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Michael Joseph Lavery, Carolyn Stull, Iain McCaw, Rachel B Anolik
Dermatitis artefacta, also known as factitial dermatitis, is a condition whereby self-induced skin damage is the means used to satisfy a conscious or unconscious desire to assume the sick role. It is particularly common in women and in those with an underlying psychiatric diagnosis or external stress. The diagnosis is one of exclusion, and it is often difficult to confirm, with patients rarely admitting their role in the creation of their lesions. Treatment can be challenging, and management should adopt a multidisciplinary team approach composed of dermatologists and mental health professionals...
November 2018: Clinics in Dermatology
Christopher Bass, Derick T Wade
Although exaggeration or amplification of symptoms is common in all illness, deliberate deception is rare. In settings associated with litigation/disability evaluation, the rate of malingering may be as high as 30%, but its frequency in clinical practice is not known. We describe the main characteristics of deliberate deception (factitious disorders and malingering) and ways that neurologists might detect symptom exaggeration. The key to establishing that the extent or severity of reported symptoms does not truly represent their severity is to elicit inconsistencies in different domains, but it is not possible to determine whether the reports are intentionally inaccurate...
November 13, 2018: Practical Neurology
Joshua A David, William J Rifkin, Ernest S Chiu
OBJECTIVE: Despite the presence of self-inflicted wounds (SIWs) across all of medicine, our current understanding of SIWs in surgery is limited. Here, we detail the pertinent aspects of the history, diagnosis, decision making, and management of SIWs as they relate to the field of surgery. In addition, we present the first comprehensive review of SIWs across the surgical literature. SUMMARY BACKGROUND DATA: Self-inflicted wounds have been recognized for much of recorded human history and span a wide spectrum of patient behaviors, motivations, and underlying psychiatric illnesses...
October 31, 2018: Annals of Plastic Surgery
Mohamed El Amraoui, Badredine Hassam
Self-induced dermatoses are more and more frequent in adolescent substance abusers with adaptation problems. We here report a case of self-induced bullous lesions on the shoulder in an adolescent with major depression and suicidal ideations. The study involved a 22-year old man, who was a chronic smoker, an occasional user of cannabis and alchool with no particular past medical history, with divorced parents, in conflict with his father. He presented with bullous eruption on the left shoulder made of bubbles, post-bullous skin erosions and scabs on a healthy skin...
2018: Pan African Medical Journal
A Marzouki-Zerouali, A Schoeffler, A-L Liegeon, P Le Vaou, F Truchetet
BACKGROUND: Factitious disorders constitute a complex pathology for the dermatologist. Although a diagnosis is often indicated, it is difficult to confirm and treatment is complicated. Dermatitis artefacta is the somatic expression of an often serious psychiatric disorder consciously created by patients on their own cutaneous-mucosal surfaces but the motivation is unconscious and no secondary benefits are sought (in contrast to simulation). Pathomimicry represent a specific entity: the provocation of outbreaks of a known disease, triggered by voluntary exposure to a causative agent...
October 22, 2018: Annales de Dermatologie et de Vénéréologie
Lingzhan Miao, Peifang Wang, Jun Hou, Yu Yao, Zhilin Liu, Songqi Liu, Tengfei Li
Microplastics are frequently detected in freshwater environments, serving as a new factitious substrate for colonization of biofilm-forming microorganisms. Distinct microbial assemblages between microplastics and surrounding waters have been well documented; however, there is insufficient knowledge regarding biofilm colonization of plastic and non-plastic substrates, despite the fact that microbial communities generally aggregate on natural solid surfaces. In this study, the effects of substrate type on microbial communities were evaluated by incubation of biofilms on microplastic substrates (polyethylene and polypropylene) and natural substrates (cobblestone and wood) for 21 days under controlled conditions...
