An 11-year-old girl had light brown lesions or erythematous macules, many with atrophic and scaling surfaces for two years. Long, linear abrasions were present on the lower extremities. Lesions were within reach of the patient's hands, and several showed geometric patterning. Scalp, neck, ears, shoulders, posterior trunk and thighs, genitalia and palms and soles were unaffected. Corneal and pharyngeal reflexes were absent. She appeared unconcerned with her condition but finally admitted self-infliction. Morphology and distribution of the lesions, the patient's attitude and lack of response to corneal and pharyngeal stimulation justify the diagnosis of hysterical factitial dermatitis.
Self-inflicted dermatosis can be recognized on clinical grounds. Diagnostic maneuvers to confirm the diagnosis and efforts to elicit admission of guilt are unnecessary. Referral for psychiatric evaluation is recommended.