Dermatologic Patterns and Psychological Drivers of Factitious Dermatitis in Adolescent Females

¹Department of Medicine, Lenox Hill Hospital, Northwell Health, New York, NY, USA

²Department of Medicine, Baptist Health, Birmingham, AL, USA

³Department of Medicine, St. Joseph’s Hospital BayCare, Tampa, FL, USA

⁴Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA

⁵Department of Dermatology, Northwell Health, New Hyde Park, NY, USA

*Corresponding author: Kelly Frasier, DO, MS, Department of Dermatology, Northwell Health, New Hyde Park, NY, United States, Phone: 3105956882, Email: [email protected]

Received Date: July 14, 2025

Publication Date: September 09, 2025

Citation: Werpachowski N, et al. (2025). Dermatologic Patterns and Psychological Drivers of Factitious Dermatitis in Adolescent Females. Dermis. 5(5):48.

Copyright: Werpachowski N, et al. © (2025).

ABSTRACT

Factitious dermatitis in adolescent females presents a dermatologic enigma characterized by self-induced skin lesions that mimic inflammatory, autoimmune, and infectious dermatoses, complicating timely diagnosis and intervention. The condition often manifests as sharply demarcated, geometric, or angulated plaques, erosions, and ulcerations in accessible areas such as the face, arms, and legs, with a predilection for sparing traditionally seborrheic or flexural regions. Lesions frequently exhibit an artificial, non-inflammatory border with varying stages of healing, often incongruent with reported symptom progression. Repetitive excoriation, occlusion-based maceration, and exposure to irritants or topical caustics contribute to an evolving dermatitic phenotype, ranging from lichenified plaques resembling chronic atopic dermatitis to erosive dermatitis artefacta. Given the tendency for patient concealment and non-admission, differentiation from atopic, contact, and neurotic excoriation disorders requires thorough clinical correlation, supported by dermatoscopic and histopathologic findings such as epidermal necrosis, lack of inflammatory cell infiltration, and absence of characteristic spongiotic or psoriasiform changes. The psychosocial underpinnings often linked to stress, anxiety, body dysmorphia, and perfectionistic tendencies necessitate a dual approach integrating dermatologic intervention with psychotherapeutic support. Management strategies include barrier-repairing emollients with occlusive properties to mitigate recurrent trauma, alongside structured behavioral interventions such as cognitive-behavioral therapy (CBT)-guided skin protection protocols. As adolescent mental health concerns surge, dermatologists must refine their diagnostic acumen and therapeutic strategies to bridge the gap between dermatologic precision and the nuanced psychological drivers of factitious dermatitis, fostering both skin barrier restoration and long-term behavioral modification.

Keywords: Factitious Dermatitis, Self-Inflicted Skin Lesions, Psychocutaneous, Morphology, Psychodermatology, Cognitive-Behavioral Therapy, Multidisciplinary Management