Dermatitis Simulata mimicking malar rash
Source- Hanumanthu V, Kamat D, Vinay K. Dermatitis simulata: A curious case of photodistributed facial rash. Indian Dermatol Online J 2022;13:138-9.
Dermatitis Simulata mimicking malar rash- Psycho-cutaneous disorders are an under-recognized group of diseases in dermatological practice. They can mimic various dermatological diseases so a high index of suspicion is required for its diagnosis. Dermatitis simulata is such an entity where apparent skin disease is produced using an external disguise and there is no significant damage to the skin. Recently a case of dermatitis simulata clinically resembling a photosensitive rash was reported in the Indian Dermatology Online Journal.
A 24‑year‑old female on imatinib therapy for chronic myelogenous leukemia (CML) presented with an asymptomatic intermittent rash involving her face. She complained of development of rash since 3 years after initiation of imatinib. She also complained of photosensitivity and occasional joint pains but denied fever, oral ulcers, Raynaud's phenomenon, and muscle weakness. The differentials of imatinib‑induced photosensitive rash and connective tissue disease‑associated malar rash were considered. On examination, well‑defined pink patches were noted over both cheeks and peri‑ocular area with similar pink patches in a linear distribution over abdomen and legs. On dermatoscopic examination, pinkish‑red exogenous pigment deposits, over perifollicular and eccrine gland openings were observed. A clinical possibility of dermatitis simulata was considered. The lesions were rubbed with an alcohol swab with which the artificial color was easily wiped off. On further questioning, the patient initially denied the application of cosmetics but later on she admitted to have self‑inflicted the lesions using lipstick. She was referred for further psychiatric evaluation to find the intention behind this behavior. She was advised for projective personality testing by psychiatry but the patient refused to participate in the test and didn't follow up.
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