‘Self-made skin disease’ in depressed people

Some patients with depression and anxiety disorders come to Ho Chi Minh City Dermatology Hospital with serious skin damage of their own making.

On September 25, Doctor Pham Dang Trong Tuong, Deputy Director of Ho Chi Minh City Dermatology Hospital, said that a 50-year-old patient came to the clinic because there were two difficult-to-heal ulcers on his right hand.

The doctor did not record any other lesions on the body, the skin manifestations are also difficult to explain, different from normal. The patient’s family said that the patient suffered from depression after suffering a stroke that caused paralysis of the right side of his body two years ago. These two ulcers appeared about 4 months ago, barely healed.

The patient was diagnosed with self-generated skin ulcers that appeared after a depressive illness. The doctor instructs family members on how to take care of the wound, give antibiotics, reduce inflammation, and provide psychological support and psychiatric treatment. After a while, the patient’s condition was fine, the ulcers also disappeared and did not reappear.

Doctor Tuong examines a patient. Image: Lan Anh

In addition, recently, the hospital received a 48-year-old female patient who was brought to the hospital by her family members with many red spots on the skin in different locations such as neck, chest, back, abdomen, thighs, etc. Patients with contact dermatitis cause intentional skin burns (burns).

“The patient appeared many burns, both on the front and back, scattered on many areas of the body like deliberately causing contact dermatitis,” the doctor analyzed. This manifestation is not consistent with the characteristics of skin burns caused by chemical exposure.

The patient’s family said that the patient is being monitored at the neurologist. The doctor prescribes topical medication, recommends re-examination with a psychiatrist to be re-evaluated. After about two weeks, the lesions healed and did not appear to reappear.

Not long ago, the hospital also received two male patients with skin sores because they thought there was “something crawling on their skin”, so they took tweezers to cause inflammation. The doctor diagnosed the patient with paranoid psychosis infected with parasites.

According to Dr. Tuong, self-made skin disease is a form of pseudo-disease disorder, in which the patient self-injures the skin with available items or chemicals such as acids or injecting foreign objects, drugs… on In these patients, skin lesions have characteristics, morphology, location… unlike common diseases, often respond poorly to treatment.

Observing and taking a careful history, the doctor found that the patient had symptoms of anxiety, depression or other mental disorders such as paranoia. Patients are often unaware of what they are doing or always hide their self-injurious behavior. Therefore, doctors need to have an approach to encourage, share and listen to patients.

Tuong said that although the rate of self-made skin diseases is not much, “it has not been paid enough attention”. In addition to dermatologists, patients also need psychological support for treatment, counseling to help change behavior, as well as the attention and care of the whole family and society.

Le Phuong


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