Cutaneous factitia in elderly patients: alarm signal for psychiatric disorders
A 77-year-old woman was hospitalized in a dermatology department for atrophic skin lesions, with discrete erythema at the edges on the preauricular area and hyperpigmented macules on the frontal and malar area (). She described the lesions as being present for several months, accompanied by slight pruritus on the face and scalp. The patient was diagnosed 10 years before with arterial hypertension well controlled by indapamide; a cardiological examination revealed no anomaly or no neurological symptoms. Dermatological examination failed to unfold other skin lesions, except the one on the face strictly related to the patient’s age.\nShe was referred to the hospital under suspicion of discoid lupus; a punch biopsy was taken from the preauricular area. The histopathological report excluded lupus and concluded orthokeratosis, spongiosis, and sparse lymphocytic perivascular infiltrate in the dermis ().\nAll the routine lab tests were within normal range. Based on clinical grounds, histological report, and lab investigations, the suspicion of discoid lupus was excluded. A psychiatric consult was demanded, and a transfer to the psychiatric department was accepted. New dermatological advice was asked for 1 month later, the patient being in very good condition, with no new lesions and minor hyperpigmentation on the face. The patient admitted the self-mutilation by causing the skin lesions herself, but without being able to explain the automutilation, most of the time being unaware of doing it; furthermore, she did not claim any delusions of parasitosis. She was transferred to the psychiatric unit and not followed up in the dermatology unit.