Advanced Neck Dermatillomania Leading to Cervical Osteomyelitis and Epidural Abscess.

Dermatillomania, a condition characterized by compulsive skin picking, can lead to tissue damage and severe infections of adjacent structures. This case report presents the first documented instance of dermatillomania-induced cervical osteomyelitis and epidural abscess. Herein, we describe the case of a 45-year-old male patient with a history of a non-healing posterior neck wound, which progressively worsened and extended to the posterior cervical spine. The patient subsequently experienced weakness and paresthesia in the left arm. Neuroimaging revealed cervical spine osteomyelitis and an associated epidural collection/phlegmon compressing the spinal cord. The abscess was evacuated via posterior laminectomy, followed by culture-guided antibiotic therapy. The presence of a chronic wound or ulcer in the setting of psychiatric comorbidities should raise suspicion of dermatillomania-induced complications. Early diagnosis is essential to guide management and prevent serious complications. Management involves a multidisciplinary approach that includes addressing behavioral abnormalities and concurrent psychiatric disorders.