Chapter 124 My daughter can’t be doing this to herself! Self-inflicted injuries
Dermatitis and keratoconjunctivitis
In adults there are often a number of associated complex psychological and emotional problems; sometimes these may have more serious underlying psychopathology. When dermatitis or keratoconjunctivitis artefacta affects adults with a long history of psychiatric illness, recovery only occurs with a change in the patient’s circumstances. Some adult patients are malingerers, classically trying to escape military service.1 In factitious disease the patients deny the cause of their injury, are deceptive, and their motivation is to play the sick role; they are much more difficult to treat, requiring skilled psychiatric intervention.2 When the patient and the parents admit to the self-destructive nature of their problem the outcome is much more benign.
The diagnosis is suggested by the combination of sharply delineated lesions in the inferior and nasal quadrants of the cornea bulbar and lid conjunctiva. Lesions on the skin around the eye are commonly associated with keratoconjunctivitis (Fig. 124.1). This dermatitis is variable in character and it may contain some of the irritant. Keratoconjunctivitis was described in an 11-year-old girl who induced a keratoconjunctivitis with chalk grains.3 There is often an unconcerned attitude (“belle indifférence”) and other psychological features.
