ABSTRACT
A schoolteacher noticed these marks (Image 76) on this boy’s chest when he said he was too ill to play at football practice. The boy’s mother took him to the emergency department. The rash was non-blanching. The boy was afebrile and otherwise well. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig76.jpg"/>
What is the diagnosis?
What could be the underlying cause?
172The purple lesions were diamond shaped and scattered randomly across the anterior chest and abdomen, within reach of the child himself. There were no other lesions anywhere on the child’s body. This uniform rash, unlike any skin condition, was due to dermatitis artefacta and had been caused by the child himself.
Dermatitis artefacta is skin damage caused by the child himself, but not acknowledged by the child. It is relatively rare and, although sometimes done for experimental reasons or under peer pressure, is usually a cry for help in a child who feels trapped in an intolerable situation. It may be a reaction to sexual abuse, social difficulty or bullying. Children who self-harm in other ways such as cutting or overdosing on medications usually acknowledge what they have done. This child will need careful and sensitive management, which may involve the input of a child psychiatrist or psychologist. 1 , 2
