Fabricated facial rash - an unusual presentation of factitious disorder

Patients with factitious disorder typically present with signs or symptoms suggesting a medical problem, but which transpire to be self-induced or fabricated. Repeated investigations and treatments are often carried out to no avail before this possibility is considered. In this case, a 51-year-old female presented to the oral and maxillofacial surgery unit with toothache and a facial rash. Following admission to hospital a range of investigations were performed, and a tooth was extracted. Judicious attention by nursing staff led to the discovery that the patient had been applying make-up to mimic a skin rash. This concern was raised with the patient and she admitted falsifying the rash. Although this patient may have been experiencing pain, by applying make-up in this manner she sought to exaggerate the severity of her condition and as a result underwent potentially unnecessary procedures. This case provides a reminder that the possibility of factitious disorder should be considered in cases where patients present with symptoms or signs which appear fabricated or self-inflicted, defy anatomical or physiological principles, or do not correlate with the history. Thorough history taking is essential, and access to electronic care records may be informative. Psychiatric follow-up is recommended, but not all patients are willing to engage with this process.