Dermatitis artefacta and artefactual skin disease: the need for a psychodermatology multidisciplinary team to treat a difficult condition

Dermatitis artefacta, also known as factitial dermatitis, is a disease in which self-inflicted skin injury is utilized to fulfill a conscious or unconscious urge to playthe sick part. It is more frequent in women and individuals who have anunderlying mental illness or are under external stress. The diagnosis is one ofexclusion, and it is sometimes difficult to establish since patients seldomacknowledge to playing a part in the development of their lesions. Treatment canbe difficult, and treatment should rely on a multidisciplinary team comprised ofdermatology and psychiatrist.

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Dermatitis Artefacta

Open Access Indonesian Journal of Medical Reviews ◽

10.37275/oaijmr.v1i1.550 ◽

2021 ◽

Vol 1 (1) ◽

pp. 16-19

Author(s):

Pandu Haryo Jatmiko

Keyword(s):

Mental Illness ◽

Multidisciplinary Team ◽

External Stress ◽

Skin Injury ◽

Dermatitis Artefacta

Dermatitis artefacta, also known as factitial dermatitis, is a disease in which self-inflicted skin injury is utilized to fulfill a conscious or unconscious urge to play the sick part. It is more frequent in women and individuals who have an underlying mental illness or are under external stress. The diagnosis is one of exclusion, and it is sometimes difficult to establish since patients seldom acknowledge to playing a part in the development of their lesions. Treatment can be difficult, and treatment should rely on a multidisciplinary team comprised of dermatology and psychiatrist.

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Psychogenic Skin Disease: A Review of35Cases

The British Journal of Psychiatry ◽

10.1192/bjp.149.5.636 ◽

1986 ◽

Vol 149 (5) ◽

pp. 636-643 ◽

Cited By ~ 36

Author(s):

N. P. Sheppard ◽

S. O'Loughlin ◽

J. P. Malone

Keyword(s):

Clinical Practice ◽

Skin Disease ◽

Psychiatric Assessment ◽

Related Factors ◽

Delusional Parasitosis ◽

Dermatitis Artefacta ◽

Psychiatric Referral ◽

Dermatological Disorders ◽

Psychological Origin

In three years of clinical practice, the authors saw 35 cases of dermatological disorders of strictly psychological origin-8 patients withdermatitis artefacta, 8 with delusional parasitosis, and 19 who presented with skin complaints but showed no dermatological pathology (‘dermatological non-disease’). All but two initially presented for dermatological opinion rather than psychiatric assessment, and 12 refused psychiatric referral. Demographic and clinical details of all 35 cases are given, including possible related factors, course, treatment, and outcome, and the cases are discussed in the context of the existing literature. Liaison between dermatologists and psychiatrists is strongly advocated.

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Paracrystalline Aggregates of Psoriatic Keratin and Their Relation to Normal Keratin Structure

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100120096 ◽

1985 ◽

Vol 43 ◽

pp. 680-681

Author(s):

S. Trachtenberg ◽

P.M. Steinert ◽

B.L. Trus ◽

A.C. Steven

Keyword(s):

Cell Death ◽

Stratum Corneum ◽

Intermediate Filament ◽

Skin Disease ◽

Amorphous Matrix ◽

Terminal Differentiation ◽

Proteolytic Degradation ◽

Horny Layer ◽

Chronic Skin ◽

Chronic Skin Disease

During terminal differentiation of vertebrate epidermis, certain specific keratin intermediate filament (KIF) proteins are produced. Keratinization of the epidermis involves cell death and disruption of the cytoplasm, leaving a network of KIF embedded in an amorphous matrix which forms the outer horny layer known as the stratum corneum. Eventually these cells are shed (desquamation). Normally, the processes of differentiation, keratinization, and desquamation are regulated in an orderly manner. In psoriasis, a chronic skin disease, a hyperkeratotic stratum corneum is produced, resulting in abnormal desquamation of unusually large scales. In this disease, the normal KIF proteins are diminished in amount or absent, and other proteins more typical of proliferative epidermal cells are present. There is also evidence of proteolytic degradation of the KIF.

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Much Ado About Fried Chicken: Abetting Aspiration or Respecting Autonomy?

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-18-0207 ◽

2019 ◽

Vol 28 (3) ◽

pp. 1356-1362

Author(s):

Laurence Tan Lean Chin ◽

Yu Jun Lim ◽

Wan Ling Choo

Keyword(s):

Palliative Care ◽

End Of Life ◽

Multidisciplinary Team ◽

Biopsychosocial Model ◽

Family Members ◽

Clinical Decisions ◽

Goals Of Care ◽

Complex Needs ◽

Aspiration Risk ◽

Patient Centric

Purpose Palliative care is a philosophy of care that encompasses holistic, patient-centric care involving patients and their family members and loved ones. Palliative care patients often have complex needs. A common challenge in managing patients near their end of life is the complexity of navigating clinical decisions and finding achievable and realistic goals of care that are in line with the values and wishes of patients. This often results in differing opinions and conflicts within the multidisciplinary team. Conclusion This article describes a tool derived from the biopsychosocial model and the 4-quadrant ethical model. The authors describe the use of this tool in managing a patient who wishes to have fried chicken despite aspiration risk and how this tool was used to encourage discussions and reduce conflict and distress within the multidisciplinary team.

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Food for Thought

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd21.2.68 ◽

2012 ◽

Vol 21 (2) ◽

pp. 68-72 ◽

Cited By ~ 7

Author(s):

Caryn Easterling

Keyword(s):

Multidisciplinary Team ◽

Clinical History ◽

Team Members ◽

Speech Language Pathologist ◽

Expected Outcome

Our professional American Speech-Language-Hearing Association (ASHA) guidelines state, if a speech-language pathologist suspects on the basis of the clinical history that there may be an esophageal disorder contributing to the patient's dysphagia, then “An esophageal screening can be incorporated into most [videofluoroscopic swallowing studies, or] VFSS” (ASHA, 2004). However, the esophageal screen has not been defined by ASHA or by the American College of Radiology. This “Food for Thought” column suggests deglutologists work together to determine the procedure and expected outcome for the esophageal screen so that there is acceptance and consensus among the multidisciplinary team members who evaluate patients with dysphagia.

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