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Recurrent Midface Deep Ulcer Caused by Excoriation Disorder.

Heewoong Yang1, Jaewoo Kim1,2

  • 1Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine.

The Journal of Craniofacial Surgery
|April 22, 2025
PubMed
Summary

Excoriation disorder, a compulsive skin-picking condition, can cause severe tissue damage. Successful treatment of a large facial wound required addressing the underlying psychiatric disorder alongside surgical reconstruction.

Keywords:
Behavioral therapyexcoriation disorderpsychiatric managementwound healing

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Area of Science:

  • Dermatology
  • Psychiatry
  • Plastic Surgery

Background:

  • Excoriation disorder involves compulsive skin picking, leading to self-inflicted tissue damage.
  • Unexplained facial wounds unresponsive to treatment may indicate underlying psychiatric conditions.

Purpose of the Study:

  • To present a case of severe facial wound due to excoriation disorder.
  • To highlight the importance of psychiatric evaluation in complex wound cases.
  • To emphasize a multidisciplinary approach for successful treatment.

Main Methods:

  • Case report of a 43-year-old female with a large facial defect.
  • Surgical debridement, reconstruction with flaps and dermal matrix.
  • Psychiatric management including medication and behavioral therapy.

Main Results:

  • Initial surgical interventions failed due to persistent wound dehiscence.
  • Psychiatric evaluation confirmed excoriation disorder.
  • Combined surgical and psychiatric treatment led to successful wound healing without recurrence.

Conclusions:

  • Excoriation disorder is a critical differential diagnosis for unexplained soft tissue defects.
  • A multidisciplinary approach integrating psychiatric care is essential for long-term wound healing.
  • Addressing compulsive behaviors is key to managing complex wounds in psychiatric patients.