Dermatitis Artefacta: Facts for a Facial Plastic Surgeon

Objective: 1) To report a large scalp lesion secondary to dermatitis artefacta, requiring reconstruction. 2) To emphasize the need for a multidisciplinary approach involving dermatologist, psychiatrist, and facial plastic surgeon for optimizing outcome. 3) To highlight specific issues in the patient’s care in the perioperative period.

Method: Case report of a 44-year-old white female patient who presented to our combined dermatology–facial plastic surgery clinic with a large lesion on her scalp and a known diagnosis of dermatitis artefacta.

Results: The scalp lesion had gradually increased in size over 4 years. Prior to this she was being followed up by the dermatologists for this and other multiple, bizarre ulcerating areas on her face; the patient had associated depression. A diagnosis of dermatitis artefacta was made by the dermatologists and supported by the psychiatrists. She was treated with antibiotics for the excoriating lesions and local dressing for the scalp wound initially. Regional reconstruction of scalp was subsequently carried out to achieve closure of the scalp defect, with the active involvement of the dermatology and psychiatry teams.

Conclusion: 1) Close monitoring is required postoperatively, as these patients can be passively noncompliant with treatment, inducing self-harm repeatedly because of lack of insight in causing skin damage. 2) Prompt discussion in a multidisciplinary setting with earlier input from facial plastic surgeons will potentially minimize the extent of reconstructive surgery required.