Comment on Obsessive‐compulsive behaviour related cutaneous ulcers: two cases with therapeutic considerations

Dear Editors, We read with interest the article by Marcello MS Nico and Silvia V Lourenço entitled ‘Obsessive-compulsive behaviour related cutaneous ulcers: two cases with therapeutic considerations’ (1). The authors state that anxiety, depression, psychosis, obsessive-compulsive disorder and classic dermatitis artefacta can be associated with self-inflicted skin lesions. We have a contribution regarding it. A 16-year-old female patient presented with an ulcer on the lower lip. Further history showed that the patient had a dental operation performed under local anaesthesia 6 hours ago. The patient’s mother reported that she found the patient with bleeding lower lip. The patient admitted that she caused that self-inflicted ulcer by repetitive lip biting. She had no pain during the lip biting because of the anaesthetic lower lip. There was a bleeding ulcer, measuring 2× 1 cm in size, on the right half of the lower lip. After wound cleaning, antiseptic spray and analgesics were prescribed. The patient was referred to the psychiatry department for further investigation of possible psychopathology. We would like to suggest the dermatologist to advise patients with psychocutaneous disorders that dental procedures under local anaesthesia could cause self-inflicted injuries. Patients with psychocutaneous disorders should be advised to avoid any oral surgery under local anaesthesia if the procedure can be postponed. Physicians and dentists should question the medical history of the patient for psychocutaneous disorders in order to prevent self-inflicted lip injury. We believe these suggestions are of help.