Well-defined macules on young girl’s forearms
Speaking to the teen without her mother in the room made the diagnosis crystal clear.
Also, check for blanching and fever—both of which can signal that other factors are at play. Blanching is characteristic of conditions such as drug eruptions, viral exanthems, and roseola. A fever may suggest that a rash is associated with infectious diseases, such as Lyme disease or Rocky Mountain spotted fever.3
Family support is key to helping nonsuicidal patients who self injure
Nonsuicidal self injury (NSSI)—self inflicted, deliberate, direct destruction of body tissue without conscious suicidal intent—is prevalent in up to 45% of adolescents worldwide.5,6 An Australian study that followed 1973 adolescents for one year found that low self-esteem and poor self-efficacy were prominent predictors of NSSI.6 These researchers also found that family support is important to getting patients to refrain from NSSI.6
Peer pressure is a major issue that most adolescents will face. Encourage patients to be open with you and their family about any concerns or issues they may be facing.
Our patient. She was referred to a counselor for family therapy as well as started on citalopram 20 mg for depression. Follow-up appointments were made monthly to reassess mood as well as monitor the healing of her burns. Some of the superficial burns healed completely. However, the deeper ones—where she kept up the “challenge” for longer periods of time—scarred. The large rash on her arm that had blistered ended up forming a keloid. At her 6-month follow-up appointment, she remained free of further NSSI.
CORRESPONDENCE
Jessica Thomas, MD, UT Family Practice Center, 1100 East Third Street, Chattanooga, TN 37403; jesthomas6@gmail.com
