I was totally fobbed! Great new vocabulary word for me!
Excellent post, after just reading the Conclusion to the 2008 report on Factitious Cheilitis I know what you mean:
"Factitious cheilitis should be distinguished from infectious cheilitis, contact dermatitis, actinic cheilitis, photosensitivity dermatoses, exfoliative cheilitis, cheilitis glandularis and neoplasia that may look similar on physical exam. Bizarre hemorragic or keratotic crusts should alert the clinician to a possible factitious origin.
"We noticed that there is an interchangeable usage of exfoliative cheilitis and factitious cheilitis in the literature [5, 6, 11], however the differentiation of these two has clinical significance. We suggest exfoliative cheilitis is a disorder where patients impulsively/compulsively induce the lesions without any primary goal of attaining the emotional care and attention that comes with the sick role, whereas in factitious disorder the lesions are intentionally produced with the primary goal of the sick role and these patients deny the self inflicted nature of their lesions at all cost.
"We think that making this differentiation is important in terms of further psychiatric intervention and treatment modalities. As self-inflicted disorders of compulsivity-impulsivity spectrum mostly benefit from selective-serotonin reuptake inhibitors with or without combined low doses of atypical antipsychotics, factitious disorders have to be handled with much more versatile modalities depending on the underlying pathologies."