Factitial panniculitis as a manifestation of self-imposed factitious disorder

Factitious disorderimposed on self is characterized by self-induction. Dermatitis artefacta, the cutaneous subtype of factitious disorderimposed on self, can have a variety of atypical presentations. A 36-year-old woman with an extensive past medical historypresented with painful nodules on her abdomen, thighs, and arms. Histologic evaluation identified panniculitiswith foreign body material seen under polarization. Chart review from previous hospital visits established a history of factitious disorderimposed on self and upon subsequent search of the hospital room, syringes with an unknown substance were found. Factitial panniculitisshould be considered in cases with atypical lesions or locations that do not conform to the presentation of organic causes of panniculitis. Management should include a multidisciplinary approach that prioritizes patient safety and establishes a therapeutic patient-provider relationship.