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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
PubMed
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.

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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.

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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.