Bullous Dermatitis Artefacta
Bullous dermatitis artefacta is a psychodermatologic factitious disorder in patients who mimic skin disease by inflicting themselves with blisters. The diagnosis is often apparent at first visit. The diagnosis should never be immediately revealed to the patient. Instead a serious, yet limited, workup is advised while developing a trustful patient-doctor relation. The strategy is to give the patient the impression you know it was self-inflicted but leaving an escape for clearance by trivial causes imagined by the patient such as avoiding drinking coffee (narrow escape). In refractory cases, when confrontation becomes unavoidable, dual approach by dermatologists and psychiatrists is necessary.
KeywordsFactitious disorder Psychodermatology Self-injury Munchausen syndrome
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On the Web
- NYU Langone: http://www.med.nyu.edu/content?ChunkIID=165426.
- Psycho-dermatology, British Association of Dermatology: http://www.bad.org.uk/healthcare-professionals/clinical-services/service-standards/psycho-dermatology.
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