Dermatitis artefacta

Age: 38 years
Gender: female
Site: flexor forearm
Duration: one month
History: the patient denied any self-mutilation
Findings:clear cur longitudinal ulcer about 12 x 2.5 cm with red border and yellowish brownish crustation
Diagnosis: depends on high suspicion index. Suspicion originated from:
* Regularity of the ulcer
* Rapid evolution
* Lack similarity to known ulcerative dermatoses
* Patient's denial of self inflection
* Non specific histologic findings on skin biopsy
It was suspected to be self induced with a caustic chemical material (chemical burn)!
Treatment:
* Reassurance and topical antibiotics to prevent secondary bacterial infection.
* Referral to a psychiatrist.