Factitial dermatitis (dermatitis artefacta) is a psychiatric condition, characterized by skin lesions that are self-induced to satisfy an unconscious or conscious psychological need, which often is to assume the sick role. Patients will not admit to creating the lesions, which are usually more elaborate than simple excoriations. Factitial dermatitis should be differentiated from malingering, in which lesions are created deliberately for secondary gain, such as collecting disability or evading prosecution. Malingering is not a mental illness. Additionally, factitial dermatitis should be distinguished from neurotic excoriations, in which the patient is aware of, and will typically admit to, scratching or picking.

Clinical appearance depends on the method of self-injury. Dermatitis-like lesions, panniculitis, ecchymosis, ulcers, and vasculitis-like lesions are all possible. The diagnosis tends to occur more frequently in women and in those working in health care. It can be seen in the setting of acute stressors but is predominantly seen in patients with an underlying psychiatric ailment (eg, borderline personality disorder).

The patients' typical lack of concern for how disfiguring their lesions appear is out of proportion to the reality of their presentation. The patient history tends not to corroborate the unusual cutaneous findings. This so-called "hollow history" is a characteristic of the disease. The lesions may be produced by scratching, picking, biting, cutting, burning, injecting, and puncturing and may be produced by hand, instruments, or topical or injectable chemicals. More serious wounds can be complicated by gangrene, abscess formation, or other life-threatening infections. Treatment is often challenging and multidisciplinary.

Related topics: factitious disorders, medical child abuse