Artefakt Dermatiti nedir? Bir gözden geçirme

Yıl 2024, Cilt: 11 Sayı: 3, 412 - 417, 30.09.2024

Ahmet Kerim Demirbaş , Çiçek Hocaoğlu

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

Öz

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.

Anahtar Kelimeler

Artefakt dermatiti, psikokutanöz hastalıklar, tanı, tedavi

What is Artifact Dermatitis?: A review

Öz

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.

Anahtar Kelimeler

Artifact dermatitis, psychocutaneous disorders, diagnosis, treatment

Kaynakça

• Adebanjo, G. A. R., Parisella, F. R., Cittadini, A., Luzi, F., & Tammaro, A. (2020). A case of dermatitis artefacta during a pandemic. Dermatology Therapy, 33(6), e14235.
• Aksaray, G., & Kaptanoğlu, M. (1999). Dermatitis Artefactan›n Psikiyatrik Yönleri. T Klin J Dermatol, 9, 193-196.
• Basfar, L., Almadfaa, A., Nazer, B. A., Al Hawsawi, K., & Khayyat, S. T. (2023). Dermatitis Artefacta: A Challenging Case Report. Cureus, 15(1), e34244.
• Boyd, A. S., Ritchie, C., & Likhari, S. (2014). Munchausen syndrome and Munchausen syndrome by proxy in dermatology. Journal of the American Academy of Dermatology, 71, 376-381.
• Chandran, V., & Kurien, G. (2023). Dermatitis Artefacta. [Updated 2022 Jul 12]. Publishing.
• Chatterjee, S. S., & Mitra, S. (2016). Dermatitis Artefacta Mimicking Borderline Personality Disorder: Sometimes, Skin Could Be Misleading. Clinical Psychopharmacology and Neuroscience, 14(3), 311-313.
• Chen, Y., Li, L., & Lu, J. (2022). Purpura with regular shape in an adolescent: Beware of dermatitis artefacta. Frontiers in Pediatrics, 10, 959064.
• El Kissi, Y., Chhoumi, M., Nakhli, J., et al. (2014). Life events and quality of life in female patients with dermatitis artefacta: a comparative study with siblings and controls. Comprehensive Psychiatry, 55, 1614-1619.
• Elghazouani, F., Barrimi, M., & Hlal, H. (2017). L'image du mois. Dermatopathomimie [Image of the month. Dermatitis Artefacta.]. Rev Med Liege, 72(12), 521.
• Heras-Mendaza, F. (2009). Dermatitis artefactas cien años atrás, por Juan de Azúa. Actas Dermosifiliogr, 100, 657-660.
• Ferri, J. V. V., & de Araujo, D. B. (2019). Dermatitis artefacta mimicking cutaneous vasculitis: Case report and literature overview. Reumatologia, 57(2), 106-108.
• Gieler, U., Consoli, S. G., Tomas-Aragones, L., et al. (2013). Self-inflicted lesions in dermatology: Terminology and classification—a position paper from the European Society for Dermatology and Psychiatry (ESDaP). Acta Dermato-Venereologica, 93, 4-12.
• Gordon-Elliott, J. S., & Muskin, P. R. (2013). Managing the patient with psychiatric issues in dermatologic practice. Clinical Dermatology, 31, 3-10.
• Gupta, M. A., Jarosz, P., & Gupta, A. K. (2017). Posttraumatic stress disorder (PTSD) and the dermatology patient. Clinical Dermatology, 35(3), 260-266. doi: 10.1016/j.clindermatol.2017.01.005. Epub 2017 Jan 22.
• Gupta, M. A., Pur, D. R., Vujcic, B., & Gupta, A. K. (2017). Suicidal behaviors in the dermatology patient. Clinical Dermatology, 35(3), 302-311.
• Gutierrez, D., Schowalter, M. K., Piliang, M. P., et al. (2016). Epidermal multinucleated keratinocytes: A histopathologic clue to dermatitis artefacta. Journal of Cutaneous Pathology, 43, 880-883.
• Huffman, J. C., & Stern, T. A. (2003). The diagnosis and treatment of Munchausen’s syndrome. General Hospital Psychiatry, 25, 358-363.
• Isiyel, E., Ersoy Evans, S., Akar, H. T., et al. (2021). Challenging diagnosis and rare disease in children: Dermatitis artefacta. Journal of Paediatrics and Child Health, 57, 1710-1712.
• Kłosowicz A, Pizun A, Pastuszczak M, Obtułowicz A, Bronikowska A, Spałkowska M, Dyduch G, Wojas-Pelc A. Large syphilitic gumma on the face mimicking dermatitis artefacta. Postepy Dermatol Alergol. 2022 Oct;39(5):996-997.
• Koblenzer, C. S., & Gupta, R. (2013). Neurotic excoriations and dermatitis artefacta. Seminars in Cutaneous Medicine and Surgery, 32, 95-100.
• Koblenzer, C. S. (2000). Dermatitis Artefacta. American Journal of Clinical Dermatology, 1(1), 47–55. Koparde, V., Patil, S., & Patil, S. (2018). Dermatitis artefacta (factitious dermatitis) responding to high-dose sertraline. Journal of Mental Health and Human Behavior, 23(1), 67–68.
• Krooks, J. A., Weatherall, A. G., & Holland, P. J. (2018). Review of epidemiology, clinical presentation, diagnosis, and treatment of common primary psychiatric causes of cutaneous disease. Journal of Dermatological Treatment, 29(4), 418-427.
