Bullous dermatitis artefacta induced with a hot spoon

Abstract

The skin is an organ of immense psychological importance which plays a role in emotional expression as well as in discharge of anxiety. Stress or emotional factors are known to play a secondary role in exacerbating various skin diseases like psoriasis, atopic dermatitis, etc, but in certain psycho-cutaneous diseases like dermatitis artefacta they may play the primary pathogenetic role. These patients usually present to dermatologists with unexplained, variable, cutaneous lesions which are rarely bullous as in our patient and a high index of suspicion is required for diagnosis.A 22-year-old female presented with a 8-month history of blistering lesions over the left forearm and face. Intact, tense, non-haemorrhagic, 2-3 cm sized, tender bullae were present over apparently normal looking skin on the extensor aspect of left forearm. Examination revealed lesions in different DOI: http://dx.doi.org/10.3315/jdcr.2014.1181 81 PHOTOLETTER TO THE EDITOR AbstractA 22-year-old female presented to the dermatology department with a 8-month history of blistering lesions over the left forearm and face. Most of the bullae and erosions were perfectly round and of nearly the same size. In absence of any obvious etiological, precipitating or aggravating factor, a provisional diagnosis of dermatitis artefacta (self-inflicted dermatological lesions) was made. A detailed anamnesis revealed that stress caused by her ex-boyfriend's threats and apprehension of consequences prompted her to create the lesions using a hot spoon. The patients of dermatitis artefacta usually present to dermatologists as their pathology manifests as unexplained and variable cutaneous lesions which may go undiagnosed for a long time. It is important for the dermatologist to have a high index of suspicion to recognise the underlying psychopathology. (J Dermatol Case Rep. 2014; 8(3): 81-83) Key words: burn, differential diagnosis, factitious disorder, pemphigoid, intraepidermal blister, subepidermal blister Blistering lesions (left forearm).

Histopathological patterns in dermatitis artefacta

“…In some cases, there may be eosinophils and neutrophils as well as pigment incontinence; the histological changes are thus reminiscent of fixed drug eruption. In such cases, multinucleated, deformed keratinocytes and the lack of a lichenoid infiltrate are suggestive of thermally induced dermatitis artefacta .…”

Dermatopathologische Hinweise auf Artefakte

“…Teilweise kann man eosinophile und neutrophile Granulozyten sowie eine Pigmentinkontinenz finden, so dass die histologischen Veränderungen an ein fixes Arzneimittelexanthem erinnern. In diesem Fall weisen mehrkernige, deformierte Keratinozyten und das Fehlen einer lichenoiden Entzündung den Weg zur thermischen Dermatitis artefacta .…”

Localized subepidermal blistering: not always bullous pemphigoid but a diagnostic challenge

“…Zarei et al [ 8 ] beschrieben den Fall einer 17-jährigen Frau, die sich durch Auftragen eines heimischen Krauts Blasen in ihrem Gesicht zufügte. Es gab auch einen Fall einer bullösen Dermatitis artefacta, die durch einen heißen Löffel verursacht wurde [ 9 ] .…”