Dermatitis Artefacta: A Multidisciplinary Approach

BACKGROUND Dermatitis artefacta is a challenging and often under-recognized psychodermatosis characterized by self-induced skin injury. Its clinical presentation frequently mimics other chronic ulcers, leading to frequent misdiagnosis and diagnostic delays. This delay prolongs symptoms and perpetuates the detrimental itch-injury cycle, whereby chronic pruritus drives compulsive scratching, creating a barrier to effective healing. CASE REPORT We report the case of a 59-year-old man with a 3-year history of a refractory, intensely pruritic ulcer on the right temporal scalp, which subsequently extended to the auricle. Physical examination revealed a solitary, well-demarcated ulcer with an erythematous border. Histopathological analysis confirmed epidermal hyperkeratosis and mild lymphocytic infiltration, while a comprehensive immunohistochemical panel effectively excluded common infectious, vascular, and neoplastic mimics. A targeted, multidisciplinary management strategy was implemented to break the itch-injury cycle. This integrated approach included gabapentin for neuropathic itch modulation, topical tacrolimus for anti-inflammatory and barrier repair effects, simple protective dressings to prevent mechanical trauma, and behavioral counseling. This resulted in complete ulcer healing within 8 weeks, with no relapse during follow-up. CONCLUSIONS This case underscores the critical importance of early recognition and targeted interruption of the itch-injury cycle in dermatitis artefacta. It demonstrates that a structured, outpatient multidisciplinary approach integrating dermatology, psychiatry, and pain management can achieve rapid resolution even in long-standing, refractory cases, thereby promoting diagnostic stewardship and reducing unnecessary investigations.