Dynamics and management of self-induced eruptions

Self-induced eruptions are always expressions of an emotionally disturbed person. They cover a wide variety of injuries and include aggravation of preexisting dermatoses, neurotic excoriations, mucocutaneous changes from compulsive movements, factitial dermatitis and trichotillomania. The emotional disturbances in such patients range from mild psychoneuroses to severe psychoses. Attention should be focused primarily on the emotional disturbance. The management of psychotic patients is the domain of the psychiatrist. But those unsuitable for psychiatric care and persons with mild psychoneuroses-who fortunately constitute the majority among patients with self-inflicted eruptions-should remain with their dermatologist or general physician and get from him effective supportive psychotherapy in addition to such treatment for the self-induced damage to the skin as may be indicated.