Facial ulcer treated with olanzapine

Area of Science:

• Psychodermatology
• Dermatology
• Psychiatry

Background:

• Dermatitis artefacta (DA) is a factitious dermatosis characterized by self-inflicted skin lesions.
• Management of DA often involves a multidisciplinary approach, including psychotropic medications.

Observation:

• A 69-year-old woman presented with a nonhealing right cheek ulcer.
• Histopathology excluded granuloma formation and malignancy, consistent with DA.
• Initial treatment with risperidone was ineffective.

Findings:

• Switching treatment to olanzapine 2.5 mg twice daily resulted in complete healing of the chronic facial ulcer within 10 months.
• This case adds to the literature supporting the use of atypical antipsychotics in DA management.

Implications:

• Olanzapine demonstrates significant efficacy in treating refractory dermatitis artefacta.
• The anti-impulsive, antihistaminic, and low parkinsonian side-effect profile of olanzapine may contribute to its success in managing DA.