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Self-induced dermatoses, including body-focused repetitive behaviors and dermatitis artefacta, comprise 2% of dermatology visits. These conditions can mimic primary skin diseases, requiring a high index of suspicion for accurate diagnosis.

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Area of Science:

  • Dermatology
  • Psychiatry
  • Behavioral Science

Background:

  • Self-induced dermatoses account for approximately 2% of dermatology patient visits.
  • These conditions encompass body-focused repetitive behaviors (BFRBs) like skin-picking and nail-biting, dermatitis artefacta, and symptoms secondary to other psychiatric disorders.
  • BFRBs, particularly onychophagia and onychotillomania, can present with lesions mimicking various primary dermatologic conditions.

Purpose of the Study:

  • To review the spectrum of self-induced dermatoses.
  • To highlight the diagnostic challenges posed by these conditions, especially when they mimic primary dermatologic diseases.
  • To emphasize the importance of clinical suspicion in identifying self-induced dermatoses.

Main Methods:

  • Literature review and synthesis of existing research on self-induced dermatoses.
  • Analysis of clinical presentations and diagnostic criteria for BFRBs and dermatitis artefacta.
  • Discussion of the behavioral subtypes (obsessive-compulsive vs. impulsive-dissociative) and their implications.

Main Results:

  • Self-induced dermatoses are diverse, including BFRBs and dermatitis artefacta.
  • Lesions from self-induced dermatoses can closely resemble primary skin conditions such as psoriasis, lichen planus, vasculitis, onychomycosis, and melanoma.
  • Dermatitis artefacta lesions are self-inflicted, often to assume a sick role, and can be intentionally designed to mimic other diseases.
  • Behavioral styles in self-induced dermatoses range from obsessive-compulsive to impulsive-dissociative, with the latter associated with more severe presentations and psychopathology.
  • These conditions can coexist with or imitate primary dermatologic diseases.

Conclusions:

  • Self-induced dermatoses represent a significant portion of dermatologic consultations and present diagnostic challenges.
  • Clinicians must maintain a high index of suspicion to differentiate self-induced lesions from primary dermatologic conditions.
  • Understanding the behavioral underpinnings is crucial for effective management and treatment of patients with self-induced dermatoses.