parasitosis and dermatitis artefacta. After consulting many doctors ultimately he took his son to aiims delhi.
Dermatological treatment occlusive dressing, tetracycline and hydrocortisone ointment, allantoin cream was introduced with a complete improvement within 2 months. Keloids and foreign body granuloma due to overvalued ideation of acupuncture sanjiv v choudhary 1, praveen khairkar 2, adarshlata singh 1, sumit gupta 1 1 department of dermatology, jawaharlal nehru medical college, sawangi, wardha, maharashtra, india 2 department of psychiatric, jawaharlal nehru medical college, sawangi, wardha, maharashtra, india. Acute, subacute or chronic spongiotic dermatitis in acute lesions, there is focal, usually mild, spongiosis with overlying scale crust containing a few neutrophils. The size and features of surgical pathology gross room depend on the. Histopathology from the crusted plaque revealed foreign body granuloma. From the department of dermatology, university hospital, queens medical centre. Carnoys fixative is used to increase the speed of tissue processing. It is slow to penetrate, hardens and shrinks the tissue. A diagnosis of dermatitis artefacta is often reached after. To achieve this it is important that the tissue must be prepared in such a manner. Mechanical and chemical devices are most commonly used to produce such injuries. Laboratory investigations, including histopathological examination, are usually nonspecific and do not give a correct clue to diagnosis. By choudhary sanjiv, khairkar praveen, singh adarshlata and gupta sumit. It acts as a reducing agents, become oxidized to acetaldehyde and then to acetic acid.
Later, the association of infective dermatitis with an underlying human tcell lymphotropic virus infection was recognized. Dermatitis artefacta is a condition in which skin lesions are solely produced or inflicted by the patients own actions. Factitial dermatitis or dermatitis artefacta is a psychocutaneous disorder produced by or perpeturated by the patients own actions. The investment you make in yourself must receive top priority. Summary background dermatitis artefacta is a relevant and frequently unrecognized clinical condition associated with self. Dermatitis artefacta in a patient with paranoid syndrome.
Dermatitis artefacta da is a selfinflicted dermatological condition where the underlying motive is to assume a sick role. Histology page 1 histological techniques histology is the study of the cellular organization of body tissues and organs. Dermatitis artefacta of paraoral region 263 reprint requests o. This usually occurs as a result or manifestation of a psychological problem. Dermatitis, an inflammation of the skin usually characterized by redness, swelling, blister formation, and oozing and almost always by itching. Dermatitis artefacta is defined as the deliberate and conscious production of selfinflicted skin lesions to satisfy an unconscious psychological or emotional need. Dermatitis artefacta is a form of factitious disorder in which patients will intentionally feign symptoms and produce signs of disease in an attempt to assume the patient role. You are the stone, you are the chisel, and you are the sculpture. Skin is well recognized as an important somatic mirror of ones emotion and a site for the discharge of ones anxieties. From the last two years, he is suffering from cracking of the skin. Patients with dermatitis artefacta may report the following. Apr 24, 2018 dermatitis artefacta is a relevant and frequently unrecognized clinical condition associated with self. Histopathology techniques histopathology definition. Dermatitis artefacta da is a factitious dermatological disorder with many forms of presentation that may involve any part of the body.
Histopathological patterns in dermatitis artefacta request pdf. Histopathological patterns in dermatitis artefacta wiley online library. A 21yearold soldier had multiple painful erosions on dorsum of both forearms of three weeks duration normal with inbetween skin. The lesions are in sites readily accessible to the patients hands. Dermatitis artefacta means selfinflicted lesions of the skin. In women, it is regarded as a cry for help, especially when the patient is faced with psychosocial stressors.
We present a case of a 42yearold female patient presenting with a vague history of generalized body pain and skin lesions in the form of cotton threads buried under the skin, crusted plaque, multiple keloids and rusted pin buried through the skin mostly in the easily. Dermatitis artefacta of the paraoral region sciencedirect. It is a rare pathology of skin lesions characterized by. It is also selfinflicted skin damage, most commonly from prolonged deliberate scratching, but sometimes by means of sharp instruments or another agency. Dermatitis artefacta frequently is associated with underlying psychosocial problems 1,2. Factitial dermatitis dermatitis artefacta may be defined as any form of selfinflicted skin. It is a branch of pathology which deals with the study of disease in a tissue section. Brough, northwood, middlesex summary an unusual case of dermatitis artefacta is presented. Dermatitis artefacta is a challenging condition whose management requires dermatologic and, often, psychiatric expertise. Histopathology of the skin lesions was nonspecific. Complex medical history with unexplained chronic abdominal pain 10 yr duration requiring regular high dose oral and transdermal opiates. Dermatitis artefacta da is a psychocutaneous disorder where the skin lesions are self selfinduced to.
Infective dermatitis represents a severe form of recurrent eczematous skin change that presents in childhood. While atypical lesions and an unusual disease course may give rise to clinical suspicion of a self. It could be a form of emotional release in situations of distress or part of an attention seeking behaviour. It is also selfinflicted skin damage, most commonly from prolonged deliberate scratching, but sometimes by. Request pdf on apr 24, 2018, jorg tittelbach and others published histopathological patterns in dermatitis artefacta find, read and cite all the research you need on researchgate. After consulting many doctors ultimately he took his son to aiims. In dermatitis artefacta, the patient creates skin lesions to satisfy an internal psychological need, usually a need to be taken care of. The methods used to injure the skin include deep excoriations with a sharp instrument, scarification with a knife, the application of caustic chemicals and burning, sometimes with a cigarette. Rhinitis is common, and although the distribution of the rash is similar.
Acantholytic keratinocytes may also be evident within the. Dermatitis artefacta da is a skin condition caused entirely by the actions of the patient on the skin, hair, nails or mucosae. Differential diagnoses may vary greatly depending on the methodology and type of skin. Typically, they are reluctant to seek a consultation with a.
Dermatitis artefacta patients may also have a personal or family history of psychiatric illness, including anxiety, depression, personality disorder borderline, dependent, or obsessivecompulsive, dissociative disorder, body dysmorphic disorder, or posttraumatic stress disorder. However, this emotional stress may be difficult to detect. Dermatitis occurs at site of contact antigens are initially taken up by langerhans cells and carried to lymph nodes upon reexposure, cytokines are released, causing endothelial activation and adherence of memory t cells, which release lymphokines, causing spongiotic dermatitis. The patient lost the whole of the index finger of his dominant hand before the diagnosis was established. Dermatitis artefacta is a factitious dermatological disorder with many forms of presentation that may occur on any part of the body. The second histopathology taken from the thigh revealed.
1622 1265 184 1499 1454 50 843 685 368 1156 1632 915 375 182 1386 868 1425 493 1151 458 1284 368 938 524 1137 356 434 1668 772 771 1106 1087 722 178 277 159 982 1004 1466 1182