Sir,
A 10-year-old boy presented with recurrent painful skin lesions over body since 2 years, appearing at an interval of 5–6 days. Examination revealed square-shaped erosions with crusting and hypopigmented and hyperpigmented scars over approachable areas of body [Figure 1]. The lesions were of two different sizes indicating two types of square-shaped instruments used for inflicting injuries. On the basis of pattern of lesions and their distribution, diagnosis of dermatitis artefacta was made. Psychiatric evaluation revealed separation from father, getting less attention of parents, and patient's anxiety being the cause of the disease condition. The patient and parents were counselled separately, family therapy was given, and stressors were addressed. The child was given cognitive behavioral therapy and he did not develop any new skin lesions during the 4 months of follow-up.
Figure 1.
Square-shaped scars of two different sizes on approachable areas
Dermatitis artefacta is characterized by self-inflicted skin lesions over accessible areas of the body to satisfy a psychological need of which he or she is not completely aware.[1] It is mostly found in prepubertal and adolescent age groups.[2] The lesions are symmetrical, bizarre-shaped, and monomorphic at variable stages of healing. Several causes such as delayed developmental milestones, loss of close relatives in the recent past, separation from parents/close relatives, disturbed parent–child relationship, domestic violence, gender bias, pressure to do well in exam, bullying in school, conflict with siblings have been implicated as the precipitating factors for dermatitis artefacta.[3,4,5] In our case, separation from the father and getting less attention from the mother was the cause of dermatitis artefacta in the child; he was injuring himself with square-shaped wooden stamp and some irritant to gain the attention of parents. The child was given cognitive behavior therapy along with identification of cognitive errors and correction of maladaptive cognition.
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