A 32-year-old male presented with asymptomatic ulcerative lesions on the dorsal aspects of his hands since months ago. He was an IV drug abuser.

 What is your diagnosis? 

Diagnosis: Dermatitis Artefacta

Factitial syndromes recognized since the time of Hippocrates and can be classified as dermatitis artefacta, cutaneous compulsions and malingering.

Most cases of dermatitis artefacta are adolescents or young adults, often with emotional problems.

Self-inflicted lesions vary widely in their morphology and distribution, and may be difficult to recognize. The wide spectrum of diagnoses proposed for this patient by our visitors (from echthyma to calcifilaxis and even sub acute bacterial endocarditis), denotes that these syndromes should be keep in mind in differentials of diverse skin disorders. History taking is the cardinal point in making the correct diagnosis.