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Dermatitis Artefacta — SCE Dermatology MCQ

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HardPsychodermatologyDermatitis ArtefactaSCE Dermatology

A 40-year-old woman presents with dermatitis artefacta. She has bizarre geometric skin lesions on accessible sites that do not match any known dermatological condition. She denies self-infliction. What is the characteristic psychological feature that distinguishes dermatitis artefacta from neurotic excoriations?

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Correct answer: D — Patients with DA deny self-infliction (the lesions are produced unconsciously or with denial)

The best answer is “Patients with DA deny self-infliction (the lesions are produced unconsciously or with denial)”. Repeated cosmetic procedures with persistent preoccupation and shifting perceived defects should prompt assessment for body dysmorphic disorder rather than further procedure-led care. The alternatives “Patients with DA acknowledge self-infliction, within an appropriate UK pathway, after clinicopathological correlation”, “DA is associated with malingering, after clinicopathological correlation, after specialist assessment”, “DA occurs in children, after specialist assessment, when the full phenotype supports it”, “DA and neurotic excoriations are psychologically identical, when the full phenotype supports it” are clinically adjacent possibilities, but they do not fit the defining morphology, distribution, histopathology, risk signal or management sequence in this stem.

Reference: NICE CG31 obsessive-compulsive disorder and body dysmorphic disorder: https://www.nice.org.uk/guidance/cg31/chapter/Recommendations