Dermatitis artefacta: A review of 14 cases

Background: Dermatitis artefacta (DA) is a self-inflicted dermatologic inju ry sometimes produced for secondary gains. Laboratory investigations, inclu ding histologic examination of lesional tissue biopsy, are usually negative and do not give a clue to the correct diagnosis. Patients and Methods: Over a five-year period, 14 patients were diagnosed w ith DA at King Fahad Hospital (KFH) in Al Baha during routine outpatient an d inpatient dermatologic consultations. The diagnoses were based on vaguene ss of history given by the patients, and the presence of bizarre skin lesio ns distributed over sites accessible to the patients' hands. Investigations excluded the possibility of other diseases. In some cases, consultant psyc hiatric assessment was sought in order to identify possible underlying psyc hopathologic factors. Seven patients were hospitalized while the rest were managed as outpatients. Results: The 14 patients comprised 12 females and two males aged 12 to 71 ( mean 25.9) years. All except one were Saudis. DA in the males was probably caused for secondary gains. The females, four of whom were married and eigh t single, were aged 12-36 (mean 21.8) years. Nine of the females (64%) had identifiable severe emotional or psychiatric problems. The remaining two we re unmarried and had no identifiable underlying factors. Conclusion: This study reveals that the presentation of DA in Saudi Arabia is essentially similar to what has been reported from other parts of the wo rld. It brings into focus a medical problem which needs to be recognized, a s greater awareness may bring about earlier correct diagnosis and treatment .