Obsessive Compulsive Disorder remains on the upper strata of the pyramid of psychiatric disorders as far as prevalence and disability are concerned, but yet to gain the importance in reporting, diagnosis and awareness. Owing to the under reporting of OCD, the less common forms, like biting, picking, chewing etc, especially those where preceding intrusive thoughts remain unidentified, pass undiagnosed and untreated, often with, multiple referrals and unnecessary medical/surgical interventions. A 19-Year-old male, presented with a non-healing ulcer on the lower lip mucosa since 4 year duration, with a non-contributory medical history, past and family histories. Patient provided a vast Medical History of multiple referrals with ENT, OMFS, Dermatology & Onco-surgery Departments, with various interventions including biopsy and unremarkable reports. Patient was advised admission, and after thorough evaluation, a diagnosis of obsessive-compulsive disorder, predominantly compulsions was made and was started on Fluoxetine(20mg) and Psychotherapy sessions. Over follow-up  with dose optimisation to 80 mg, behaviour therapy, reported healing of existing ulcers and no new lesions. Skin lesions may have many distinct clinical presentations, ranging from excoriations to ulcers and blisters; with many underlying pathologies. Few may present with underlying psychic causes and mechanism, like the complex mechanism of compulsive acts. Many patients& physicians might be unable to identify the preceding obsessions, or may have a lack of these thereof. A broader sense of awareness & attentiveness towards possible psychiatric basis for resistant skin manifestations like above needs to be developed.