Some of the most difficult chronic wounds to manage are those that are self-inflicted. Diagnosis may not be easy and often requires a high index of suspicion.
Clinical features of factitious wounds:
(1) The patient typically has an underlying neurotic, borderline or other severe psychiatric disorder.
(2) The patient often denies the cause or provides misleading information.
(3) Skin damaging behavior (picking, scratching, etc) may be observed (typically by family members) especially when the patient is stressed.
(4) The distribution of lesions is over an area accessible to the patient, with a predilection to the dominant hand.
(5) The wounds do not fit with any known disease process, have odd shapes, or do not follow normal anatomic distributions.
(6) Excessive interest or talking about the wounds.
(7) The wound may improve if it can be protected from further trauma or if the psychiatric condition remits.
• If the patient admits to causing the wounds then diagnosis is a bit more straightforward.
Factors making wounds worse:
(1) use of a mechanical device
(2) applying caustic or tissue damaging solutions to the wounds
(3) rubbing debris or stool into the wounds
(4) presence of concurrent diseases such as immunosuppression or diabetes
(5) not returning for care once confronted with the diagnosis
(1) chronic pruritus (affected patients admit the condition and ask for relief)
(2) physical abuse
(3) vasculitis (which may be associated with neuropsychiatric symptoms)
(5) drug seeking behavior (creating wounds to get opiates)
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Specialty: Dermatology, Surgery, general