Artefactual skin disease in the paediatric population: diagnosis and guidance for management. Issue 2 (February 2023)

• Record Type: Journal Article
• Authors: Barlow, Richard; Srinivasan, Jothsana; Mohandas, Padma
• Is Part Of: Paediatrics and child health. Volume 33:Issue 2(2023)
• Page Start: 44
• Page End: 50
• Publication Date: 2023-02
• Subjects: artefactual -- dermatitis -- externally induced -- factitious -- paediatric -- skin; Pediatrics -- Periodicals; Pediatrics -- Periodicals; Pédiatrie -- Périodiques; 618.920005
• DOI: 10.1016/j.paed.2022.12.004
• Languages: English
• ISSNs: 1751-7222

Abstract

Abstract: Artefactual skin disease (ASD) or dermatitis artefacta (DA) is a factitious disorder uncommonly reported in the paediatric population. It is a psychocutaneous condition where patients present with externally induced skin (hair or nail) lesions that do not fit recognised patterns of organic disease. Patients classically deny any involvement in the pathogenesis of their skin lesions and will not be inclined to divulge their origin. Individuals may present with acute (e.g. blistering), intermittent (e.g. petechiae) or chronic (e.g. panniculitis) skin changes often having consulted with different health care professionals in their illness journey. The underlying drivers of the behaviour are variable and sometimes complex, lesions may have been produced consciously or in the dissociated state. When formulating a management plan for this vulnerable group of patients it is important to understand " why " this is happening rather than " how ". The prognosis in children and adolescents is generally good but depends on eliciting the underlying psychosocial precipitators. Establishing a strong physician-patient-family relationship is key in managing this condition. The authors advocate a multidisciplinary team approach in this group of patients.