Body dysmorphic disorder in a hairdresser: contact dermatitis due to voluntary exposure to occupationally relevant allergens.
نویسندگان
چکیده
Sir, Body dysmorphic disorder (BDD) is primarily a psychiatric condition, but frequently found in dermatologi-cal settings, where it often goes undetected (1). BDD is characterized by subjective beliefs of physical ugliness or disfigurement despite an objectively normal appearance. Often minor blemishes are blown out of proportion. The affected individual is convinced that others perceive them as disfigured and deformed. BDD is associated with substantial suffering, suicide attempts and reduced quality of life (2). While this under-studied disorder is now being increasingly researched (3), an excessive preoccupation with skin-associated features such as hair has received little attention thus far. We report here the case of a 20-year-old hairdresser who had become extremely dissatisfied with her hair. Although being aware of having type IV sensiti-zations to para-phenylenediamine, para-toluenediamine, para-aminophenol and 3-amino phenol she displayed an extreme willingness to accept contact dermatitis due to regular exposure to allergen-containing hair dye. A 20-year-old woman had had atopic dermatitis (AD) in childhood , but was symptom-free when starting her hairdressing apprentice ship in 2003. The patient lived at home with her parents and one brother and had a boyfriend who she did not live with. In the second year of her training she developed hand dermatitis. A dermatologist diagnosed type IV allergy to para-phenylenediamine. She was treated with topical corticosteroids and recommended to use skincare products. After diagnosis she used alternative hair dye products where possible; however, she otherwise continued as usual in her profession. She reported regular use of protective gloves when washing and dyeing hair. Due to persistent contact dermatitis she attended a 3-week tertiary prevention measure for treatment of occupational dermatoses in October 2007 (4), consisting of dermatological treatment, allergy testing and intensive educational programmes about occupational skin diseases and their prevention. She was diagnosed with allergic contact dermatitis on the hands, ears, scalp, neck and forehead (Fig. 1). The type IV sensitization found previously was confirmed, and additional type IV sensitizations to para-toluenediamine, para-aminophenol and 3-aminophenol were found. All these substances can be found in hair dye products. During her 3-week in-patient treatment an excessive preoccupation with her hair became apparent. She was consequently seen by the department's psychologist for further assessment. She described her problems as stemming from her hair, which she found extremely repulsive and ugly. She also described her self-esteem as very low. Dyeing her hair which she begun doing at the age of 15, improved her self-esteem. …
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ورودعنوان ژورنال:
- Acta dermato-venereologica
دوره 90 1 شماره
صفحات -
تاریخ انتشار 2010