Serial photography and Wood's light examination as an aid to the clinical diagnosis of dermatitis artefacta

Abstract

A patient is described with dermatitis artefacta, which is a common psychocutaneous disorder whereby a fully-aware patient self-inflicts injury to their skin. The motives for their behaviour can vary and the patient always tries to hide the responsibilities for their actions.

In this case report, serial use of standardised photography provided strong evidence to support the diagnosis of dermatitis artefacta. The fluorescent properties of Trimovate^® Cream under Wood's light examination corroborated the diagnosis. Trimovate^® Cream was applied to the skin surrounding the injuries and the limb was occluded with four layers of bandages. Traces of Trimovate^® Cream were seen under Wood's light on the outer layers of the bandage. This suggested transfer of the cream from the occluded skin surface by the patient's fingers whilst tampering with the dressings.

This case report shows how serial photography and imaging using ultraviolet (UV) fluorescence can provide evidence to support the diagnosis of dermatitis artefacta.

Acknowledgement

Clinical photographs courtesy of the Media Resources Centre, Cardiff and Vale University Local Health Board.