Factitial Erosion

A 50-year-old woman was concerned about a nonhealing, painful lesion on the medial aspect of the left side of the nasal bridge. The lesion had been present for several weeks. The patient believed that a "cyst" had developed in the area. She had been attempting to remove it manually.

The ulceration was 2 3 1.5 cm, clean-based, and polyangulated. There was minimal serous exudate. Results of culture obtained from the exudate revealed normal skin flora.

The patient had been under severe stress because of the illness and recent death of her spouse. Ted Rosen, MD, of Houston suspected that the stress probably caused the patient to "pick" repeatedly at the affected area, which resulted in a self-induced (factitial) erosion. Although a neurotrophic ulcer might appear similar, there would be no or minimal sensation associated with its development.

The ulcer was managed with application of a bland ointment, and the patient was referred for intensive psychological counseling. The ulcer eventually reepithelialized.