# Factitious Disorder as a Skin Ulcer: A Case Report

## TL;DR

A 17-year-old girl's skin ulcer was found to be a factitious disorder, linked to her anxiety and need for attention.

## Contribution

This case highlights the psychological underpinnings and management of factitious skin ulcers in adolescents.

## Key findings

- The skin ulcer was caused by factitious disorder, not a physical illness.
- The patient's anxiety and refusal of mental health care contributed to the condition.
- Psychotherapy and dermatosurgical treatment were recommended for management.

## Abstract

Dermatitis artefacta (factitious dermatitis) is a dermatological disease of different types; it could appear on various parts of the body. It is associated with severe difficulties, such as psychic distress and negative feelings aroused in healthcare personnel or borderline personality disorder, and the long-term possibility of patient self-harm to create more symptoms, resulting in unnecessary medical procedures.

This is a case of a 17-year-old girl who was hospitalized with a skin ulcer on her right ankle that proved to be a factitious disorder. She was experiencing severe symptoms of anxiety, such as feeling nervous, having trouble sleeping and concentrating, and an inability to control worry due to her preparation for university studies. She refused to see a mental health professional since the onset of anxiety symptoms, i.e., the last four months.

Patients who present with factitious disorder deliberately create clinical signs of a somatic disease because they need warmth and attention in a medical environment. Symptoms offer no significant benefit, and the pathophysiological mechanisms are mainly psychological. The primary treatment for factitious disorder is psychotherapy while the management of the ulcer requires dermatosurgical treatment.