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, welldemarcated 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.