Factitial Dermatitis as the Presenting Sign of Multiple Lentigines Syndrome

Abstract

Factitial dermatitis was the presenting sign of the multiple lentigines syndrome (leopard syndrome) in a young woman. Six years of an unremitting succession of erosive lesions was medically interpreted as a continuous, nonverbal appeal for help in avoiding an undesirable job. Manifestations of her multiple lentigines syndrome included generalized lentigines, mild mental retardation, diabetes mellitus, transitory ECG abnormalities, a cardiac murmur, ocular hypertension, eye muscle paresis, webbed toes, and skeletal deformities of the hands and chest. Through the years, the repetitive sequence of factitial, erosive, nonscarring lesions eradicated her lentigines, leaving the relatively inaccessible back as the only site of residual multiple lentigines.