PMC6429999_01
(A) Major ulcers, 15 cm in diameter, with clear lines, elevated cyanotic edges on the front surface of the scrotum. The surface was presented by tender granulations, with parts showing yellow purulent discharge thickenings. On the internal surface of the hips there were ulcers 3x5 cm in size, with clear lines, even edges, and tender granulations on the bottom of the ulcers and yellow-green purulent discharge thickenings. The penis was deformed, and was actually presented by the urethra, covered with granulation tissue (before the treatment). (B) Occlusive dressing with an epithelizing ointment. (C) Complete healing through granulation and scarring of ulcers on completion of the 24-week treatment.
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A 52-year-old male presented to our department complaining of ulcerative defects on the internal surface of the hips, accompanied by pain and itching of the scrotum and shaft of the penis, progressing since the age of 47 (Figure 1A). He also received an atypical antipsychotic (olanzapine 10 mg/d), psychotherapy, and occlusive dressings with an epithelizing ointment, which prevented him from perpetrating self-inflicting injuries (Figure 1B). The patient achieved significant improvement with the 4-week treatment with a complete healing through granulation and scarring of ulcers on the completion of the 24-week treatment (Figure 1C).
Lack of epidermis, infiltrate in the upper and mid dermis, which was mostly made up of leukocytes, lymphocytes, and histiocytes; absence of leukoplakia, widened vessel walls, gaping lumen, and disconnection between infiltrate and vessels (Magnification x100).
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Based on histologic findings of the skin biopsy, which were characteristic for the simplest type of chronic inflammation (Figure 2), and psychiatric opinion, he was diagnosed with pyoderma secondary to dermatitis artefacta, and treated with rifampicin 300 mg twice daily and prednisone 25 mg/d.