Alexandra-Maria Roman^1,2, Mihai Cristian Dumitrascu^3,4, Aida Petca^3,5, Corina Ionescu^1,2* and Florica Sandru^1,2

¹Department of Dermatovenerology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
²Dermatology Department, "Elias" University Emergency Hospital, Bucharest, Romania
³Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
⁴Department of Obstetrics and Gynecology, University Emergency Hospital of Bucharest, Bucha-rest, Romania
⁵Department of Obstetrics and Gynecology, Elias Emergency University Hospital, Bucharest, Romania

*Corresponding Author: Corina Ionescu, Department of Dermatovenerology, "Carol Davila" University of Medicine and Pharmacy and "Elias" University Emergency Hospital, Bucharest, Romania.

Received: July 15, 2024; Published: September 11, 2024

Abstract

Diagnosing skin ulcerations can be challenging, especially when accompanied by unusual clinical features and a complex medical history. We present the case of a 79-year-old woman who presented to our emergency care department with multiple large (some > 5 cm in diameter) skin ulcers affecting various areas of her body. The lesions were previously diagnosed as a multitude of dermatological diseases, including prurigo nodularis, granuloma annulare, bullous IgA dermatosis, and bullous pemphigoid. Consequently, she was prescribed treatments with systemic corticosteroids and azathioprine, but the lesions progressively worsened over the past two years.

Further investigation revealed a unique aspect: the patient's belief that small organisms emerged from the ulcers, leading to self-induced lesions through scratching and digging into the affected areas. Neurological and psychiatric evaluations confirmed the hallucinations, resulting in the implementation of psychological interventions alongside wound care and infection management. Biopsy results also suggested nonspecific ulceration, possibly exacerbated by repetitive mechanical trauma, with a potential diagnosis of acquired perforating collagenosis. Bandaging and psychological support facilitated gradual ulcer healing, indicating a favorable prognosis.

In conclusion, this case underscores the importance of thorough anamnesis and psychiatric evaluation in dermatological patients with difficult-to-define and refractory skin conditions. The complex relationship between dermatological manifestations, psychiatric symptoms, and patient perceptions requires identifying deliberate or unintentional acts of self-harm. Multidisciplinary approaches integrating dermatological, neurological, and psychiatric expertise are essential for effective treatment and patient recovery. Incorporating these comprehensive evaluations supports a holistic approach to patient care, addressing both the physical and psychological dimensions of the condition, ultimately enhancing the quality of care and improving patient outcomes.

 Keywords: Factitial Dermatitis; Ulcers; Parkinson’s Disease; Hallucinations

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Citation

Citation: Corina Ionescu., et al. “Self-Inflicted Cutaneous Ulcers in the Context of Zoomorphic Hallucinations: A Case Report”.Acta Scientific Medical Sciences 8.10 (2024): 43-47.

Copyright

Copyright: © 2024 Corina Ionescu., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.