PS42 Bullous dermatitis artefacta: a series of four cases

Abstract

Dermatitis artefacta (DA) is a self-inflicted psychocutaneous condition with varying morphologies. Herein we discuss four cases of DA with bullous lesions (Table). The first patient had right-hand dominance with involvement of a covered area, and spontaneous healing of bullous lesions, which led to suspicion of DA. The second patient was left-hand dominant with almost complete involvement of the right upper limb, with extensive scarring but minimal concern. She had visited multiple doctors and was a divorcee in her second marriage, after which the disease had started. The single most important clinical pointer towards her disease was presence of linear hyperpigmented macules at most proximal area of the arm. The third patient was an adolescent boy accompanied by his father; his mother had died 5 years earlier, after which these episodes had started. Older photographs showed uniform disc-shaped bullous lesions suggestive of burns. The fourth patient was a student preparing for a competitive exam. Some linear imprints suggestive of fingers were noticed over the left arm, which gave a suspicion of self-infliction. DA can be associated with conditions such as underlying depression, anxiety and/or borderline personality disorder. In patients with bullous lesions, it is important to rule out immunobullous disorders.TableSummary of clinical detailsCase1234Age (years), sex25, female30, female13, male21, femaleSiteLeft breastRight upper limbGeneralizedBilateral upper limbs and trunkPresentationPainful recurrent bullous lesionsFlaccid bullae with background of oedema and scarringMultiple round atrophic and/or dyspigmented scarsBright erythema with vesicles and bullaeClinical diagnosisLocalized BPLocalized BPDermatitis artefactaSevere irritant contact dermatitisHistopathologySubepidermal cleftNonspecificNot doneNot doneDirect immunofluorescenceNegativeNegativeNot doneNot doneFinal diagnosisBorderline personality disorderMajor depressive disorderImpulse control disorderAcute stressManagementOcclusive bandagingOcclusive bandagingCounsellingObservationBP, bullous pemphigoid.