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

Abstract

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.

Pediatric skin picking disorder: A review of management

“…These products should be designed to be aesthetically pleasing to the pediatric patient, to be personalized by them, and to match the patient's skin tone, allowing for optimal psychosocial functioning during treatment. 43 If behavioral therapy is insufficient to relieve symptoms or the patient refuses to seek mental health counseling (the majority of dermatology referrals to psychiatry are not pursued by patients), 10 pediatric patients with SPD can be treated with pharmacologic therapy. 48 Several pharmacologic treatments have been studied for SPD, but there is no single gold standard.…”

“…If behavioral therapy is insufficient to relieve symptoms or the patient refuses to seek mental health counseling (the majority of dermatology referrals to psychiatry are not pursued by patients), 10 pediatric patients with SPD can be treated with pharmacologic therapy 48 . Several pharmacologic treatments have been studied for SPD, but there is no single gold standard.…”

“…Having a dermatologist who can provide detailed and accurate information about CBT and HRT will strengthen the dermatologist–patient–parent relationship. Moreover, while there is a paucity of data regarding psychiatric referrals in children, only a minority of adult dermatology patients with SPD are referred to psychiatry 10 10 …”

Dermatillomanie

“…Die häufigsten komorbiden Störungen sind Angststörungen, Depressionen und Abhängigkeitserkrankungen [2,6]. Außerdem wurden hohe Komorbiditäten mit der körperdysmorphen Störung, Trichotillomanie und Zwangserkrankungen [2] gefunden.…”

Self‐inflicted Dermatoses in Adolescence: A Case Series

“…The third patient was diagnosed with neurotic excoriation, classified under the obsessive-compulsive and related disorders, and characterised by recurrent skin picking, resulting in heterogeneous skin lesions (erosions, crusts, atrophic areas, hyperpigmented, hypopigmented scars or lichenification), sometimes mimicking worsening acne. 2,3 The girls are being managed by our psychological department and are improving. We stress the importance of clinical history, physical examination and a multidisciplinary approach to the management of self-induced dermatoses.…”