[Ulcus terebrans. Therapy options and their limits]

[Artificial ulcer with perforating bone defect on the scalp due to repeated - scratching attacks in dementia syndrome]

HISTORY

 We 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 FINDINGS

 A 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.

EXAMINATIONS

 There 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 COURSE

 First, 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.

CONCLUSION

 Due 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.