Factitious Leg Ulcers Associated With an Unusual Sleep Disorder

In a letter to the editor, Caroline S. Koblenzer, MD, critiques an article by Brodland et al. that suggested polysomnographic studies for patients with factitious leg ulcers and an unusual sleep disorder. Koblenzer argues that the patient in the study, who had erythromelalgia followed by sleep disturbances and then developed self-inflicted leg ulcers, likely had a borderline personality disorder with an acute depressive episode, rather than a primary sleep disorder. She contends that the sleep disturbances were part of a broader psychiatric issue and that the patient's improvement with chlorpromazine treatment supports this interpretation. Koblenzer suggests that an in-depth psychiatric evaluation would have been more beneficial than polysomnographic studies, questioning the assumption that increased slow-wave sleep is physiologically necessary. The letter emphasizes the importance of considering psychiatric conditions in patients with factitious lesions and sleep disturbances.