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Self-inflicted Skin Lesions in Infancy
Figure 3: Neurotic Excoriations Figure 4: Dermatitis Artefacta Consisting of
Self-injection of Cow’s Milk
car cigarette lighters and hot or lit matches. Dermatitis neglecta is accusation and blame. It is important to give the child increasing
defined as the appearance of skin lesions caused by a deliberate control over the triggering stressor and the behaviour, to observe for
failure to wash or take care of the skin, with a consequent build-up of parent–child power struggles, to screen for associated psychiatric
dirt, sebum and keratin.
17
Some of these lesions have also been conditions (depression, anxiety, body dysmorphic syndrome,
biopsied, with histology showing a mild hyperkeratosis and no other obsessive-compulsive disease) and to prescribe psychotherapy or
signs of pathology. Lesions can easily be removed just by wiping the psychotropic medications if necessary.
skin with an alcohol-soaked gauze pad.
In conclusion, self-inflicted skin lesions in infancy are a challenging
Foreign material can also be injected into the skin. The injection of field of investigation; a complete clinical and psychological
faecal material can provide a Clostridium perfringens-positive culture, evaluation is mandatory to manage these long-lasting and often
presenting the clinician with a really difficult diagnostic challenge. In treatment-resistant diseases. ■
our clinic, we observed a case of self-injection of cow’s milk (see
Figure 4).
Anna Belloni Fortina is Head and Senior Consultant
in the Dermatology Unit of the Department of
Conclusion Paediatrics at the Medical School of the University of
The diagnosis of self-inflicted skin lesions in children can be difficult
Padua. Her research interests are skin complications
in organ transplant recipients, atopic dermatitis and
and should be always be considered when lesions have an unusual
allergic contact dermatitis and the dermoscopy of
morphology. The association with psychiatric disorders in children is pigmented lesions in both children and adult patients.
less well established than in adults, but underlying psychosocial stress
is frequently a component of these disorders. Features of anxiety,
depression or other psychological conditions should also be screened
Edoardo Zattra is a PhD student in the Dermatology
in children. A supportive physician–patient–parent relationship is of
Unit of the Department of Paediatrics at the Medical
School at the University of Padua. He spent time at
paramount importance in the treatment of children. These skin
Boston University as a research fellow. His research
conditions are frequently associated with other chronic conditions
activity focuses on skin complications in organ
(e.g. asthma, atopic dermatitis).
transplant recipients, psoriasis and biological drugs,
dermoscopy of pigmented lesions in both children
and adult patients and melanoma biology. He
Management principles are to establish non-judgmental physician–
completed his residency in dermatology in 2008.
patient support and to allow the child to ‘save face’ by avoiding
1. American Psychiatric Association, Diagnostic and report and literature overview, Psychosom Med, 1998;60(5): 13. Pathak S, Danielyan A, Kowatch RA, Successful treatment
statistical manual of mental disorders (DSM-IV), 658–60. of trichotillomania with olanzapine augmentation in an
Washington, DC: American Psychiatric Association, 1994. 8. Saraswat A, Child abuse and trichotillomania, BMJ, adolescent, J Child Adolesc Psychopharmacol, 2004;14:153–4.
2. Kalivas J, Hayden CT, Dermatitis artefacta versus 2005;330:83–4. 14. Block C, West SA, Baharoglu B, Paroxetine treatment of
dermatitis factitia, Dermatol Psychosom, 2003;4:168. 9. Happle R, Trichotemnomania: obsessive-compulsive habit trichotillomania in an adolescent, J Child Adolesc
3. Koblenzer CS, Dermatitis artefacta. Clinical features and of cutting or shaving the hair, J Am Acad Dermatol, 2005;52: Psychopharmacol, 1998;8:69–71.
approaches to treatment, Am J Clin Dermatol, 2000;1:47–55. 157–9. 15. Gupta MA, Gupta AK, Fluoxetine is an effective treatment
4. Saez-de-OcarizM, Orozco-Covarrubias L, Mora-Maganˇa I, 10. Salaam K, Carr J, Grewal H, et al., Untreated for neurotic excoriations: case report, Cutis, 1993;51:
et al., Dermatitis artefacta in pediatric patients: trichotillomania and trichophagia: surgical emergency in a 386–7.
experience at the National Institute of Pediatrics, Pediatr teenage girl, Psychosomatics, 2005; 46:362-366 16. Rogers M, Fairley M, Santhanam R, Artefactual skin
Dermatol, 2004;21:205–11. 11. Zalsman G, Hermesh H, Sever J, Hypnotherapy in disease in children and adolescents, Australas J Dermatol,
5. Shah KN, Fried RG, Factitial dematoses in children, adolescents with trichotillomania: three cases, Am J Clin 2001;42(4):264–70.
Curr Opin Pediatr, 2006;18:403–9. Hypn, 2001;44:63–8. 17. Poskitt L, Wayte J, Wojnarowska F, Wilkinson JD, ‘Dermatitis
6. Hallopeau F, Alopecia par grottage (trichomania ou 12. Palmer CJ, Yates WR, Trotter L, Childhood trichotillomania. neglecta’: unwashed dermatosis, Br J Dermatol, 1995;132(5):
trichotillomania), Ann Dermatol Syphil, 1889;10:440. Successful treatment with fluoxetine following an SSRI 827–9.
7. Bouwer C, Stein DJ, Trichobezoars in trichotillomania: case failure, Psychosomatics, 1999;40:526–8.
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