A 68-year-old man presents with an extremely painful, secondarily impetiginized ulcer of the scalp. After considerable directed questioning, he admits to picking and gouging the area to “get the space aliens out.”
Key point: This is a factitious, or self-induced, condition. Any bizarre shaped skin lesion should be suspect as being self-induced. There are many reasons which may be underlying: neurosis, psychosis, obsessive-compulsive behavior, delusional states, malingering, potential for monetary gain from favorable litigation, to name a few.
Treatment: Meticulous wound care and administration of appropriate topical or systemic antibiotics would be indicated. Referral to a mental health professional is almost always required to fully assess and address underlying psychopathology.
Note: Although this patient admitted to manipulating the skin and disclosed his delusion, many cases of factitious disease are not so straightforward and require a high index of suspicion to identify.