Artefakt Dermatiti nedir? Bir gözden geçirme

Year 2024, Volume: 11 Issue: 3, 412 - 417, 30.09.2024

Ahmet Kerim Demirbaş , Çiçek Hocaoğlu

https://doi.org/10.52880/sagakaderg.1363787

Abstract

Artefakt dermatiti, bilinçli veya bilinçdışı olarak herhangi bir tatmin sağlamak için kişinin kendi cilt bütünlüğüne zarar vermesi olarak tanımlanabilir. Genel olarak artefakt dermatitinde kadın üstünlüğü vardır. Dermatoloji hastaları arasındaki prevalansı da yaklaşık %0.3’tür. Hastalık genellikle geç ergenlik ve erken erişkinlikte başlar. Etiyolojik faktörler arasında bozuk kişiler arası ilişkiler, duygusal olgunlaşmamışlık gibi psikososyal sorunlar ve depresyon, anksiyete, kişilik bozuklukları, somatoform bozukluklar gibi psikiyatrik durumlar suçlanmıştır. Artefakt dermatiti lezyonlarının sınırları genellikle belirgindir ve geometrik şekiller oluşturur. Ancak hiçbir dermatoza uymayan atipik şekiller de görülebilir. Lezyonların türü sıklıkla ekskoriasyon, ülser, bül ve pannikülit şeklindedir. Artefakt dermatiti tanısının koyulması oldukça zordur ve tanı koyulması için öncelikle bu durumdan şüphelenilmesi gerekir. Deri biyopsileri de spesifik değildir ancak çok çekirdekli keratinositler, epidermal nekroz, supepidermal bül gibi bulgular biyopside tespit edilebilir. Artefakt dermatitinin ayırıcı tanısında bir çok psikiyatrik ve dermatolojik hastalık bulunur. Deri yolma bozukluğu, temaruz, Munchausen sendromu gibi hastalıklar karışabilecek psikokutanöz hastalıklardandır. Dermatolojik hastalıklar arasında da özellikle ülsere lezyonları olanlarda piyoderma gangrenozum önemli bir ayrıcı tanıdır. Artefakt dermatiti tedavisinde cilt lezyonları ve psikiyatrik durum ayrı ayrı değerlendirilmelidir. Psikoterapi yöntemleri tedavide oldukça fayda sağlayabilir. Tedavi sırasında da hastaya suçlayıcı tavırda olmamak oldukça önemlidir. Psikiyatrik ilaç olarak da antidepresanlar, antipsikotikler veya sedatifler kullanılabilir. Hastada depresyon bulguları varsa SSRI’lar ilk tercih edilen ilaçlar olmalıdır. Kaşıntı ve uykusuzluk çeken hastalar için trisiklik antidepresanlar da faydalıdır. Antipsikotikler ise psikotik özellikleri olan hastalarda faydalı olabilir ancak bunlar güçlü yan etkileri nedeniyle uzun süre kullanılmamalıdır. Deri lezyonlarının tedavisinde de ihtiyaç duyulursa antibiyotik ilaçlar ve yara iyileştirici kremler kullanılabilir.

Keywords

Artefakt dermatiti, psikokutanöz hastalıklar, tanı, tedavi

What is Artifact Dermatitis?: A review

Abstract

Artifact dermatitis can be defined as the deliberate or unconscious act of damaging one's own skin integrity for the purpose of obtaining any form of satisfaction. Generally, artifact dermatitis is more prevalent among women. Its prevalence among dermatology patients is also approximately 0.3%. The condition typically begins in late adolescence and early adulthood. Among the etiological factors, issues such as impaired interpersonal relationships, emotional immaturity, and psychiatric conditions like depression, anxiety, personality disorders, and somatoform disorders have been implicated.
The boundaries of artifact dermatitis lesions are usually distinct and form geometric shapes. However, atypical shapes that do not correspond to any dermatosis can also be observed. The types of lesions often include excoriation, ulcer, bulla, and panniculitis. Diagnosing artifact dermatitis is quite challenging and requires suspicion of this condition as a first step. Skin biopsies are not specific, but findings such as multinucleated keratinocytes, epidermal necrosis, and subepidermal bullae can be detected in biopsies.
The differential diagnosis of artifact dermatitis includes numerous psychiatric and dermatological diseases. Conditions such as dermatillomania, trichotillomania, and Munchausen syndrome are examples of psychocutaneous disorders that can be confused. Among dermatological diseases, pyoderma gangrenosum, particularly in cases with ulcerative lesions, is an important differential diagnosis.
In the treatment of artifact dermatitis, skin lesions and psychiatric conditions should be evaluated separately. Psychotherapeutic methods can be highly beneficial in treatment. It is essential not to adopt a accusatory attitude towards the patient during treatment. Psychiatric medications such as antidepressants, antipsychotics, or sedatives can also be used. If signs of depression are present, SSRIs should be the first-line choice. Tricyclic antidepressants can also be useful for patients experiencing itching and insomnia. Antipsychotics may be helpful for patients with psychotic features, but due to their significant side effects, they should not be used for extended periods. If necessary, antibiotic drugs and wound healing creams can be used for treating skin lesions.

Keywords

Artifact dermatitis, psychocutaneous disorders, diagnosis, treatment

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