Occupational Dermatitis Artefacta

Abstract

Dermatitis artefacta is a self-inflicted complaint provoked by patient for various purposes and by various means. Other than for unconscious psychiatric problems, disease can be simulated with illegal intent, to gain advantage from situations of professional nature (to obtain prolongation of a disease or its recognition as an occupational affliction, to attain higher class of disability pension). In the latter case, the simulator is conscious of what he is doing and why. The diagnosis of dermatitis artefacta does not usually present particular difficulties, despite the fact that the dermatologist cannot rely on precise anamnestic data or the patient’s collaboration. The diagnostic criteria include the site and morphology of the dermatitis, the clinical course, the particular etiological agents, and various complementary laboratory investigations. The etiological agents may be physical, chemical or biotic in nature: in reality, however, discovering the causal agent is often very difficult, owing to obstinate reticence of most simulators. Occupational dermatitis artefacta may be provoked directly on healthy skin, or may consist in aggravation of a pre-existing spontaneous contact dermatitis. Diagnosis can be simple when the simulator attempts to reproduce eczema on healthy skin. In contrast, the diagnosis may be very difficult when the patient aggravates a pre-existing spontaneous eczematous dermatitis: it should be remember, in fact, that the simulator may be well aware of what substance provokes his dermatitis and may make use of it. Among the various diagnostic criteria, clinico-morphological examination is however the most important.