Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
Automutilating behavior is becoming ever more frequent in patients seeking dermatologic care. Psychocutaneous disorders encompass a wide range of dermatologic conditions, all of which have in common the important role of psychological factors. Dermatitis artefacta syndrome is characterized by unconscious self-injury behavior, while dermatitis para-artefacta syndrome is labeled with manipulation of an existing specific dermatosis. Consciously stimulated injuries with the purpose of obtaining material gain is known as malingering. Here we present a 20-year-old female patient with a sudden pain and an oval, yellowish skin defect on her left lower leg, 3x3.5 cm in diameter, with an erythematous, clearly defined border, surrounded by erythematous, painful skin resembling pyoderma gangrenosum. The patient had a clinically typical skin presentation but with atypical therapeutic outcome. The diagnosis of dermatitis artefacta was made. Liaison psychiatry can reaffirm the diagnosis of dermatitis artefacta and provide necessary psychopharmacotherapy and psychotherapy.Samoozljeđivajuće ponašanje postaje učestalije kod bolesnika koji traže dermatološku skrb. Psihokutani poremećaji obuhvaćaju širok raspon dermatoloških stanja kojima je zajednička važna uloga psiholoških čimbenika. Sindrom artefaktnog dermatitisa je obilježen nesvjesnim samoozljeđivanjem, dok sindrom paraartefaktnog dermatitisa označava manipulaciju određene postojeće dermatoze. Svjesno izazivanje ozljede u svrhu stjecanja materijalne koristi smatra se simuliranjem. Ovdje prikazujemo slučaj 20-godišnje bolesnice s iznenadnom boli i ovalnim, žućkastim defektom kože na lijevoj potkoljenici, 3x3,5 cm u promjeru, s eritematoznim, jasno ograničenim rubom, okruženim eritematoznom, bolnom kožom, što podsjeća na piodermu gangrenozum. Bolesnica je imala klinički tipičan prikaz kože, ali s atipičnim terapijskim ishodom. Postavljena je dijagnoza artefaktnog dermatitisa. Liason psihijatrija može potvrditi dijagnozu artefaktnog dermatitisa i omogućiti potrebnu psihofarmakološku terapiju i psihoterapiju
