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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).
Reference:
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