[ XXXX in dermatology: Value of the dissociative state concept].

@entity1 @entity6 @entity146 @entity13593 @entity272
BACKGROUND: @entity13593 in dermatology consist of intentionally self-inflicted @entity272 that vary in morphology and distribution and occur on surfaces readily accessible to the @entity1 's hands. They tend to be a chronic condition that waxes and wanes according to the circumstances of the @entity1 's life. @entity1 management poses a particular challenge to the clinician and the prognosis is considered poor. The aetiopathogenesis of @entity13593 in dermatology is not completely understood. We present a case in which we suggested the occurrence of factitious behaviour during a dissociative state, and we briefly describe our diagnostic and therapeutic approach. @entity1 AND METHODS: A 48-year-old unemployed @entity1 was referred to our department of psychiatry by her dermatologist for suspected @entity13593 . The @entity1 was diagnosed with @entity6 and had been hospitalized repeatedly for confirmed @entity6 . The onset of the disease was related to marital discord with her spouse. Numerous @entity272 had appeared on her face, arms, legs, neck and back. These lesions resulted in multiple hospital admissions and in amputation of her left leg. The condition had worsened considerably after her separation from her husband. During the initial conversation, the @entity1 was unable to provide a clear history of the disease. She denied any knowledge of the circumstances in which these @entity272 appeared, and she did not admit self-infliction. Her mood was depressed and her speech was slow. We suspected that our @entity1 was herself causing her @entity272 while in a dissociative state. Several arguments militate in favour of our hypothesis, particularly her history of childhood maltreatment and the association of traumatic life events with simultaneous deterioration of the skin. The explanation of the dissociative mechanism helped us to strengthen the therapeutic relationship. Within a few days, we noted a slow regression of the lesions, but the @entity1 was still unable to explain how the lesions had occurred. DISCUSSION: The pathophysiology of @entity13593 in dermatology is poorly understood. It has strong ties with other @entity146 , and according to several authors, @entity272 occur in dissociative states, after which @entity1 do not remember how the skin change started. Management of this disease is challenging. An improved understanding of its mechanisms may enhance the prognosis for this particular group of @entity1 .
