Abstract An 11-year-old girl had light brown lesions or erythematous macules, many with atrophic and scaling surfaces for two years. Long, linear abrasions were present on the lower extremities. Lesions were within reach of the patient's hands, and several showed geometric patterning. Scalp, neck, ears, shoulders, posterior trunk and thighs, genitalia and palms and soles were unaffected. Corneal and pharyngeal reflexes were absent. She appeared unconcerned with her condition but finally admitted self-infliction. Morphology and distribution of the lesions, the patient's attitude and lack of response to corneal and pharyngeal stimulation justify the diagnosis of hysterical factitial dermatitis. Self-inflicted dermatosis can be recognized on clinical grounds. Diagnostic maneuvers to confirm the diagnosis and efforts to elicit admission of guilt are unnecessary. Referral for psychiatric evaluation is recommended. References 1. Gandy DT: Concept and clinical aspects of factitial dermatitis . South Med J 46:551-555, 1953.Crossref 2. Ormsby OS: Factitious dermatoses . JAMA 65:1622-1628, 1915.Crossref 3. Stokes JH, Garner VC: The diagnosis of self-inflicted lesions of the skin . JAMA 93:438-443, 1929.Crossref 4. Leider M: Practical Pediatric Dermatology . St. Louis, CV Mosby Co, 1961. 5. Allen AC: The skin: A Clinicopathological Treatise . New York: Grune & Stratton Inc, 1967. 6. Waisman M: Pickers, pluckers and imposters: A panorama of cutaneous self-mutilation . Postgrad Med 38:620-630, 1965. 7. Battle RJV, Pollitt JD: Self-inflicted injuries Br J Plast Surg 17:400-412, 1964.Crossref 8. Pillsbury DM, Shelley WB, Kligman AM: Dermatology . Philadelphia, WB Saunders Co, 1956. 9. Stelwagon HW: A case of feigned eruption . Arch Derm 8:236-240, 1882. 10. Simpson JS, Hawke WA: Self-mutilation: Case of a 13-year-old girl . Pediatrics 45:1008-1011, 1970. 11. Green AH: Self-mutilation in schizophrenic children . Arch Gen Psychiatry 17:234-244, 1967.Crossref 12. Stinnett JL, Hollender MH: Compulsive self-mutilation . J Nerv Ment Dis 150:371-375, 1970.Crossref 13. Lovejoy FH Jr, Marcuse EK, Landrigan PJ: Two examples of purpura factitia . Clin Pediatr (Phila) 10:183-184, 1971.Crossref 14. Lesch M, Nyhan WL: A familial disorder of uric acid metabolism and central nervous system function . Am J Med 36:561-570, 1964.Crossref 15. Zaidens SH: Self-inflicted dermatoses and their psychodynamics . J Nerv Ment Dis 113:395-404, 1951. 16. Klauder JV: Psychogenic aspects of skin diseases . J Nerv Ment Dis 85:249-273, 1936.Crossref 17. Malmquist CP: Hysteria in childhood . Postgrad Med 50:112-117, 1971.
American Journal of Diseases of Children – American Medical Association
Published: Apr 1, 1973
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