Self-Inflicted Skin Lesions (SISL)

Self-inflicted skin lesions include the creation of physical or psychiatric symptoms in oneself or other reference persons. In dermatology, frequently there are mechanical injuries by pressures, friction, occlusion, biting, cutting, stabbing, thermal burns, or self-inflicted infections with wound-healing impairment, abscesses, mutilations or damages by acids, and other toxic to the skin. The current classification distinguishes three groups: (1) factitious disorder imposed on self and factious disorder imposed on another, (2) nonsuicidal self-injury (NSSI), and (3) obsessive-compulsive (OCD) and related disorders. The differential diagnosis includes a wide spectrum of psychiatric diseases like borderline personality disorder (BPD), inherited disorders like Lesch-Nyhan syndrome (LNS), and also body modifications. In all these cases, the self-harm is a subphenomenon. This review focuses on the typical dermatological pictures. This categorization is helpful in understanding the different pathogenic mechanisms and the psychodynamics involved, as well as in developing various therapeutic avenues and determining the prognosis.