Munchausen syndrome by proxy: diagnostic and therapeutic difficulties

A ten-year-old girl who consulted for the appearance of spots spread on the skin, of varied morphology, asymptomatic and of evanescent character, of two months of evolution. Initially cataloged as non-specific rash, but before the torpid evolution of the picture, studies are requested to rule out vasculitis or rash of viral origin, with normal results; and dermatological assessment without clear diagnosis. Later the girl comes with a lock of pink hair, evidencing that they disappear when rubbing it with alcoholic solution; but both the mother and the girl deny that any type of coloring product has been applied (paint, spray, makeup…). Given the suspiction of a non-organic etiology, interconsultation is requested with Mental Health and, after the hostile attitude of the mother in it, the diagnostic impression is reached, supported by all the professionals involved (primary care pediatrician, pediatrician of the hospital emergency department, dermatologists and psychiatrist) of factitious disorder or Munchhausen syndrome by proxy.