Cutaneous factitia in elderly patients: alarm signal for psychiatric disorders
A 61-year-old woman was hospitalized in a dermatology department for evaluation of atrophic scars disseminated on the face, trunk, and upper limbs (). She could not recall when she had first noticed the lesions, but her medical documents were filled with hospitalizations, investigations, and therapies for the last 2 years, varying from chronic eczema, anetoderma, morphea, prurigo, discoid lupus erythematosus, mycosis fungoides, and others not remembered by the patient. The patient was in good medical condition, with no comorbidities, treatments, or complaints. Clinical examination did not reveal anything worthy.\nA complete battery of blood tests was performed, but did not reveal the cause of the disorder. On the fifth day of hospitalization, during the night, she attempted suicide by taking an aspirin overdose. She was transferred to a psychiatric hospital, where she was diagnosed with severe depressive syndrome. Thereafter, she underwent stabilization and treatment, with no information on the therapeutic plan being available. The patient finally admitted the self-mutilation that had been going on for years.\nBased on the elusive history of the lesions, chronic evolution, and weird cutaneous impairments displayed upon attainable areas of the body, which did not mirror any of the known dermatoses, and associated to inconclusive biopsy (), with remission after specific psychiatric therapy, we finally reached a diagnosis of factitial dermatitis.