Pathomimia: From diagnostic errors to interdisciplinary interaction

According to the accumulated data, concomitant mental disorders are detected in a significant proportion of patients who initially seek medical care in dermatovenereological institutions. Psychodermatological disorders are a complex group of pathologies, the diagnosis and treatment of which are associated with the need to integrate knowledge from different areas of medicine. Skin symptoms of these diseases can imitate various pathologies, which prolongs the diagnostic search, contributes to the chronicity of the disease and deterioration in the quality of life of patients. An important aspect of treatment is an integrated approach, including dermatological and psychopharmacological therapy. Particular difficulties arise when managing patients with pathomimia (artifactual or artificial dermatitis) – a psychological disorder that is accompanied by self-harming behavior aimed at traumatizing the skin, mucous membranes, hair or nails. Patients with pathomimia conceal or do not realize the autodestructive nature of the rash, which is often accompanied by a refusal to consult a psychiatrist due to embarrassment or doubts about its necessity. Such behavior leads to an increase in the number of doctors involved by the patient in the diagnostic process and the volume of unjustified examinations, while patients often provide specialists with false anamnestic data. The article describes our own clinical observations of patients with pathomimia who had errors in verifying the disease.

An analysis of the features of the anamnesis, differential diagnostic criteria and therapeutic tactics is presented. Attention is focused on the need to include this pathology in the list of differential diagnoses at the initial appointment. The importance of interdisciplinary interaction of doctors in order to form an effective strategy for treating patients with psychodermatological pathology is noted.

1. Marek-Jozefowicz L, Czajkowski R, Borkowska A, Nedoszytko B, Zmijewski MA, Cubała WJ et al. The brain-skin axis in psoriasis-psychological, psychiatric, hormonal, and dermatological aspects. Int J Mol Sci. 2022;23(2):669. https://doi.org/10.3390/ijms23020669.

2. Bondade S, Hosthota A, Bindushree R, Raj PR. Psychodermatology: an evolving paradigm. Dermatologica Sinica. 2022;40(2):71–77. https://doi.org/10.4103/ds.ds_20_22.

3. Jafferany M. Classification of Psychodermatological Disorders. In: Jafferany M (ed.). Handbook of psychodermatology: introduction to psychocu-taneous disorders. Cham: Springer International Publishing; 2021, pp. 9–13. https://doi.org/10.1007/978-3-030-90916-1.

4. Latheef EN, Hafi BN. Introduction to psychodermatology. Clin Dermatol Rev. 2023;7(4):303–309. https://doi.org/10.4103/cdr.cdr_10_22.

5. Rahman SM, Abduelmula A, Jafferany M. Psychopathological symptoms in dermatology: a basic approach toward psychocutaneous disorders. Int J Dermatol. 2023;62(3):346–356. https://doi.org/10.1111/ijd.16344.

6. Tohid H, Shenefelt PD, Burney WA, Aqeel N. Psychodermatology: an association of primary psychiatric disorders with skin. Rev Colomb Psiquiatr. 2019;48(1):50–57. https://doi.org/10.1016/j.rcp.2017.07.002.

7. Ferreira BR, Vulink N, Mostaghimi L, Jafferany M, Balieva F, Gieler U et al. Classification of psychodermatological disorders: Proposal of a new international classification. J Eur Acad Dermatol Venereol. 2024;38(4):645–656. https://doi.org/10.1111/jdv.19731.

8. Tlish MM, Gluzmin MI, Sycheva NL, Shavilova ME, Lazarev VV, Shevchenko AG. Self-destructive dermatosis mimicking pyoderma gangrenosum: a clinical case. Kuban Scientific Medical Bulletin. 2022;29(6):84–95. (In Russ.) https://doi.org/10.25207/1608-6228-2022-29-6-84-95.

9. Tlish MM, Shavilova ME, Psavok FA, Lomakina GV, Stepanova DV. Psychodermatology: practical aspects of diagnosing autodestructive dermatoses on the example of our own clinical observations. Vrach. 2023;(11):16–20. (In Russ.) https://doi.org/10.29296/25877305-2023-11-04.

10. Tlish MM, Shavilova ME, Boyko NA, Romanova GV. Psychodermatological disorders as an interdisciplinary problem: diagnostic features based on the example of our own clinical observations. Meditsinskiy Sovet. 2024;(14):65–71. (In Russ.) https://doi.org/10.21518/ms2024-32.

11. Poot F. Factitious Disorders (Pathomimia) and Necrosis. In: Teot L, Meaume S, Akita S, Del Marmol V, Probst S (eds.). Skin Necrosis. Cham: Springer International Publishing; 2024. https://doi.org/10.1007/978-3-031-60954-1_39.

12. Olisova OY, Teplyuk NP, Kayumova LN, Smirnova LM, Anpilogova EM, Nikulina AS. Self-induced dermatosis: a diagnostic problem at the intersection of two specialties. Russian Journal of Skin and Venereal Diseases. 2021;24(1):61–70. (In Russ.) https://doi.org/10.17816/dv61909.

13. Kiafar M, Faezi ST, Kasaeian A, Baghdadi A, Kakaei S, Mousavi SA et al. Diagnosis of Behçet’s disease: clinical characteristics, diagnostic criteria, and differential diagnoses. BMC Rheumatol. 2021;5:2. https://doi.org/10.1186/s41927-020-00172-1.

14. Кубанов АА, Гладько ВВ, Лопатина ЮВ, Малярчук АП, Соколова ТВ, Богданова ЕВ и др. Чесотка: клинические рекомендации. 2020. Режим доступа: https://cnikvi.ru/klinicheskie-rekomendacii-rossijskogo-obshchestva/klinicheskie-rekomendacii/#proekty-klinicheskih-rekomendacij/dermatologiya.