Factitious Ulcer Misdiagnosed as Pyoderma Gangrenosum

Area of Science:

• Dermatology
• Psychosomatic Medicine
• Medical Case Reports

Background:

• Dermatitis artefacta presents a diagnostic challenge due to the patient's denial of self-inflicted lesions.
• Misdiagnosis is common, often leading to confusion with conditions like pyoderma gangrenosum.
• Delayed or incorrect diagnosis results in unnecessary investigations and potentially harmful treatments.

Observation:

• A case of recurrent factitious abdominal ulcer initially treated as pyoderma gangrenosum is presented.
• The patient's lesion morphology, history, and treatment resistance were difficult to explain by other diagnoses.
• The importance of considering dermatitis artefacta in unexplained dermatological presentations is highlighted.

Findings:

• Suspecting dermatitis artefacta is essential when clinical presentation and treatment outcomes are incongruent with initial diagnoses.
• A supportive, non-confrontational approach is vital for patient rapport and accurate diagnosis.
• In-patient management and long-term follow-up can be effective in managing recurrent factitious ulcers.

Implications:

• Clinicians should maintain a high index of suspicion for dermatitis artefacta in challenging cases.
• Adopting a patient-centered, empathetic approach can improve diagnostic accuracy and therapeutic outcomes.
• Early recognition and appropriate management of dermatitis artefacta can prevent patient harm and reduce healthcare costs.