Factitious Skin Disorders Without External Incentives

Self-inflicted skin disorders without external incentives are conditions in which patients induce, feign, or exaggerate physical or psychiatric symptoms. The anomalous behaviour of these subjects can be linked to various dysmorphic symptoms, such as tension, loneliness, anxiety, and aggression. Patients produce the symptoms artificially using various means, ranging from mechanical to chemical and biotic injuries. Dermatitis artefacta is a disorder consisting of continual self-manipulation of the skin, appendices (hair, nails), and mucosae. The patient denies any responsibility for the problem and presents a clinical history inconsistent with the laboratory findings and physical examination. The lesions are morphologically varied, depending on the simulator’s creativity and the methods employed, and are often in easily accessible areas. Dermatitis simulata is most common in children, who make use of makeup or topical printing dyes to produce a rash or a birthmark. Dermatitis passivata is a result of deliberate failure to wash specific areas of the body: in these cases, a build-up of sebum, dirt, and keratin accumulates on the skin. In dermatological pathomimicry, the lesions are those of a known complaint, achieved through exposure by contact or ingestion to the same agent that had provoked the spontaneous disease. Gardner-Diamond syndrome is characterized by recurrent atraumatic spontaneous, tender skin lesions that develop into ecchymosis, correlated with episodes of severe psychiatric disorders. Morgellons syndrome is morphologically characterized by superficial ulcerations, linear excoriations, and excoriated papules; the patient believes that the cause of the disorder is an infection or infestation, and obsessively self-manipulates the skin. Münchausen syndrome is a chronic, severe type of factitious disease, observed in patients who constantly demand medical care, laboratory tests, and surgery. Münchhausen syndrome by proxy refers to illness induced in children by a parent, often the mother, for the purpose of indirectly acting out the sick role. The management of the above-mentioned disorders is generally extremely complex: the patients usually have a poor prognosis, and the only treatment that could be efficacious is appropriate psychotherapy.