Figure 6 Pseudoknuckle pads on the left hand of an year-boy with severe mental retardation. Factitious cheilitis is a common observation in pediatric dermatology patients with compulsive disorders.
The main mechanism is licking the lips, with or without biting, followed by development of an irritant contact dermatitis and a characteristic clinical picture Figure 7A — C. Figure 7 A Lip-lickers dermatitis in a 4-year-old boy. B Cheilitis artefacta in a year-old girl with secondary eczematization. C Small ulcerations on the lower lip of an 8-year-old girl, self-induced by biting.
Onychophagia is nail biting or chewing with swallowing of nail fragments, and is often diagnosed in children. In small children, onychophagia can be associated with thumb-sucking or secondary irritant dermatitis, infection, inflammation, and even malformation of the digits.
It results from stressful situations and does not require a psychiatric evaluation in all situations. Onychotillomania refers to a self-induced nail disease brought on by chronic traumatization of the nail, also involving the paronychia and cuticle, with a variable degree of severity Figure 8. Onychotemnomania is the result of cutting the nails too short, with secondary trauma to the nails. Figure 8 Onychophagia affecting the right hand and onychotillomania affecting the left thumb. Psychodermatology is an expression of the interaction between skin and mind. It is of paramount importance for the clinician to establish an appropriate physician-patient-family relationship in order to diagnose and treat factitial skin diseases.
Clues to the clinical diagnosis include bizarre, linear, or geometric features on accessible parts of the body, ambiguous history of lesions that are done by the patient for public eye.
Clinical Cases in Skin of Color
Skin injuries can be found on locations easily accessible for self-injury, ie, the face, trunk, and extremities. Moreover, the patient denies having produced the lesions, and family members, particularly parents, may seek multiple medical consultations before accepting the diagnosis of dermatitis artefacta and the need for psychiatric assessment.
Team work between dermatology and psychiatry is the most important step in long and very difficult road of treatment for psychocutaneous disorders in children. There are no national data regarding the occurrence of these disorders in children; this is a report made by dermatologists based on clinical information.
This paper seeks to draw attention to the distinctive aspects of skin lesions induced by psychiatric disorders and to emphasize the importance of an interdisciplinary approach. With close collaboration between dermatologists, psychiatrists, and pediatricians, a national or international report could be done in the future.
Clinical Management in Psychodermatology.
Al Hawsawi K, Pope E. Am J Clin Dermatol. Facticious disorders in dermatology. J Dtsch Dermatol Ges. Psychiatric syndromes of interest to dermatologists. Neurotic excoriations, acne excoriee and factitial dermatitis. Contemporary Diagnosis and Management in Psychodermatology.
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Psychosomatic diseases dermatoses with a multifactorial basis and a psychiatric component Psoriasis Atopic dermatitis Acne excoriata Chronic forms of urticaria Lichen simplex chronicus Hyperhidrosis. Description Clinical cases are a key component in modern medical education, assisting the trainee or recertifying clinician to work through unusual cases using best practice techniques.
Dermatology is an important discipline in this regard since it is a highly visual subject requiring the reader to describe often very subtle differences in the presentation of patients and define accurately the diagnostic and management criteria to base their clinical decision-making on. This is particularly the case in the field of psychocutaneous disease where scientific advances are shedding new light on the understanding and treatment of long-recognized conditions located at the interface of dermatology and psychiatry.
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