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Factitious panniculitis masquerading as pyoderma gangrenosum
C C Y Oh1, D B McKenna, K M McLaren
1Department of Dermatology, Royal Infirmary of Edinburgh, Edinburgh, EH3 9HA, Scotland.
Clinical and Experimental Dermatology
|April 6, 2005
Summary
This case study highlights factitious panniculitis mimicking pyoderma gangrenosum. Early suspicion and psychiatric support led to healing, emphasizing the importance of considering non-organic causes in persistent skin conditions.
Area of Science:
- Dermatology
- Psychiatry
Background:
- Factitious panniculitis can present with symptoms mimicking other inflammatory skin conditions.
- Distinguishing factitious disorders from genuine dermatoses is clinically challenging.
Observation:
- A 35-year-old woman presented with tender, ecchymotic plaques and ulcerations.
- Histopathology revealed active lobular panniculitis, but clinical presentation suggested pyoderma gangrenosum.
- Standard treatments for pyoderma gangrenosum were ineffective.
Findings:
- Factitious panniculitis was suspected due to the disparity between clinical and histological findings.
- Initiation of antidepressant therapy and physical containment (fibreglass casts) led to ulcer healing.
- The patient's underlying depression was a key factor.
Implications:
- This case underscores the importance of considering factitious etiology in refractory skin ulcerations.
- Multidisciplinary approach involving dermatology and psychiatry is crucial for accurate diagnosis and management.
- Psychological assessment and support are vital for patients with factitious disorders.