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May 1990

Factitial Leg Ulcers

Author Affiliations

Mayo Clinic and Mayo Foundation Rochester, MN 55905

Arch Dermatol. 1990;126(5):682-683. doi:10.1001/archderm.1990.01670290130027

To the Editor.—  We appreciate Dr Koblenzer's comments,1 which appeared in the March issue of the Archives, concerning our article, but feel that she missed the point in her criticism of performing polysomnographic studies in patients with factitious disease. We are not implying that the patient's disordered sleep pattern is the "primary psychiatric disturbance." Even if we assume Dr Koblenzer's conclusion, we still cannot be certain of the cause of this "psychiatric illness." Rather, we stress that polysomnography with video monitoring was useful in the management of this patient and that polysomnography has intriguing possibilities in terms of the evaluation of other patients with factitial or pruritic disorders.We agree that our measures "permitted healing to begin." The ulcers had not improved despite 8 months of previous medical therapy and 3 weeks of hospital care, which included nearly around-the-clock observation and intervention for manipulating behavior. Healing did not

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