van Rijssen A, Molier L, Vrijlandt A J, Jonkman M F
Afd. Dermatologie, Academisch Ziekenhuis Groningen.
Ned Tijdschr Geneeskd. 2000 Jul 29;144(31):1465-9.
In three patients, two women aged 37 and 20 years and a man aged 46 years, a blistering skin condition was observed. Histopathological examination of the skin lesions revealed a blister level just beneath the stratum granulosum, which is proof of a friction blister. The patients were suffering from bullous dermatitis artefacta or bullous pathomimia. This is a psychiatric disorder characterised by rubbing skin blisters but denying self-infliction. Early diagnosis is important to prevent unnecessary drug therapy and chronic morbidity. The typical histology supports the doctor in his suspected diagnosis. A supportive and empathic dual disciplinary approach (by somatic physician and psychosocial worker) is recommended, avoiding direct confrontation with the self-inflicted nature of the lesions, and using the 'narrow escape' strategy, avoiding loss of face of the patient.
在三名患者中,两名女性分别为37岁和20岁,一名男性为46岁,观察到有皮肤水疱情况。对皮肤损伤进行组织病理学检查发现水疱位于颗粒层正下方,这是摩擦水疱的证据。这些患者患有人工性大疱性皮炎或大疱性模仿症。这是一种精神疾病,其特征为摩擦皮肤水疱但否认是自我造成的。早期诊断对于避免不必要的药物治疗和慢性发病很重要。典型的组织学表现有助于医生进行疑似诊断。建议采用支持性且具有同理心的双学科方法(由躯体医生和心理社会工作者实施),避免直接面对损伤是自我造成的这一事实,并采用“侥幸脱险”策略,避免患者丢面子。