Treatment of Dermatitis Artefacta: A Systematic Review

Abstract

Dermatitis artefacta (DA) is a rare psychocutaneous disorder characterised by self-inflicted skin lesions that the patient denies producing. DA poses a complex clinical challenge to clinicians as patients often are resistant to the diagnosis, and can be hesitant to follow up with psychiatric or psychological services. There is a need to understand the optimal approach for management of patients with DA. This systematic review was undertaken to address this gap in knowledge. A search was conducted on PubMed and Embase using the following search strategy: Dermatitis artefacta OR factitious dermatitis OR factitial dermatitis OR artefactual skin AND treatment OR management OR therapy OR psychotherapy OR pharmacotherapy. Included studies were published from inception to 5ᵗʰ April 2023 in peer-reviewed journals, and discussed the treatment and management of DA. Studies were excluded if they were published in a language other than English. A total of 11 retrospective or prospective studies were included in this systematic review. They all found DA to be challenging to treat, with every study reporting patients experiencing a comorbid psychiatric condition or associated psychosocial stressor. Overall, there were better reported outcomes among follow-up patients treated in psychodermatology clinics with multidisciplinary teams of dermatologists, psychiatrists, and psychologists. Medical treatments can help with symptom control and promote wound healing, while psychological and psychiatric treatments can help address underlying psychosocial stressors for the condition. Further research is needed to evaluate optimal management and long-term treatment outcomes in patients with DA.