Dermatological pathomimicry: a form of patient maladjustment

Thirteen patients (eleven female, two male; aged 19-72 years) who mimicked their original dermatological disease by reproducing the original mechanisms of disease or by interfering with therapy were seen over a period of 5 years. Six patients had exacerbations of eczema, four drug reactions, and three non-healing leg ulcers. Exacerbations of dermatological disease were related to the patient's need for a sickness role. This maladjustment responded to positive directive psychotherapy rather than a superficial sympathetic approach which tended to reinforce the maladjustment. Eleven patients admitted their part in actively producing their disease, and the outcome was good. This clinical syndrome appears to be predominantly an opportunist reaction although one patient was depressed and one had early dementia. The syndrome should not be confused with dermatitis artefacta.