Dermatitis Artefacta in Pediatric Patients: Experience at the National Institute of Pediatrics

Abstract

Dermatitis artefacta is a factitious disorder in which there is deliberate conscious production of skin lesions. There are only a few reports that evaluate instances of dermatitis artefacta in the pediatric population. The aim of this retrospective study was to assess the characteristics of patients with this disorder who were seen at the National Institute of Pediatrics in Mexico City. The records of all patients diagnosed with dermatitis artefacta from January 1980 to December 1999 were analyzed. There were 29 patients (25 females, 4 males). The upper limbs and the face were the most commonly involved areas. Superficial erosions were the most frequent initial event, and residual lesions consisted of scars and crusts. Time taken to diagnosis was on average 10 months. Half of the patients were lost to follow-up. No correlation was found between the length of time from the disease onset to diagnosis, the type of lesions, and the clinical outcome. Twelve patients had an associated systemic disorder. The possible association with chronic disease has not been sufficiently stressed and demonstrates the importance of providing psychological support for these patients. Psychiatric diagnoses were anxiety, depression, and personality disorder. No correlation was found between the psychiatric diagnosis and the outcome of dermatitis artefacta. A young age at presentation, which has been considered important as a favorable prognostic sign, could not be demonstrated in our patients.

Dermatitis Artefacta in a Child

“…In children it is unusual to observe a direct correlation between a structured psychopathologic disorder diagnosis and that of dermatitis artefacta, particularly in those very young (13).…”

Factitial dermatoses in children

“…Many children who present with dermatitis artefacta have acquired some medical knowledge through exposure to the healthcare system, with more knowledgeable children presenting with more sophisticated clinical findings [9,55]. Children with an underlying chronic disease may be at higher risk for the development of dermatitis artefacta, presumably due to the combination of increased psychological stress and exposure to the medical field [9,55,56].…”

“…Children with an underlying chronic disease may be at higher risk for the development of dermatitis artefacta, presumably due to the combination of increased psychological stress and exposure to the medical field [9,55,56]. Dermatitis artefacta should be differentiated from self-inflicted injuries seen in children with mental retardation, who are unable to understand or control such behaviors.…”

“…A variety of traumatic mechanisms were employed, including physical injury, chemical injury, thermal injury, hair cutting or shaving, pigment application and introduction of foreign material. A similar retrospective study from Mexico City, Mexico, described 29 children aged 1-17 years, the majority of whom were also females, and determined a frequency of 1:23 000 for a diagnosis of dermatitis artefacta in their pediatric dermatology subspecialty clinic [55]. Seventytwo percent of patients had more than one type of skin lesion and 31% had more than three different types of lesions, which is very unusual in organic skin disease.…”

Dermatitis artefacta unter dem Bild einer Lichtdermatose

“…Dies erschwert die Diagnosestellung, der oft zeitaufwändige und extrem breit gefä-cherte Untersuchungen mit fehlgeleiteten therapeutischen Konzepten vorausgehen. Bei pädiatrischen Patienten tritt die Erkrankung mit 1 von 785 Fällen relativ selten auf und betrifft dann meist Adoleszente [7].…”