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Indian Pediatr 2013;50: 897-898

Bullous Dermatitis Artefacta


D Pandhi and A Singal

Department of Dermatology and STD, University College of Medical Sciences and Guru Tegh Bahadur Hospital,
University of Delhi, Delhi, India.
Email: [email protected]



A 14-year-old girl presented with bullous lesions over both thighs for 3 weeks. There were variably sized, discrete and coalescent, tense bullae surrounded by irregular erythema (Figs. 1,2) and linear and curvilinear erosions at various stages of healing. She provided inconsistent history of evolution and had been treated with systemic steroids without improvement. Her skin biopsy showed necrosis of epidermis and direct immunofluorescence was negative for C3, IgG, IgA, IgM. A diagnosis of bullous dermatitis artefacta was made and psychiatric evaluation was sought. She was given a diagnosis of borderline personality disorder with poor impulse control and admitted to inducing lesions with chemicals and pinching. She was kept under observation and treated with Olanzapine and topical antibiotics with counseling which led to healing of lesions.

Fig. 1 Tense, hemorrhagic bullae, bizarre shaped, crescent shaped and linear superficial erosions over the thigh.

 

Fig. 2 A tense blister with linear erythema and vesiculation indicating streaking.

Dermatitis artefacta is a disorder of self-injurious behavior for psychological gain. There is predominant involvement of adolescent females. Bullous dermatitis artefacta can be differentiated from immunobullous diseases by the erratic history, overnight onset and presence of bizarre, linear or geometric lesions and superficial erosions. The lesions can be induced by picking, pinching, burning, scalding with chemicals, suctioning or cryoinjury. The management should include avoidance of confrontation, behavioral therapy, and appropriate pharmaco therapy. A high index of suspicion can ensure timely psychiatric intervention.

 

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