ABSTRACT
The spectrum of self-induced dermatological conditions is very extended. Self-mutilative and self-destructive psychological tendencies tend to express themselves in a continuum of behaviors motivated by a myriad of causes ranging from simple distress to perverse intentions, and the underlying psychiatric disorders are the most complicated. Although the definitions of both dermatitis artefacta and neurotic excoriations suggest specific skin lesions, specific motivations, and specific underlying psychiatric conditions, it must be emphasized that the spectrum of self-indiced dermatological disorder is very extended. Patients with cutaneous artefacts present their double morbidity-dermatological and psychiatric-to the dermatologist, so most of the burden of detecting, diagnosing, and treating these difficult cases falls on that physician (1). The dermatologist will find guidelines in this
chapter for the management of a wide range of artificial dermatosis, from lesions inflicted through tics and obsessive-compulsive behavior such as neurotic excoriations, nail biting (onychophagy), and hair pulling (trichotillomania, trichophagy) to the different types of dermatitis artefacta and even cases of clear malingering or pathomimesis (simulating a dermatosis with a motive of definite material gain, such as release from prison or obtaining a sickness allowance) (2,3).
