Factitial dermatitis in the hospital setting

Abstract

Factitial Dermatitis (FD) is a notoriously difficult disease to diagnose, as patients produce self-induced cutaneous lesions and provide an inadequate or inaccurate history. We performed a cross-sectional study, querying an inpatient consultation database of all patients admitted to the Ohio State University Wexner Medical Center from 2012 to 2017 with a dermatologic ICD as a discharge diagnosis. Our exhaustive keyword search produced 189 candidates. Consult notes were thoroughly examined, and 32 patients were found to meet case definition of FD. Our analysis of this cohort revealed a significantly greater proportion of cases in the female population. Lesions were more often found to involve the skin on the upper extremities. Isolated secondary skin changes such as erosions, ulcers and excoriations in the absence primary morphologies were also significant in our cohort. As FD is difficult to identify, further understanding of its presentation pattern will decrease time to diagnosis and improve both hospital resource allocation and patient care.