Autodestructive dermatosis of the facial skin

Objective. The article presents a description of a clinical case of autodestructive dermatosis of the facial skin, resolved by foci of cicatricial changes in the skin. The diagnosis of a psychodermatological disorder was confirmed by a psychiatrist and a dermatologist, based on clinical and anamnestic data, and a histological examination.

Results. The initial referral to a dermatovenereologist, discrepancy between the anamnesis and the clinical picture of the disease, atypical dynamics of the skin process, the location of skin lesions in localizations accessible to the patient's hands, an unusual, unnatural configuration of the rash elements, and a predominantly linear nature, served as the basis for suspicions of the presence of skin self-damage. The patient was informed about the suspicion of an autodestructive skin disease and a doubt in the diagnosis was recorded, a denial of the fact of self-damage of the skin. If the patient was in doubt about the diagnosis, a histological examination of the skin biopsy was performed with confirmation of autodestruction and referral for a consultation with a psychiatrist. The psychiatrist diagnosed a generalized anxiety disorder requiring long-term use of escitalopram. At the same time, symptomatic dermatological treatment was prescribed. Due to the patient's disregard for the psychiatrist's prescriptions, there was a progression of the manifestations of the psychopathological process (aggravation of anxiety, anxiety, fatigue, irritability, perfectionism) and an increase in the size of self-harm foci.

Conclusion. The effectiveness of therapy is determined by the patient's readiness to accept a psychiatric diagnosis and long-term use of medications that normalize the psycho-emotional state and, consequently, lead to the prevention of dermatological self-harm and remission of psychogenic symptoms. It is necessary to create the patient's motivation for recovery with joint dispensary observation of a psychiatrist and a dermatologist.

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