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Factitious Ulcer

Factitious ulcers are self-induced lesions. They can be single or multiple, and are typically located on part of the body within easy reach of the dominant hand. The ulcer morphology is often angulated or geometric with patterns of necrosis that do not resemble any known dermatosis.

The condition is most common in adolescents and young adults, but can occur at any age. Adult patients with factitious ulcers have personalities that are infantile, dependent, and manipulative, with poor impulse control. Many patients are health care workers or have family members who are health care workers. The patient is characteristically not distressed by the lesions, which appear not to be painful. Patients will deny responsibility for the lesions. The diagnosis is based upon the bizarre morphology of the lesion, and personality of the patient.

Differential Diagnosis: Factitious ulcers can be distinguished from cutaneous anthrax in the following manner.

Factitious Ulcer

 

Cutaneous anthrax

*Shape of the lesion is bizarre

*Lesion is within reach of dominant hand

*Personality of the patient is infantile, dependent

 

* Ulcer and eschar are surrounded by characteristic non-pitting edema

* Typical lesion progresses from papule, vesicle, or bulla, to formation of edema, necrotic ulcer, and eschar

 

 

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