Abstract
Dermatitis artefacta is a rare psychological disorder in which patients self-inflict cutaneous lesions to satisfy an emotional need. Due to the nature of this disease, patients can present with a wide array of sometimes very severe skin lesions. Here, we describe a case of dermatitis artefacta initially misdiagnosed as pyoderma gangrenosum and treated as such for eight years. The patient reported a long history of cutaneous ulcers on her extremities and trunk, with resultant extensive scarring. Upon presentation, she displayed rapidly progressing necrotizing skin lesions on her bilateral distal lower extremities. Both the skin manifestations and histologic sections were extremely atypical for pyoderma gangrenosum leading to extensive medical records review and subsequent diagnosis of dermatitis artefacta. This case represents the importance of the timely recognition and treatment of dermatitis artifacta to prevent its progression to severe harm and even death.
Highlights
Dermatitis artefacta (DA) represents a type of factitious disorder within the broad Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) category of “somatic symptom and related disorders”
We describe a case of dermatitis artefacta initially misdiagnosed as pyoderma gangrenosum and treated as such for eight years
The patient reported a long history of cutaneous ulcers on her extremities and trunk, with resultant extensive scarring. She displayed rapidly progressing necrotizing skin lesions on her bilateral distal lower extremities. Both the skin manifestations and histologic sections were extremely atypical for pyoderma gangrenosum leading to extensive medical records review and subsequent diagnosis of dermatitis artefacta
Summary
Dermatitis artefacta (DA) represents a type of factitious disorder within the broad Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) category of “somatic symptom and related disorders”. A 36-year-old female was transferred to the burn unit with rapidly progressing necrotizing skin lesions on her bilateral distal lower extremities. She reported noting small red-brown lesions on her right lower leg that rapidly progressed within 24 hours into black necrotic plaques, circumferential around both of her lower extremities (Figure 1). Histologic sections from wedge biopsies taken from the edge of the lesions showed extensive necrosis involving the epidermis, dermis, and subcutaneous tissue with vascular thrombosis and acute inflammation (Figure 2) Due to this extremely atypical presentation, extensive medical records were reviewed to reveal no confirmed diagnosis of PG, vasculitis, vasculopathy, or associated illnesses. The patient received a final diagnosis of chemical burn, full thickness (third degree) of left and right lower leg, and DA
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