We greatly appreciate Dr Waldman's comments. We are aware of the biblical controversy that he reviews. However, Dorland's Medical Dictionary does list onanism and masturbation as synonyms. I am more concerned, however, with Dr Waldman's suggested appellation, factitial frictional dermatitis of the penis. The history of the diagnosis factitial dermatitis in dermatology has been filled with controversy. Current dermatologic opinion regarding self-induced cutaneous disease favors separating cutaneous artifactual disease (contrived disease) from clinicopathologic entities such as lichen simplex chronicus and prurigo nodularis, which often are the result of compulsive habit and are not contrived.1-3 If the term factitial dermatitis. is used at all, it is usually as a synonym for cutaneous artifactual disease. The correct dermatologic diagnosis for our patients, as stated in our original letter, was lichen simplex chronicus of the penis; however, we continue also to use the not totally accurate, but quaint, appellation frictional
Jorizzo JL, Subrt P, Archer ME. Onan's Act-Reply. JAMA. 1984;251(8):1026. doi:10.1001/jama.1984.03340320016009
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