Dermatitis artefacta and artefactual skin disease: the need for a psychodermatology multidisciplinary team to treat a difficult condition.

BACKGROUND: Dermatitis artefacta (DA) is a factitious skin disorder caused by the deliberate production of skin lesions by patients with a history of underlying psychological problems. The patient may not be fully aware of this, and the true extent of this disorder, especially in children, is currently unknown. Management of these patients is challenging as many fail to engage effectively with their dermatologist. OBJECTIVES: To explore the various clinical presentations and strategies employed to treat DA in our local population, and note outcomes in order to evaluate effectiveness of our management. METHODS: A retrospective case note review was conducted of 28 patients attending the regional psychodermatology clinic at the Royal London Hospital from January 2003 to December 2011. RESULTS: Out of 28 patients identified with DA, the majority of patients were female, and the most frequent sites for skin lesions were the face and upper body. Anxiety, depression and personality disorders were common underlying psychiatric diagnoses. Ninety-three per cent of patients were successfully managed (i.e. the DA resolved or was in remission at the time of writing) in our combined psychodermatology clinic by a multidisciplinary psychocutaneous medicine team. Thirty-two per cent of our cases were children (aged < 16 years) and one of these was referred to local child protection services; 46% of patients had a concomitant mental health disease at the time of presentation with DA. CONCLUSIONS: A multidisciplinary psychocutaneous team is important in this condition particularly as the patient is likely to require psychological intervention (to facilitate the resolution of the precipitant), in addition to dermatological (to make the diagnosis and, importantly, to exclude organic disease) and psychiatric (to manage concomitant psychiatric disease) input. Our findings indicate that our model of a psychodermatology multidisciplinary team will achieve greater successful treatment of patients with DA and we are the first to describe this important service in the U.K.