A structural MRI study of excoriation (skin-picking) disorder and its relationship to clinical severity

Harries, Michael; Chamberlain, Samuel R.; Redden, Sarah A.; Odlaug, Brian L.; Blum, Austin W.; Grant, Jon E.

doi:10.1016/j.pscychresns.2017.09.006

Cited by 21 publications

(13 citation statements)

References 38 publications

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“…Decreased serotonin and increased dopamine in the ventral striatum are inherent to impulsive behavior, whereas the converse is true of less impulsive behavior [ 35 ]. Furthermore, neuroimaging studies have correlated the dysfunction of right fronto-striatal neural network [ 8 ], disconnection of white matter tract in regions involved in motor generation and suppression [ 57 ] as well as volume and cortical thickness abnormalities in both the left and right cerebral [ 58 , 59 , 60 ] and cerebellar regions [ 59 , 60 , 61 ] with impaired motor inhibitory control and maladaptive emotion regulation observed in individuals with SPD [ 61 ].…”

Section: Resultsmentioning

confidence: 99%

Dermatillomania: Strategies for Developing Protective Biomaterials/Cloth

et al. 2021

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Dermatillomania or skin picking disorder (SPD) is a chronic, recurrent, and treatment resistant neuropsychiatric disorder with an underestimated prevalence that has a concerning negative impact on an individual’s health and quality of life. The current treatment strategies focus on behavioral and pharmacological therapies that are not very effective. Thus, the primary objective of this review is to provide an introduction to SPD and discuss its current treatment strategies as well as to propose biomaterial-based physical barrier strategies as a supporting or alternative treatment. To this end, searches were conducted within the PubMed database and Google Scholar, and the results obtained were organized and presented as per the following categories: prevalence, etiology, consequences, diagnostic criteria, and treatment strategies. Furthermore, special attention was provided to alternative treatment strategies and biomaterial-based physical treatment strategies. A total of six products with the potential to be applied as physical barrier strategies in supporting SPD treatment were shortlisted and discussed. The results indicated that SPD is a complex, underestimated, and underemphasized neuropsychiatric disorder that needs heightened attention, especially with regard to its treatment and care. Moreover, the high synergistic potential of biomaterials and nanosystems in this area remains to be explored. Certain strategies that are already being utilized for wound healing can also be further exploited, particularly as far as the prevention of infections is concerned.

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Section: Resultsmentioning

confidence: 99%

Dermatillomania: Strategies for Developing Protective Biomaterials/Cloth

et al. 2021

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“…Off-label therapy with SSRIs and lamotrigine has had variable success [ 23 , 24 , 25 , 26 , 27 ]. Recent functional magnetic resonance imaging (fMRI) studies have shown abnormal brain activation in patients with ED, suggesting that abnormal neural circuitry in habit formation, action monitoring and inhibition may be involved in the pathophysiology of ED [ 28 , 29 ]. Indeed, N-acetylcysteine therapy has been shown reduce skin-picking behaviors, presumably by improving the glutamatergic dysfunction implicated in the pathophysiology of compulsive behaviors [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and Comorbidities of Excoriation Disorder: A Retrospective Case-Control Study

Kwon

Sutaria

Khanna

et al. 2020

JCM

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Excoriation disorder is a psychocutaneous disorder characterized by repetitive skin-picking and associated with significant morbidity. Currently, epidemiological data in patients with excoriation disorder are lacking so we sought to characterize common patient demographics and comorbidities. We conducted a retrospective case-control study comparing 250 patients with excoriation disorder with 250 age-, race- and sex-matched controls identified between 2007 and 2019 at a single tertiary care center. We found that the majority of excoriation disorder patients were female (76%), Caucasian (82%) and unmarried (62%), with a mean age of 49 years. Compared to the matched controls, patients with excoriation disorder had increased odds of several psychiatric illnesses, including obsessive compulsive disorder (odds ratio (OR) 28.48, 95% confidence interval (CI): 1.68, 481.75), substance use disorder (OR 24.33, 95% CI: 5.81, 101.77), post-traumatic stress disorder (OR 8.23, 95% CI: 2.24, 129.40), depression (OR 8.19, 95% CI: 4.86, 13.80), bipolar disorder (OR 7.55, 95% CI: 2.22, 25.65), attention-deficit/hyperactivity disorder (OR 5.63, 95% CI: 1.62, 19.57), and anxiety (OR 5.01, 95% CI: 2.92, 8.62). Only a minority (42%) of patients were given psychiatry referrals and of those referred, a majority (64%) did not follow-up with psychiatry. The outcomes were also generally unfavorable as only 21% of patients experienced a resolution or improvement in their symptoms. This highlights the need for a multidisciplinary approach to manage patients with excoriation disorder, involving both dermatologists and psychiatrists.

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“…Previous structural neuroimaging studies have found reduced integrity of white matter tracts connecting anterior cingulate cortices in SPD patients [ 6 ], a greater volume of the bilateral nucleus accumbens, and reduced cortical thickness in the right frontal areas, compared to those in control participants and patients with trichotillomania [ 7 ]. In contrast, Harries et al [ 8 ] detected no differences in gray matter volume between SPD patients and controls.…”

Section: Introductionmentioning

confidence: 92%

The Role of the Cerebellum in Skin-Picking Disorder

Wabnegger

Schienle

2018

Cerebellum

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Previous research indicated that the cerebellum is involved in psychopathologies with body-focused repetitive behaviors. The present study investigated whether patients with a diagnosis of skin-picking disorder (SPD) also show altered cerebellar structure and function. Structural as well as functional MRI data from 30 SPD patients and 31 controls were analyzed. The fMRI approach compared cerebellar activity and connectivity between the two groups during scratching and caressing of a small skin area on the arm. Relative to controls, SPD patients were characterized by reduced gray matter volumes in the left cerebellar lobules Vand VI. During picking (relative to caressing), SPD patients displayed increased activation of the left crus I, which showed enhanced coupling with the left ventrolateral prefrontal cortex (VLPFC). This study provides the first evidence that SPD patients display structural as well as functional abnormalities in specific subregions of the cerebellum related to motor (V) and affective-cognitive functions (VI, crus I). The SPD-related altered cerebellar connectivity with an area implicated in affect control (VLPFC) fits nicely to the model of pathological skin picking as a maladaptive emotion regulation strategy.

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A structural MRI study of excoriation (skin-picking) disorder and its relationship to clinical severity

Cited by 21 publications

References 38 publications

Dermatillomania: Strategies for Developing Protective Biomaterials/Cloth

Dermatillomania: Strategies for Developing Protective Biomaterials/Cloth

Epidemiology and Comorbidities of Excoriation Disorder: A Retrospective Case-Control Study

The Role of the Cerebellum in Skin-Picking Disorder

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