We report the case of a 27-year-old lady with psychiatric history, presented to dermatological consultation with 6 years, ambiguous history of recurrent skin ulcerations on her members, abdomen, chest and face, the cause of which she could not explain. Examination revealed different age lesions: erosive lesions of one to two centimeters, with net borders coexisting with crusted lesions and scarring hyper pigmented lesions situated on accessible parts of the body. No general signs accompanied these lesions and laboratory testing was normal. The diagnosis of dermatitis artefacta was raised, motivating a deepening interrogation that revealed psychosocial and interpersonal difficulties. Abandoned by her husband, who had married a second wife for six years (date of appearance of lesions). She was also accused to be responsible of repeated miscarriages of the second wife, and then repudiated without her 3 children who are abused by the second wife.
Her psychiatric evaluation revealed a severe depression without psychotic symptoms. The recommended psychiatric treatment (psychotherapy and antidepressant medication) could not be conducted because she had broken up the medical following.