It is a form of factitious disorder. This refers to self-induced or a self-aggravated, bizarre lesion without an obvious cause and the patient typically denies inducing them (1). Any site may be affected.
It is a rare condition, more common in women than in men. There may be a psychological basis to the disease such as attention seeking because of loneliness, or it may underlie an attempt to secure industrial compensation. Often, no satisfactory explanation can be found.
Presentation is variable. Exposed areas are common sites. The lesion is often bizarre and of an unusual angular or geometric shape. Substances such as caustic soda may be applied to the skin or finger nails, and hair may be damaged or removed. Inappropriate interest and persistence of the lesion away from in-patient care are important clues.
Differential diagnosis may include physical and sexual abuse as well as psychosocial stressors (1).
OCD, borderline personality disorder, depression, psychosis and learning disabilities have all been reported in association with this condition (1).
Treatment is difficult. Denial and failure to keep appointments are common. The aid of a psychiatrist may be useful.
Direct confrontation is best avoided and a supportive, non-judgemental approach is recommended (1).
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