Psychogenic Skin Excoriations: Diagnostic Criteria, Semiological Analysis and Psychiatric Profiles

Abstract

Psychogenic excoriations are also called neurotic excoriations, dermatillomania or skin picking syndrome. We proposed diagnostic criteria and then performed a study of the psychiatric profiles of outpatients with psychogenic excoriations and the circumstances around the creation of these excoriations. Although the results must be interpreted with caution because the study was performed with only 10 patients, interesting data is provided about the onset of psychogenic excoriations, the behaviour of picking, and comorbidity. Common or specific characteristics were identified according to type of case. The majority of patients associated first excoriations with personal problems. Four patients reported abuse in childhood or adolescence. This study confirms that skin picking is an impulsive reaction and does not belong to the obsessive-compulsive disorders: impulsivity is defined by ineffective or failing control resulting in uninhibited behaviour.

Psychiatric Features in Neurotic Excoriation Patients: The Role of Childhood Trauma

“…In their study conducted on 57 patients, Snorrason et al (21) demonstrated that all patients with NE are diagnosed with at least one Axis I condition during their lifetime and that depression and anxiety are the most frequently observed comorbidities. Misery et al (22) also reported that NE is closely associated with major depression and anxiety disorders.…”

“…While certain authors classify NE within the spectrum of obsessive-compulsive disorders, other authors associate it with impulse control disorders (3,22). Arnold has suggested a classification based on compulsive, impulsive, and mixed subtypes.…”

Position Statement: Linear prurigo is a subtype of chronic prurigo

“…Patients with linear prurigo normally do not deny their scratching (as in malingering or factitious disorders). In linear prurigo, the scratching behaviour is usually not compulsive or impulsive, in most patients it is a reaction to chronic pruritus, while in skin picking and related SISL the respective behaviour is executed without severe pruritus . Therefore, underlying pruritus is essential in the pathophysiology of linear prurigo.…”

“…In linear prurigo, the scratching behaviour is usually not compulsive or impulsive, in most patients it is a reaction to chronic pruritus, while in skin picking and related SISL the respective behaviour is executed without severe pruritus. 6,7 Therefore, underlying pruritus is essential in the pathophysiology of linear prurigo. Of course in some patients with pruritus (and also with linear prurigo), the scratching can develop into an obsessive, compulsive or impulsive behaviour, which they regularly execute even when no itch is present.…”

Skin Picking Heralding Parkinson’s Disease

“…To the Editor: Skin picking has been reported in Parkinson's disease (PD) as dermatillomania, an impulsive behavior, 1 or as a delusion of parasitosis. Skin picking is commonly linked to dopamine agonist treatment of PD 2 and leads to tissue damage and, subsequently, medical complications and psychological distress.…”