- There is a strong association with eating disorders - the condition occurring in approximately a third of patients with anorexia or bulimia.
- Onset or relapse of dermatitis artefacta is often precipitated by definable psychosocial stressors, varying according to age and life situations.
- Many patients also have an associated chronic medical or dermatological condition.
- Close supervision and symptomatic care of skin lesions will hopefully lead to a doctor-patient relationship in which psychological issues may gradually be introduced. Regularly review suicide and self-harm risk.
- Palliative dermatological measures such as occlusive bandages, ointments or placebo drugs, as well as admission to hospital that includes bathing and massaging by nurses, can have a therapeutic impact on the psychiatric problem by symbolizing the medical attention and care for which the dermatitis artefacta patient is craving. Improvement of lesions under protective dressings is supportive of the diagnosis.
- Antidepressants may be of value. Selective serotonin reuptake inhibitors (SSRIs) are often preferred although the tricyclic antidepressants may have some antipruritic effect and sedation can be beneficial. If the patient is motivated, cognitive and behavioral therapy (CBT) may be helpful as part of a package of care, although evidence is currently lacking. Atypical antipsychotics such as olanzapine may also be helpful. Inevitably, patients with different psychiatric illnesses require different approaches.
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