Whipps Cross University Hospital, London, U.K.
Br J Dermatol. 2013 Sep;169(3):600-6. doi: 10.1111/bjd.12416.
Dermatitis artefacta (DA) is a factitious skin disorder caused by the deliberate production of skin lesions by patients with a history of underlying psychological problems. The patient may not be fully aware of this, and the true extent of this disorder, especially in children, is currently unknown. Management of these patients is challenging as many fail to engage effectively with their dermatologist.
To explore the various clinical presentations and strategies employed to treat DA in our local population, and note outcomes in order to evaluate effectiveness of our management.
A retrospective case note review was conducted of 28 patients attending the regional psychodermatology clinic at the Royal London Hospital from January 2003 to December 2011.
Out of 28 patients identified with DA, the majority of patients were female, and the most frequent sites for skin lesions were the face and upper body. Anxiety, depression and personality disorders were common underlying psychiatric diagnoses. Ninety-three per cent of patients were successfully managed (i.e. the DA resolved or was in remission at the time of writing) in our combined psychodermatology clinic by a multidisciplinary psychocutaneous medicine team. Thirty-two per cent of our cases were children (aged < 16 years) and one of these was referred to local child protection services; 46% of patients had a concomitant mental health disease at the time of presentation with DA.
A multidisciplinary psychocutaneous team is important in this condition particularly as the patient is likely to require psychological intervention (to facilitate the resolution of the precipitant), in addition to dermatological (to make the diagnosis and, importantly, to exclude organic disease) and psychiatric (to manage concomitant psychiatric disease) input. Our findings indicate that our model of a psychodermatology multidisciplinary team will achieve greater successful treatment of patients with DA and we are the first to describe this important service in the U.K.
人为性皮炎（DA）是一种由有潜在心理问题病史的患者故意制造皮肤损伤而引起的人为皮肤疾病。患者可能没有完全意识到这一点，而且这种疾病的真实程度，特别是在儿童中，目前尚不清楚。由于许多患者未能与皮肤科医生有效接触，因此管理这些患者具有挑战性。
探索我们当地人群中人为性皮炎的各种临床表现和治疗策略，并注意结果，以评估我们管理的效果。
对 2003 年 1 月至 2011 年 12 月期间在伦敦皇家医院区域性精神皮肤病诊所就诊的 28 例患者进行回顾性病历回顾。
在所确定的 28 例 DA 患者中，大多数患者为女性，皮肤损伤最常见的部位是面部和上半身。焦虑、抑郁和人格障碍是常见的潜在精神诊断。在我们的联合精神皮肤病诊所，由多学科精神皮肤医学团队管理，93%的患者（即在撰写本文时，DA 已解决或处于缓解期）成功得到管理。我们的病例中有 32%是儿童（年龄<16 岁），其中一例被转介到当地儿童保护服务机构；46%的患者在出现 DA 时同时患有心理健康疾病。
多学科精神皮肤团队在这种情况下很重要，特别是因为患者可能需要心理干预（以促进诱因的解决），除了皮肤科（以做出诊断，重要的是排除器质性疾病）和精神病学（以管理伴随的精神病学疾病）。我们的研究结果表明，我们的精神皮肤病多学科团队模式将更有效地治疗 DA 患者，我们是第一个在英国描述这种重要服务的人。
