Dermatitis Artefacta

A 30-year-old woman had an extensive psychiatric history of anxiety and depression. She was concerned that the numerous lesions on her body might be signs of possible infection or infestation. The patient was undergoing treatment for multiple addictions to drugs, primarily methamphetamine (“crank”).

The linear, uniformly deep hand lesion with very little associated inflammation and the multiple old and new scars on the patient's back raised the suspicion of dermatitis artefacta. Joe Monroe, PA-C, of Tulsa, Okla, writes that the diagnosis was confirmed when the patient admitted that she had caused the lesions with her fingernails and a nail file. All the wounds were located on areas the patient could reach easily with her dominant hand.

Dermatitis artefacta occurs more often in women than in men. Generally, the patient is unable or unwilling to supply a history or possible cause of the skin lesions and appears relatively untroubled by the often unsightly wounds. The differential diagnosis includes ectoparasitic infestation and various systemic diseases, such as renal failure and hypothyroidism; however, in the absence of severe infection, laboratory findings are normal in persons with dermatitis artefacta.

Generally, dermatitis artefacta is self-inflicted for secondary gain, such as sympathy or avoidance of work or responsibility. Treatment includes gentle confrontation, support, and a psychiatric referral and evaluation. If necessary, offer symptomatic relief for pruritus and secondary infection.