Dermatitis Artefacta in a 38-Year-Old Female with Coexisting Anxiety Disorder: A Diagnostic Challenge and the Importance of Multidisciplinary Management

Dermatitis artefacta (DA) is a psychocutaneous disorder characterized by self-inflicted skin lesions and frequently associated with underlying psychological distress. We report a case of a 38-year-old woman who presented with recurrent erythema, papules, exudation, and severe pruritus involving the head and neck for over one year. The patient was initially misdiagnosed with atopic dermatitis and treated with immunosuppressive therapy, partly due to overlapping clinical features and the presence of peripheral eosinophilia, which was misinterpreted as evidence of allergic inflammation. Further evaluation revealed significant comorbid anxiety, and the diagnosis of dermatitis artefacta was established based on clinical morphology, disease course, behavioral features, and response to combined dermatological and psychiatric management. This case highlights how nonspecific laboratory abnormalities, such as eosinophilia, may contribute to diagnostic delay and inappropriate treatment escalation if psychocutaneous disorders are not considered. Early recognition of dermatitis artefacta and timely integration of psychological assessment are essential to prevent misdiagnosis and unnecessary immunosuppressive therapy in patients with atypical or treatment-refractory dermatoses.