February 10, 2019: Science of the Total Environment
M P Pereira, C Zeidler, T Nau, S Bobko, A W M Evers, S Garcovich, M Gonçalo, J A Halvorsen, J Lambert, F J Legat, T Leslie, M Metz, L Misery, K Nordlind, A Reich, G Schneider, H Ständer, M Streit, J C Szepietowski, J Wallengren, E Weisshaar, S Ständer
BACKGROUND: Chronic prurigo (CPG) is a distinct disease characterized by chronic pruritus, history and/or signs of prolonged scratching and multiple pruriginous lesions. It may present with various clinical manifestations, including papules, nodules, plaques or umbilicated lesions. Some patients with chronic pruritus show pruriginous linear and scaring scratch lesions (LSSL) and it is unclear whether these lesions belong to the spectrum of CPG. OBJECTIVE: To achieve a consensus on the classification of pruriginous LSSL and establish criteria to differentiate them from similar appearing conditions of different nature...
October 5, 2018: Journal of the European Academy of Dermatology and Venereology: JEADV
Alexandra J Sequeira, Michael G Fara, Ariane Lewis
Tissue plasminogen activator (tPA) is administered to patients with suspected ischemic stroke to improve blood flow to the brain In rare cases, patients present with complaints of stroke symptoms that appear to be non-organic due to malingering, factitious disorder, or conversion disorder (psychogenic stroke mimics). Deciding whether or not to administer tPA to these patients can be challenging. The risk of hemorrhage after administration of tPA is low, but not zero. The ethical principles of beneficence and nonmaleficence need to be weighed carefully in these situations...
2018: Journal of Clinical Ethics
Sarah Velsor, Richard Rogers
Practitioners and researchers have long been challenged with identifying deceptive response styles in forensic contexts, particularly when differentiating malingering from factitious presentations. The origins and the development of factitious disorders as a diagnostic classification are discussed, as well as the many challenges and limitations present with the current diagnostic conceptualization. As an alternative to a formal diagnosis, forensic practitioners may choose to consider most factitious psychological presentations (FPPs) as a dimensional construct that are classified like malingering as a V code...
September 17, 2018: Behavioral Sciences & the Law
Mario Diplomatico, Pierluigi Marzuillo, Daniela Capalbo, Michela Stanco, Rosaria Marotta, Stefano Guarino
: A 12-year-old boy, with intermittent abdominal pain from 3 years of age, presented with increased frequency of right lower quadrant pain (at least three episodes per week over the past six months) and pain during micturition affecting school attendance. His family history included referred urolithiasis. An abdominal ultrasound performed 1 year before our visit showed a small stone of 4 mm in the right renal pelvis for which he did not receive any therapy. The patient brought 25 hard stones with irregular outline, 2-8 mm in diameter, of deep brown/grey colour that he claimed to have found in his underwear (figure 1)...
September 15, 2018: Archives of Disease in Childhood. Education and Practice Edition
Jean-Louis Bayart, Mélanie Closset, Alexandra Coulon, Raluca-Maria Furnica, Damien Gruson
Our team of diabetologist is challenged by the case of a 41 year-old woman with recurrent hypoglycaemic episodes. Her clinical background was complex with, among others, a neuroendocrine tumor, a nonalcoholic steatohepatitis and an adrenal insufficiency; these conditions require the exploration of several potential causes. After excluding an endogenous etiology, a factitious hypoglycemia was quicky suspected by clinicians. However, several venous samples showed normal insulinemia and a moderately decreased C-peptide...
August 1, 2018: Annales de Biologie Clinique
Raghavendra L Girijala, Rachel Falkner, Scott R Dalton, Brent D Martin
Factitial cheilitis is a rare diagnosis of exclusion that occurs most frequently in young women with a history of anxiety disorders and recent psychosocial stressors. It presents as continuous keratinaceous build-up, crusting, and desquamation of the lips, consistent with exfoliative cheilitis. Affected areas can progress to superinfection with Staphylococcus aureus or Candida albicans. We report a case of a 23-year-old woman who presented with diffuse hyperkeratosis of the upper and lower lips that was initially suspected to be allergic or irritant contact dermatitis based on clinical examination...
May 2, 2018: Curēus
C Moss, S M Srinivas, N Sarveswaran, M Nahorski, V K Gowda, F M Browne, G Woods
BACKGROUND: Midface toddler excoriation syndrome (MiTES) is a condition recently reported in three unrelated children. Habitual scratching from the first year of life inflicted deep, chronic, scarring wounds around the nose and eyes. One child had a mild neurological deficit but there was no other evidence of insensitivity to pain. Bilateral distribution and localization to the midface distinguish MiTES from other causes of self-inflicted skin damage such as trigeminal trophic syndrome...
