Diagnosis: Dermatitis artefacta
Description: Healing excoriations
Morphology: Excoriation
Site: Scalp
Sex: F
Age: 30
Type: Clinical
Submitted By: Ian McColl
Differential Diagnosis
History:
| Lady visits me with these lesions on the scalp, have been there on and off for the last year but much worse now, she admits scraching the areas all the time, usually it is not itchy or painful and hair is normal betweeen episodes, she just "does not know why she scratches them" and she "keeps forgetting not to scratch there", scracthing breaks out the condition.
It is painful now, she looks mildly anxious, finger biting marks are noted, she does not have other PMH or allergies. Dx: Dermatits artifacta. Rx: I Started her straight away on prednisolone short course for a few days and oral flucloxacillin, advised her to wear a hat until recovers, educated about the condition and about the temporarily mechanical alopecia, ?trichotillomania, referred for counselling, she rejected psychiatric Rx. I took photos before and after treatment (one week in between) was good improvement. photos in order.
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