title: Obsessive-compulsive behaviour related cutaneous ulcers: two cases with therapeutic considerations.
abstract: Obsessive-compulsive-related cutaneous disease most often includes trichotillomania, neurotic excoriations and nail biting. In this report, we present two cases of self-inflicted severe wounds that were diagnosed as secondary to obsessive-compulsive behaviour. Patients were middle-aged females who presented with deep cutaneous ulcers that were acknowledgedly maintained through repetitive manipulation. Obsessive-compulsive-related cutaneous disease is better treated with serotonin reuptake inhibitor antidepressants in higher dosages than those used to treat depression. Both patients were treated with fluoxetine 60-80 mg that resulted in adequate healing of the ulcers; relapses were observed during attempts to taper fluoxetine dosage. An adequate psychic diagnosis is required if an effective therapeutic response to self-inflicted cutaneous lesions is desired, because clinically identical lesions can also be caused as a result of distinct mental mechanisms: anxiety, depression, psychosis, obsessive-compulsive disorder and classic dermatitis artefacta.
authors.affiliation: Department of Dermatology, Medical School, University of São Paulo, São Paulo, Brazil. mentanico@hotmail.com.
authors.forename: Marcello Ms
authors.initials: MM
authors.lastname: Nico
authors.affiliation: Department of Pathology, Dental School, University of São Paulo, São Paulo, Brazil.
authors.forename: Silvia V
authors.initials: SV
authors.lastname: Lourenço
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000150:complications* / Q000628:therapy*; D016728:Self-Injurious Behavior / Q000150:complications* / Q000628:therapy*; D012883:Skin Ulcer / Q000209:etiology* / Q000628:therapy*
keywords: Dermatitis artefacta; Factitious lesions; Obsessive-compulsive disorder; Psychodermatology