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Histopathological patterns in dermatitis artefacta
Jörg Tittelbach1, Melanie Peckruhn1, Peter Elsner1
1Department of Dermatology, Jena University Hospital, Jena, Germany.
Background:
Dermatitis artefacta is a relevant and frequently unrecognized clinical condition associated with self-harming behavior, in which unconscious manipulation causes skin lesions. While atypical lesions and an unusual disease course may give rise to clinical suspicion of a self-induced disorder, questioning and examining these patients usually fails to confirm or clarify this suspicion. In this setting, the dermatopathologist may be faced with the question whether there are any histological signs corroborating the diagnosis of dermatitis artefacta.
Methods:
We conducted a Pubmed search (without time frame) using the terms "dermatitis artefacta", "factitious/factitial dermatitis", "artefactual skin" in combination with "histology" or "pathology". Given the low number of hits, we extended the search by adding terms related to certain types of injuries (for example, "burn" or "cold") in order to identify specific patterns.
Results:
In general, there are only few studies investigating the histological features of factitious skin disorders. Another problem arises from the fact that, even if clinical and histological findings are suggestive of dermatitis artefacta, subsequent confirmation of the exact mechanism of injury is frequently not possible, thus leaving room for speculation. This complicates defining specific histological patterns based on the various types of injuries. Overall, the results of the present study suggest that a factitious disorder should be considered if histological findings include blistering with a mild inflammatory infiltrate, rupture of collagen fibers, multinucleated keratinocytes, or elongated and vertically aligned keratinocytic nuclei.
Insights
Histological examination may reveal signs of factitious dermatitis, a self-inflicted skin condition. Key findings include blistering, collagen damage, and specific changes in keratinocytes, aiding diagnosis when clinical suspicion is high.
Area of Science:
- Dermatopathology
- Dermatology
- Medical Histology
Background:
- Dermatitis artefacta is a self-inflicted skin condition often unrecognized due to unconscious manipulation causing lesions.
- Clinical suspicion arises from atypical lesions and disease course, but direct confirmation is challenging.
- Dermatopathologists may need to identify histological signs to support the diagnosis.
Purpose of the Study:
- To investigate histological features that can corroborate the diagnosis of dermatitis artefacta.
- To identify specific histopathological patterns associated with self-induced skin lesions.
Main Methods:
- Conducted a comprehensive Pubmed search using terms related to dermatitis artefacta and histology.
- Extended search with injury-specific terms (e.g., burn, cold) to identify patterns.
- Reviewed literature for histological findings in factitious skin disorders.
Main Results:
- Few studies exist on the histology of factitious skin disorders.
- Confirmation of injury mechanism is often difficult, complicating pattern definition.
- Histological findings suggesting dermatitis artefacta include blistering with mild inflammation, collagen fiber rupture, multinucleated keratinocytes, and specific nuclear changes.
Conclusions:
- Histopathology can provide crucial clues for diagnosing dermatitis artefacta.
- Specific histological findings, such as blistering and keratinocyte abnormalities, warrant consideration of a factitious disorder.
- Further research is needed to define precise histological patterns for various injury types.
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