Self‐inflicted ulcerations

Dear Editors, Self-inflicted ulceration, as part of dermatitis artefacta, is a rare condition often diagnosed by exclusion as clinical, histological and laboratory findings do not comply with any known disease (1). Patients with such skin lesions also suffer from psychiatric diseases such as schizophrenia, dementia, personality disorders and so on (1). As far as treatment is concerned, best results are achieved with regular follow up care and administration of occlusive wound dressings (1). We present the case of a 60-year-old woman, diagnosed and treated for depression and dementia, with three deep ulcerations, bordered by erythematous halo and covered with thick yellow-black necrotic crusts, localized only on the front side of the lower extremities (Figure 1). The patient denied injury of any kind, but her family members stated that she was often seen scratching her skin with subsequent forming of the ulcers. She had also tried to clean one ulcer with bleach while she was cleaning the bathroom. As a result, a net of coagulated blood vessels was visible on the largest ulcer (Figure 2). Results of routine laboratory tests (sedimentation rate, complete blood count, biochemical and urine analysis) were within normal limits; immunological studies [anti-nuclear antibody (ANA), anti-neutrophil cytoplasmic antibody (ANCA), antiRoSS-A, anti-LaSS-B, immunocomplexes, immunoglobulins, rheumatological factor and lupus anticoagulant test], virological examination [human immunodeficiency virus (HIV), hepatitis B and C viruses] and pathergy test were also negative.