November 2018: British Journal of Dermatology
R A Veselis
Mechanisms of anaesthetic actions on memory have largely focused on easily definable aspects of episodic memory, with emphasis on particular drug interactions on specific memory processes. However, the memory landscape of the perioperative experience includes many facets that lie outside these conceptualisations. These include patient recall of preoperative conversations, patient beliefs regarding allergies and unusual/uncommon anaesthetic events, memories of awareness, and particularly vivid dreams during anaesthesia...
July 2018: British Journal of Anaesthesia
Fady Ghali, Lawrence M Dagrosa, Rachel A Moses, Michal Ursiny, Brian H Eisner, Vernon M Pais
PURPOSE: We sought to describe patterns of factitious urinary stone submission over time by investigating a contemporary stone analysis database and comparing two distinct time points. MATERIALS AND METHODS: We retrospectively reviewed a single stone analysis lab database at two time points, 1990 and 2010, and compared total incidence of factitious stone submission, as well as gender patterns and type of factitious stone submitted. RESULTS: A total of 27,014 stones were analyzed, 16,216 (60%) from 1990 and 10,798 (40%) from 2010 with a decrease in total incidence from 2...
August 2018: Clinical Nephrology
Eliza Sharma, Christine Resta, Patricia Park
Finger stick blood glucose meters are widely used in outpatient and inpatient settings. However, various factors can affect accuracy of readings from these meters. Here we present a patient who had spurious glucose elevation on these meters while being on intravenous ascorbic acid.
2018: Case Reports in Endocrinology
Mojtaba Akbari, Akbar Soltani, Mohammad Reza Mohajeri-Tehrani, Hamidreza Aghaei Meybodi, Imaneh Sadat Mousavi Fakhr, Sayed Mahmoud Sajjadi-Jazi
Introduction: Factitious hypoglycemia, caused by the surreptitious use of insulin and sulfonylureas, is one of the most challenging differential diagnoses of hypoglycemia. Diagnosis is usually established via exclusion with respect to the special patterns of plasma insulin and C-peptide during hypoglycemic episodes. Case Presentation: We report a case of recurrent hypoglycemic episodes and confusing patterns of insulin and C-peptide levels. In the primary evaluations, insulinoma was suspected considering the high plasma concentrations of insulin and C-peptide, besides negative urine and plasma sulfonylureas during hypoglycemic episodes...
January 2018: International Journal of Endocrinology and Metabolism
Noemi Faedda, Valentina Baglioni, Giulia Natalucci, Ignazio Ardizzone, Mauro Camuffo, Rita Cerutti, Vincenzo Guidetti
Factitious Disorder Imposed on Another (FDIA), also known as Munchausen Syndrome by Proxy (MSbP) is a very serious form of child abuse. The perpetrator, usually the mother, invents symptoms or causes real ones in order to make her child appear sick. Usually this is due to a maladaptive disorder or to an excessive of attention-seeking on her part. We report here two new cases of FDIA. The first one is a 9-year-old boy with a history of convulsive episodes, reduced verbal production, mild psychomotor disorder and urological problems who underwent several invasive procedures and hospitalizations before a diagnosis of FDIA was made...
2018: Frontiers in Pediatrics
Jörg Tittelbach, Melanie Peckruhn, Peter Elsner
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...
May 2018: Journal der Deutschen Dermatologischen Gesellschaft, Journal of the German Society of Dermatology: JDDG
Padma Mohandas, Jane C Ravenscroft, Anthony Bewley
Dermatitis artefacta (DA) or artefactual skin disease (ASD) is a factitious skin disorder rarely reported in the pediatric population. Skin lesions are produced deliberately either consciously or in a dissociative state to satisfy an underlying psychological need. Children may present with acutely formed skin changes or with chronic lesions, quite often having seen other specialists during their journey. The mechanism of formation of skin lesions can vary from the application of pigment onto the skin to simulate disease or more destructive techniques like the injection of irritant substances into the skin...
August 2018: Giornale Italiano di Dermatologia e Venereologia: Organo Ufficiale, Società Italiana di Dermatologia e Sifilografia
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