Two Cases of Self-inflicted Dermatoses with 5 and 11 Years Histories

Abstract

We report two Japanese patients with prolonged, self-inflicted dermatoses mimicking a bullous disease and Ehlers-Danlos syndrome. The first patient, a 61-year-old woman, consulted for her ill-controlled erythematous macules with a five year history that had been diagnosed histologically as pemphigus foliaceus. Skin lesions were seen on the chest, abdomen, buttocks and bilateral thighs ; they were densely distributed within the reach of her hands. Individual lesions were erosive, erythematous, spherical macules of up to 1.5 cm, their long axes were along the movements of her hands and fingers. The second patient, a 27-year-old woman, presented complaining of a long-standing ulcer on her face that developed after excisional surgery of her right accessory ear. Successful reconstruction of the facial ulcer was followed alternatively by numerous erosive macules/patches on her trunk and extremities. Those skin lesions of the present cases were characterized by their 1) non-anatomical distribution, 2) linear arrangement with parallel long axes, 3) relatively uniform size and shape, and 4) discrepancy with the findings obtained by laboratory investigations.