Recurrent Midface Deep Ulcer Caused by Excoriation Disorder

Excoriation disorder, or skin-picking disorder, is a compulsive condition that leads to self-inflicted tissue damage. The authors present a case of a 43-year-old female with a large and persistent facial wound exposing the left malar bone that remained unresponsive to multiple medical interventions. Imaging revealed a 4×3x4 cm defect extending into the intraoral cavity. Despite surgical debridement and reconstruction, wound dehiscence persisted until psychiatric evaluation confirmed excoriation disorder. Treatment included cervicofacial and subperiosteal rotation flaps, acellular dermal matrix insertion, and psychiatric management with medication and behavioral therapy. With continued psychiatric care, compulsive behaviors improved, allowing successful reconstruction without recurrence. This case illustrates excoriation disorder as an important differential diagnosis in unexplained soft tissue defects and emphasizes the need for a multidisciplinary approach, including psychiatric management, to improve long-term wound healing.