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Advances in dermatology and venereology Acta Dermato-Venereologica
Extraordinary Findings in a Case of Self-inflicted Cutaneous Lesions
Maria Julia CANUTO 1 , Ana Claudia Grizzo Peres MARTINS 1 , Alexandre Jack DWAN 2 , Cyro Festa NETO 1 and Marcello Menta Simonsen NICO 1 * Departments of 1 Dermatology , and 2 Psychiatry , Medical School , University of São Paulo , Rua Itapeva 500 , 3A , CEP-01332-000 São Paulo , Brazil . * E-mail : mentanico @ hotmail . com Accepted Apr 18 , 2017 ; Epub ahead of print Apr 19 , 2017
Factitious dermatologic disorder ( FDD ), formerly called dermatitis artefacta or factitious dermatitis , is a disorder of self-induced behavior ( 1 ). FDD can be defined as any condition that involves self-inflicted skin lesions for which the patient denies all responsibility due to extant personality disorder ( 2 , 3 ). Patients induce lesions to fulfill an unconscious psychological need ( 1 ). The clinical profile of FDD varies significantly and depends on how the patient traumatizes the skin . The lesions observed can include erosions , ulcers , eschars , blisters , nodules that follow injection of foreign material ( 4 ), and mutilation ( 1 , 2 ).
We present a case of FDD who showed extraordinary radiological findings . In addition , during a psychiatric follow-up , the patient revealed her motivations in producing the lesions , prompting a discussion on her psychopathology .
CASE REPORT
A 60-year-old married woman presented with cutaneous lesions on her left lower limb that had been present for
Fig . 1 . Multiple cutaneous ulcers .
6 months . Her husband , who was concerned about her complaints – the patient claimed to have been possessed by evil spirits – had taken her to the hospital . Since the initial presentation , the patient had been examined in many hospitals , stating that no doctor could identify the cause of her ailments .
An examination showed several irregularly shaped , well-demarcated , shallow cutaneous ulcers on the left leg and calf , with no signs of inflammation ( Fig . 1 ). The patient affirmed that the lesions developed suddenly , without any preexisting symptoms . FDD was promptly suspected ; the lower limb was X-rayed , upon insistence of the patient . On the X-ray , radio-opaque images of many intact and broken sewing needles could be seen , residing at various depths of the lower limb soft tissues ( Fig . 2 ). The patient claimed that no person had inserted the needles into her body , and she was certain that they were the result of witchcraft . Her husband supported this theory .
Fig . 2 . Left lower leg radiograph : lateral view ( left ), and front view ( right ) showing multiple self-embedded needles .
This is an open access article under the CC BY-NC license . www . medicaljournals . se / acta Journal Compilation © 2017 Acta Dermato-Venereologica . doi : 10.2340 / 00015555-2680 Acta Derm Venereol 2017 ; 97 : 967 – 968