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| Fig. 66.5 Factitial ulcer. (Courtesy of John L. Aeling, MD.) |
In this disorder, patients compulsively pick at their skin. Lesions may be preceded by focal pruritus or insect bites, or they may be generated de novo by rubbing. Once initiated, ritualized picking of all lesions occurs when they catch the patient’s attention, or at a particular hour or location. On exam, lesions are found in all stages of development, ranging from ulcerations with hyperpigmented or hypopigmented margins to hypertrophic nodules and atrophic scars. They are usually found within easy reach of the dominant hand (Fig. 66-5).
