The art of the artifact

A 10-year old girl and her mother visited four dermatologists in several months because of erosions in her face, suspected for dermatitis artefacta. However, when previously confronted the patient denied this diagnosis. Immunofluorescence investigations were negative. After building a trusted physician-patient relationship and empathically confronting the mother,the mother herself was able to provide her daughter a narrow escape, which resulted in complete remission of her condition. Dermatitis artefacta is a spot diagnosis, however the treatment is challenging for both the physician and the patient. A trusting physician-patient relation is crucial and providing verbal and non-verbal support is essential. One way of doing this is asking the patient to keep a diary. In addition every patient deserves a thorough but compact investigation. Once internal causes have been excluded and a trustful relationship has been established one can precede to a narrow escape or confrontation. In this article we provide practical tricks on how to approach a patient with dermatitis artefacta.