Dermatosi artefatte in un soggetto anziano con disturbo del controllo degli impulsi

SUMMARY: Artefacta dermatitis in an older woman with obsessive compulsive disorder. G. LUCCIOLA, E. PAPUZZO, E. TOLINO, F. NICOLUCCI, I. PROIETTI, B. GROSSI, D. INNOCENZI Artefacta dermatitis is a disease characterized by self-inflicted skin lesions and the full awareness and intention of the patient. Mechanical and chemical devices are the most commonly used to produce such injuries. Several psychological disorders like depression, obsessive compulsive disorders, hysteria, are associated with artefacta dermatitis and females are more often involved. The majority of the patients are young, with an age between 15 and 30, but it is possible to find such symptoms also in paediatric or older patients. Because of its rarity and because of the polymorphism of lesions, artefacta dermatitis is often a challenge for the clinicians and a differential diagnosis with other skin diseases must be done. Difficulties are also due to the lack of cooperation in these patients, who usually refuse the dialogue with doctors and deny their primary role in the production of the lesions. We present the case of an older woman who showed a peculiar pattern of extended deep excoriations in different parts of body and an evident state of depression. Diagnostic and therapeutic procedure, that is often long lasting and difficult in such case, was made in about 4 months by the cooperation of dermatologists with psychiatrists and psychologists, getting to a steady control of impulses and the full remission of cutaneous symptoms.