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Factitious Dermatoses -A rare pathology of self-induced skin lesions in which patients deny any role in causation. May be aware or dissociated (not conscious.) Clinical presentation and medical history tend to stand out in patients with FD because of certain classic features. Patient may bring stack of investigative studies/ bag of medications, hollow history, Mona Lisa smile, Patient seems unaffected. Bizarre shaped, oddly distributed lesions. Lesions located at sites accessible to the patient (face, hands, arms). Multiple types of concurrent lesions, foreign object source (knives, broken glass, caustics, cigarettes). Overall, the pattern of lesions is secondary to the mechanism of injury. Can include blisters, excoriations. superficial erosions, ulcers, abrasions, ecchymosis, purpura, erythema, edema, or signs of trauma and burns. Repetitive FD episodes may be precipitated by emotional stress and there is strong association with strained personal relationships. There are no specific histopathologic features specific for FD. Diagnosis is mainly of exclusion. A joint approach with both Dermatologist and mental health professionals is recommended. Symptomatic dermatology management is the treatment option from dermatology side. Psychological interventions include Cognitive behavior therapy, biofeedback, relaxation techniques, hypnosis and Supportive counseling. SSRIs, Tricyclic antidepressants, Typical (e.g. pimozide) and atypical antipsychotics (e.g. risperidone, olanzapine, etc) are used in the pharmacotherapy. Although long-term studies are rare, the prognosis is considered poor.
Hypnotherapy is a useful adjunctive psychotherapeutic procedure used in various conditions. Hypnosis can be induced by many means commonly by relaxing suggestions. I am presenting 3 cases of factitious dermatoses treated with hypnotherapy and there were no recurrences for a follow up period of 5 years .
