—
—Self-inflicted skin lesions
—in practice  - case reports
—Anna Zalewska-Janowska
—
—Psychodermatology Department
—Interfaculty Chair of Clinical Immunology
—and Microbiology, Medical University of Lodz, poLAND

Presentation Outline
—General characteristics of self-inflicted skin lesions
—Selected diagnoses for self-inflicted skin lesions
—Clinical presentations – examples
—Take home massage
—

Self – inflicted skin lesions general characteristics
•„hollow history” – patient resistance to fully describe the evolution of skin lesions
•numerous professional consultations
•conscious/unconscious performance
•triggering/exacerbating actions
• areas accessible to manipulation
•bizarre morphology
•severity span

Self – inflicted skin diseases – selected diagnoses
•Lichen simplex
•Dermatitis artefacta
•Neurotic excoriations
•Acne excoriée
•Münchausen syndrome
•Malingering (disease simulation)

Dermatitis artefacta
•Unconscious action (mostly); patients do not admit to manipulation
•F:M = 3:1 to 20:1
•„cry for help”
•borderline or paranoid personality

1076 -3 799 D 813



926 A 1 926 A 2



952 B 2 997 A



952 E 997 B



Neurotic excoriations
•majority – patients admit to self-manipulation
•mainly middle-aged single women
•difficulties in problem verbalizing
•vicious circle – itching-scratching
v

874 C 874 B



964a nowy 964b nowy 964bc nowy



1042 A 1042 B 1042 C



Acne excoriée
•squeezing and picking the acne lesions  under stress; sometimes lack of comedos
•female predominance
•mean age – 30 years; mainly face
•co-existence – phobias, depression

1139a 874 A 896



Münchausen syndrome
•dramatic presentation of symptoms, in the middle of the night
•male predominance
•aim – gaining the constant medical care („hospital dependence”)
• psychopathic personality, antisocial behaviour

799 C 799 A 799 B



1018 A 1018 B



Malingering
•totally conscious performance
•aim – responsibility avoidance, financial gain, earlier pension
•male predominance
•borderline or paranoid personality

963 A 963 C 1 963 D 1025



572 A 613 B



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Take home message
—When skin lesions present bizarre morphology or recur „too often” despite professional treatment ®
THINK about different goals of the patient and the doctor and ACT accordingly…