• Alexandra Meyer and Volker Stadie.
• Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Halle/Saale.
• Dtsch. Med. Wochenschr. 2022 Jun 1; 147 (11): 720-723.

HistoryWe report on a 72-year-old demented patient with a palm-sized skin defect on the scalp, who has been manipulating her head several times a day with her fingers but also with sharp objects for many months.Clinical FindingsA 4 × 6 cm circular, cleanly granulated ulcer was visible on the high parietal surface. On general examination, the patient was little affected: no fever, no signs of inflammation around the ulcer, no evidence of meningitis.ExaminationsThere was no histological evidence of the presence of a malignant or benign tumor. A CT of the skull showed a bony defect measuring 2.6 × 3.3 cm without involvement of the dura. The whole body CT without pathological findings.Therapy And CourseFirst, a protective helmet was made for the patient. Subsequently, a titanium plate was surgically inserted as a bone substitute and the defect was closed by means of transpositionoplasty. In the two-year follow-up, no tumor disease was detected.ConclusionDue to the lack of evidence of tumorigenesis in a follow-up period of two years, we evaluate the lesion as an artificial ulcer with perforating bone defect caused by repeated scratching attacks in the context of dementia syndrome.Thieme. All rights reserved.

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