Diagnosis: Factitial dermatitis.
MICROSCOPIC FINDINGS AND CLINICAL COURSE
The skin biopsy specimen showed many dark-colored particles in the dermis and subcutis, predominantly ingested by histiocytes. The particles did not appear to be of endogenous substance. On follow-up, 1 year later, the blue discoloration had faded.
Clinically, the clear-blue discoloration had the appearance of an artificial dye. It was not consistent with a hematoma, deep deposition of melanin pigment, or an ordinary tattoo. This clinical appearance, in combination with the phagocytosed structures observed on light microscopy, strongly suggested that the particles were of exogenous origin.
We suspected that our patient, who was familiar with the technique of self-injection, being an insulin-dependent diabetic, had injected herself with one of the commercially available ink-containing syringes used to refill printer cartridges. However, she denied this possibility.
DISCUSSION
Factitial dermatitis is an artifactual self-inflicted skin disorder that is caused entirely by actions of the patient. The clinical presentation may vary considerably as a result . . . [Full Text of this Article]
