Dermatitis artefacta of the lip in an adolescent

Self-inflicted trauma is found in several patient groups including those with learning and developmental delay, the very young and those suffering from psychiatric disturbance. The diagnosis of artefactual disease can only be made when all possible organic disease has been excluded by specific investigations. The case presented is that of a 15-year-old girl complaining of persistent bleeding and crusting of her lips. Investigations provided no real information as to the cause of the allegedly spontaneous bleeding. The diagnosis of artefactual disease was finally decided upon and a referral to a child and adolescent psychiatrist made.

Patients with unusual clinical signs may be examined regularly by their GDP. This case clearly illustrates the importance of considering a psychological disorder and referral in the differential diagnosis of conditions appearing with unusual clinical signs.