<i>N</i>-Acetylcysteine in the Treatment of Excoriation Disorder

Grant, Jon E.; Chamberlain, Samuel R.; Redden, Sarah A.; Leppink, Eric W.; Odlaug, Brian L.; Kim, Suck Won

doi:10.1001/jamapsychiatry.2016.0060

Cited by 141 publications

(106 citation statements)

References 40 publications

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“…The potential benefit of NAC in ED has been suggested by case reports 36. In addition, a recent randomized, double-blind trial (dosing range 1,200–3,000 mg/d) over 12 weeks found that NAC significantly reduced symptoms of ED 37. Almost half of the sample (15/32, 47%) receiving NAC were much or very much improved compared to 19% (4/21) of participants receiving placebo.…”

Section: Resultsmentioning

confidence: 98%

Excoriation (skin-picking) disorder: a systematic review of treatment options

Löchner

Roos

Stein

2017

NDT

105

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Although pathological skin-picking has been documented in the medical literature since the 19th century, it has only recently been included as a distinct entity in psychiatric classification systems. In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition and the proposed International Classification of Diseases, Eleventh Revision, excoriation (skin-picking) disorder (ED), also known as neurotic excoriation, psychogenic excoriation, or dermatillomania), is described as recurrent picking of skin, leading to skin lesions and significant distress or functional impairment. ED is listed as one of the obsessive–compulsive and related disorders, given its overlap with conditions such as trichotillomania (hair-pulling disorder). Arguably, its inclusion and delineation in the diagnostic nomenclature will lead to increased awareness of the condition, more research, and ultimately in treatment advances. This systematic review aims to provide readers with an up-to-date view of current treatment options for ED. A MEDLINE search of the ED treatment literature was conducted to collate relevant articles published between 1996 and 2017. The findings indicate that a number of randomized controlled trails on ED have now been published, and that current management options include behavioral therapy (habit reversal or acceptance-enhanced behavior therapy), and medication (selective serotonin reuptake inhibitors or N-acetyl cysteine).

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Section: Resultsmentioning

confidence: 98%

Excoriation (skin-picking) disorder: a systematic review of treatment options

Löchner

Roos

Stein

2017

NDT

105

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“…Thus, other therapeutic strategies are necessary. N-acetylcysteine (NAC) has been used with good results in the treatment of obsessive-compulsive disorders (OCD), and more specifically in some psychodermatological conditions, such as onychotillomania, skin picking disorder, prurigo, and trichotillomania [6-14]. …”

Section: Introductionmentioning

confidence: 99%

Trichoteiromania: Good Response to Treatment with N-Acetylcysteine

Salas‐Callo¹,

Pirmez²

2019

Skin Appendage Disord

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Lichen simplex chronicus on the scalp, also known as trichoteiromania, can be difficult to manage, as the therapeutic options are limited to topical or intralesional glucocorticoids. We describe a patient with trichoteiromania, presenting three lichenified pruriginous plaques on different regions of the scalp, associated with fracture and loss of hair shafts. Prior treatment with potent topical glucocorticoids was ineffective. However, treatment with oral N-acetylcysteine (NAC) 1,200 mg/day resulted in complete hair regrowth within 16 weeks. NAC is a safe drug with a good tolerance profile that could be a therapeutic option for patients with trichoteiromania. The potential of NAC has not been completely elucidated, thus more studies will be necessary to confirm its efficacy in the long term for some psychodermatological conditions.

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“…N -acetylcysteine (NAC) showed superiority over placebo as monotherapy in excoriation disorder,1 similar to findings in trichotillomania. However, NAC’s findings in obsessive-compulsive disorder (OCD) are mixed.…”

mentioning

confidence: 59%

How Similar Are the Disorders Included Under the Umbrella of Obsessive-Compulsive Disorder and Related Disorders?—Reply

2016

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To the Editor In JAMA Psychiatry, Grant and colleagues 1 demonstrated the efficacy of N-acetylcysteine (NAC) in the treatment of excoriation disorder (ED). The same group had previously reported the benefits of NAC for adults with trichotillomania (TTM). 2 In both studies, NAC was used in monotherapy in otherwise treatment-free patients. In the DSM-5, ED and TTM were included under the umbrella of obsessive-compulsive disorder (OCD) and related disorders because of similarities regarding phenotypic expression and common putative neurobiological underpinnings between these disorders and OCD. When used for treatment-resistant OCD, NAC was not more effective than placebo as a selective serotonin reuptake inhibitor (SSRI) augmentation strategy. 3 In striking contrast with what we know about OCD, SSRIs have not been proved to be superior to placebo in TTM treatment. 2 As for ED, the evidence regarding the efficacy of SSRIs is still scarce. 1 So far, there are no US Food and Drug Administration-approved treatments for ED and TTM. The divergent results of the trials testing either SSRIs or NAC for ED/ TTM and OCD suggest that treatments may not be used interchangeably between OCD and related disorders. Despite the possible methodological issues related to the design of specific trials, do such heterogeneous results regarding treatment response relate to heterogeneous neurobiology between OCD and related disorders?Pathological grooming behaviors in animals are widely used in the literature as a common animal model of ED/TTM and OCD. However, findings derived from animal studies do not always confirm the association between grooming behavior and OCD. For example, no differences were observed in the results of the marble-burying test of rats with different levels of grooming behavior. 4 In addition, results from genetic studies also suggest that the neurobiology of pathological grooming may not be necessarily related to OCD. It had been demonstrated that Sapap3 knockout mice groomed themselves excessively. However, using family-based association analyses, Bienvenu et al 5 found that variation within the human equivalent of the Sapap3 gene appeared associated with ED/TTM, but not with OCD.The conflicting results regarding the efficacy of NAC for ED/TTM and OCD, in addition to the findings of translational studies, suggest that the neural basis of repetitive behaviors observed in patients with these disorders might not be the same. So far, similarities between ED/TTM and OCD do not seem to go beyond the characterization by repetitive behaviors and some degree of familial aggregation.

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N-Acetylcysteine in the Treatment of Excoriation Disorder

Cited by 141 publications

References 40 publications

Excoriation (skin-picking) disorder: a systematic review of treatment options

Excoriation (skin-picking) disorder: a systematic review of treatment options

Trichoteiromania: Good Response to Treatment with N-Acetylcysteine

How Similar Are the Disorders Included Under the Umbrella of Obsessive-Compulsive Disorder and Related Disorders?—Reply

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