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To the Editor: We report the sudden outbreak of an exanthematous rash in 2 sibling girls ages 3 and 7 years. The girls, who went to bed healthy the previous evening, presented in the morning with a prominent macular rash. Curiously, the young girls did not appear to be otherwise symptomatic. Instead, the rash was associated with excessive whispering, uncontrolled giggling, and avoidance of eye contact with their parents. When asked if she felt ill, the younger responded, "I have chicken pops!" Subsequent analysis indicated that this was a sly attempt to misdirect the ultimate diagnosis.

On physical examination, the rash was most prominent on visible parts of the body, including the face and anterior neck (wallet-sized photographic data available from authors on request). The girls were further questioned during a brief parent-imposed period of nil per os and suspension of habitual electronic visual stimuli. The 2 girls eventually confessed to marking each other with a colored pen to simulate a case of chickenpox they had recently seen on television. They were expeditiously treated with a hot bath and their recovery was complete and uneventful.

Artifactual skin disease, a factitious disorder in which there is deliberate production of skin lesions, has been described in children and adolescents.¹ These lesions may be produced by the application of a pigment (as in these 2 children) or irritant to the skin, or by self-induced trauma including pinching, cutting, scraping, and burning, and may be associated with psychiatric disorders. We believe that, in contrast, these 2 reported cases were perpetrated for the purposes of mirth and mischief and offer the term "faux pox" to describe this form of artifactual skin disease.

William H. Cordell, MD
wcordellmd{at}insightBB.com
Department of Emergency Medicine
Indiana University School of Medicine
Indianapolis

Gordon Berry
Indianapolis

1. Rogers M, Fairley M, Santhanam R. Artefactual skin disease in children and adolescents. Australas J Dermatol. 2001;42:264-270. PUBMED

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292:1554.