• Kuhn, H., Mennella, C., Magid, M., Stamu-O'Brien, C., & Kroumpouzos, G. (2017). Psychocutaneous disease: Clinical perspectives. Journal of the American Academy of Dermatology, 76(5), 779-791.
• Lavery, M. J., Stull, C., McCaw, I., & Anolik, R. B. (2018). Dermatitis artefacta. Clinical Dermatology, 36(6), 719-722.
• Lee, H. G., Stull, C., & Yosipovitch, G. (2017). Psychiatric disorders and pruritus. Clinical Dermatology, 35(3), 273-280.
• Millard, J., & Millard, L. (2014). Factitious skin disorder (dermatitis artefacta). In: Bewley A, Taylor RE, Reichenberg RS, Magid M, eds. Practical Psychodermatology. Oxford, UK: Wiley-Blackwell, pp. 142-149.
• Mohandas, P., Ravenscroft, J. C., & Bewley, A. (2018). Dermatitis artefacta in childhood and adolescence: a spectrum of disease. Giornale Italiano di Dermatologia e Venereologia, 153(4), 525-534.
• Murray, A. T., Goble, R., & Sutton, G. A. (1998). Dermatitis artefacta presenting as a basal cell carcinoma--An important clinical sign missed. British Journal of Ophthalmology, 82, 97.
• Navin Mukundu Nagesh, Richard Barlow, Padma Mohandas, Maria-Angeliki Gkini, Anthony Bewley. (2023). Dermatitis artefacta. Clinics in Dermatology, 41(1), 10-15.
• Nayak, S., Acharjya, B., Debi, B., & Swain, S. P. (2013). Dermatitis artefacta. Indian Journal of Psychiatry, 55(2), 189-191.
• Økland, C., Petersen, N. E., & Bygum, A. (2016). Dermatitis artefacta [Dermatitis artefacta]. Ugeskrift for Laeger, 178(6), V10150786. (Danish)
• Patra, S., & Sirka, C. S. (2016). Attention deficit hyperactivity disorder presenting as dermatitis artefacta. Journal of Pediatric Neuroscience, 11(1), 80-82.
• Persad, L., Salim, S., & Motaparthi, K. (2017). Factitious Dermatitis Due to Thermal Burn With Histologic Features Simulating Fixed Drug Eruption. American Journal of Dermatopathology, 39(8), 622-624.
• Pichardo, A. R., & Bravo, B. G. (2013). Dermatitis artefacta: A review. Actas Dermosifiliográficas, 104, 854-866.
• Pradhan, S., Sirka, C. S., Dash, G., & Mohapatra, D. (2019). Dermatitis Artefacta in a Child: An Interesting Morphological Presentation. Indian Dermatology Online Journal, 10(1), 72.
• Raizada, A., Panda, M., Dixit, N., & Hassanandani, T. (2020). Dermatitis Artefacta Presenting as Dermatomyositis: A Diagnostic Conundrum. Indian Dermatology Online Journal, 11(4), 629-631.
• Rajkumar, R. P. (2021). Psychiatric comorbidities in dermatitis artefacta: A systematic review and meta-analysis. CosmoDerma, 1, 49.
• Ring, H. C., Miller, I. M., Benfeldt, E., et al. (2015). Artefactual skin lesions in children and adolescents: Review of the literature and two cases of factitious purpura. International Journal of Dermatology, 54, e27-e32.
• Ring, H. C., Smith, M. N., & Jemec, G. B. (2014). Self-inflicted skin lesions: A review of the terminology. Acta Dermatovenerologica Croatica, 22, 85-90.
• Rodriguez Pichardo, A., & Garcia Bravo, B. (2013). Dermatitis artefacta: A review. Actas Dermosifiliográficas, 104, 854-866.
• Sarin, A., Ummar, S. A., Ambooken, B., & Gawai, S. R. (2016). Dermatitis Artefacta Presenting with Localized Alopecia of Right Eyebrow and Scalp. International Journal of Trichology, 8(1), 26-28.
• Sheppard, M. P., O’Laughlin, S., & Malone, J. P. (1986). Psychogenic skin disease: A review of 35 cases. British Journal of Psychiatry, 149, 636–643.
• Shivakumar, S., Jafferany, M., Kumar, S. V., & Sood, S. (2021). A Brief Review of Dermatitis Artefacta and Management Strategies for Physicians. Primary Care Companion to the Journal of Clinical Psychiatry, 23(4), 20nr02858.
• Singh, S., Chikhalkar, S., & Kabbannavar, Y. R. (2023). Dermatitis artefacta: A diagnostic dilemma. Indian Journal of Psychiatry, 65(6), 703-705.
• Tittelbach, J., Peckruhn, M., & Elsner, P. (2018). Histopathological patterns in dermatitis artefacta. Journal der Deutschen Dermatologischen Gesellschaft, 16(5), 559-564.
• Tomas-Aragones, L., Consoli, S. M., Consoli, S. G., et al. (2017). Self-inflicted lesions in dermatology: A management and therapeutic approach - A position paper from the European Society for Dermatology and Psychiatry. Acta Dermato-Venereologica, 97(2), 159–172.
• Wong, J. W., Nguyen, T. V., & Koo, J. Y. (2013). Primary psychiatric conditions: Dermatitis artefacta, trichotillomania, and neurotic excoriations. Indian Journal of Dermatology, 58(1), 44-48.