Some aspects of FDIA may represent criminal behavior. Signs and symptoms
In factitious disorder imposed on another, a caregiver makes a dependent person appear mentally or physically ill in order to gain attention. To perpetuate the medical relationship, the caregiver systematically misrepresents symptoms, fabricates signs, manipulates laboratory tests, or even purposely harms the dependent (e.g. by poisoning, suffocation, infection, physical injury). It is important to note the caregiver is not performing this behavior for obvious external reward, such as money. Studies have shown a mortality rate of between six and ten percent, making it perhaps the most lethal form of abuse.In one study, the average age of the affected individual at the time of diagnosis was four years old. Slightly over 50% were aged 24 months or younger, and 75% were under six years old. The average duration from onset of symptoms to diagnosis was 22 months. By the time of diagnosis, six percent of the affected persons were dead, mostly from apnea (a common result of smothering) or starvation, and seven percent had long-term or permanent injury. About half of the affected had siblings; 25% of the known siblings were dead, and 61% of siblings had symptoms similar to the affected or that were otherwise suspicious. The mother was the perpetrator in 76.5% of the cases, the father in 6.7%.Most present about three medical problems in some combination of the 103 different reported symptoms.
Classification
Sunlight has been documented to trigger numerous skin conditions and the confusing terminology and categorisation previously has made the correct diagnosis and subsequent treatment difficult.Variants of PLE have been described:
Juvenile spring eruption is a cutaneous condition that affects the helices of the ears, particularly in boys, because their ears are relatively more exposed to sunlight. Benign summer light eruption is a cutaneous condition, and a name used in continental Europe, particularly France, to describe a clinically short-lived, itchy, papular eruption particularly affecting young women after several hours of sunbathing at the beginning of summer or on sunny vacations. Actinic Prurigo is a hereditary form of PLE occurring typically in Native Americans. Treatment
Management entails regulating triggers whilst simultaneously inducing "hardening"; that is, steadily increasing exposure to sunlight, as light sensitivity is reduced with repeated sun exposureCovering up with densely woven clothing has also been shown to help, in addition to applying a broad-spectrum, water-resistant semi-opaque sun protection factor (SPF) 50+ sunblock cream before sun exposure and then every two hours thereafter confers some protection.The application of topical corticosteroids may lessen the redness and itch, and for preventing predictable holiday flare-ups, short courses of oral corticosteroids are sometimes considered.Another treatment option is a supervised course of low dose phototherapy, usually undertaken in winter. If resistant, the administration of hydroxychloroquine in early spring is sometimes considered.As sun exposure is avoided, vitamin D levels may fall and hence supplements are sometimes advised.