Multinucleated giant cells in factitial dermatitis.

نویسندگان

Carmen Winters

Mac Machan

Deede Liu

Garth R Fraga

چکیده

Factitial dermatitis, also known as dermatitis artefacta, consists of self-inflicted cutaneous lesions. It was first described in 1951 by Asher.1 Factitial dermatitis may be associated with borderline personality disorder, post-traumatic stress disorder, and eating disorders. It is more common in women. The reported clinical morphology is diverse and includes erosions, blisters, ulcers, erythema, and ecchymoses. Lesions are usually multiple, are located in sites accessible to the patient, and may demonstrate bizarre or geometric configurations.2,3 Methods of injury include excoriation, thermal burn, application of topical caustics, blunt trauma, and foreign body injection. When confronted, patients usually deny any role in inducing the skin lesions. Bullous factitial dermatitis has been described secondary to aerosol spray, garlic burn, and curling iron injury.4– 6 Herein, we report a case of bullous factitial dermatitis with potentially misleading histopathology. A 35-year-old female presented with a one-day history of sharply demarcated, rectangular erythematous plaques on her flanks, lower back, right arm, chest and thighs (Figs. 1, 3 & 4). One plaque included a large, tense blister containing serous fluid. A biopsy demonstrated vacuolar interface dermatitis with copious eosinophils and superficial epidermal necrosis accentuated at follicular ostia (Fig. 5). There were numerous multinucleated giant cells in the epidermis with up to 16 nuclei/cell (Figs. 2 & 6). The nuclei possessed prominent nucleoli and nuclear membranes with heterochromatic nucleoplasm. Viral inclusions and chromatin margination were absent. Fig. 1. A geometric plaque has a bulla situated on its surface.

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