(Feigned eruptions; Dermatitis artificialis)
Definition. An artificial eruption, limited in extent, and produced for some ulterior purpose.
symptoms and Etiology. Many substances have been used by hysterical people, malingerers, beggars, soldiers, sailors, prisoners, or servants to excite sympathy, gain assistance, or escape from duty, etc. the lesions that are most often simulated are those that can be produced easily, like erythema, pigmentation, pustules, blebs or ulcers. Mustard, capsicum, turpentine, cantharides and other irritants are often used to simulate erythema; black lead, indigo and soot, alone or mixed with some powder have been applied to resemble chromidrosis; oils or fats scented with decayed cheese or asafetida, to simulate bromidrosis; tartrate of antimony, tar oil and croton oil, to simulate sycosis and other pustular eruptions; thapsia to imitate erysipelas; nitric acid, caustic potash, clematis and cantharides to produce ulcers. Foreign substances have been introduced into the skin so as to cause abscess; linear scratching of the skin has been done to imitate scabies; and the hair has been pulled out in spots to resemble alopecia areata.
Diagnosis. There are certain peculiarities of this eruption, such as the absence of local or constitutional symptoms of any known cutaneous disease; the lesions are usually within easy reach of the right hand or, with a left-handed individual, are proximate to the left hand; they usually lack symmetry, both in distribution and outline, being single rather than multiple; and they are usually sharply defined. When a liquid has been employed, it may show accidental effects from a drop or two running down the surface; the odor of some substance, like carbolic acid or turpentine, may be detected; or some motive may be discovered by careful questioning and by inquiry into the history of the patient.
Treatment. If the physician is satisfied as to the nature of the eruption, it is wise to keep such conclusions to himself, unless injustice is being done, and allow the patient to recover under preventive or non-mendicinal treatment rather than cause mental distress to every one concerned. If necessary to ascertain the true nature of the eruption, a fixed dressing such as a plaster-of-Paris bandage may be applied, and the patient carefully watched.