Neurotic Excoriation
Disease Details
Family Health Simplified
- Description
- Neurotic excoriation is a psychological disorder characterized by repetitive skin picking, often leading to noticeable skin lesions and tissue damage.
- Type
- Neurotic excoriation is a psychogenic skin disorder characterized by compulsive skin picking. It is not known to be linked to a specific genetic transmission pattern. The condition is typically associated with psychological factors and may co-occur with other mental health disorders such as anxiety or obsessive-compulsive disorder.
- Signs And Symptoms
- Episodes of skin picking are often preceded or accompanied by tension, anxiety, or stress. In some cases, following picking, the affected person may feel depressed. During these moments, there is commonly a compulsive urge to pick, squeeze, or scratch at a surface or region of the body, often at the location of a perceived skin defect. When picking, one may feel a sense of relief or satisfaction.The region most commonly picked is the face, but other frequent locations include the arms, legs, back, gums, neck, shoulders, scalp, abdomen, chest, and extremities such as the fingernails, cuticles, toenails, etc. Most patients with excoriation disorder report having a primary area of the body that they focus their picking on, but they will often move to other areas of the body to allow their primary picking area to heal. Individuals with excoriation disorder vary in their picking behaviour; some do it briefly multiple times a day, while others can do one picking session that can last for hours. The most common way to pick is to use the fingers although a significant minority of people use tools such as tweezers or needles.Skin picking often occurs as a result of some other triggering cause. Some common triggers are feeling or examining irregularities on the skin, and feeling anxiety or other negative feelings. This anxiety most commonly stems from a type of OCD, which can range in severity and often goes undiagnosed.Complications arising from excoriation disorder include infection at the site of picking, tissue damage, and sepsis. Damage from picking can be so severe as to require skin grafting, and severe picking can cause epidermal abscesses. Severe cases of excoriation disorder can cause life-threatening injuries. For example, in one reported case, a woman picked a hole through the bridge of her nose, which required surgery to fix, and a 48-year-old woman picked through the skin on her neck, exposing the carotid artery. Pain in the neck or back can arise due to prolonged bent-over positions while engaging in the behavior. Besides physical injuries, excoriation disorder can cause severe physical scarring and disfigurement.Excoriation disorder can cause feelings of intense helplessness, guilt, shame, and embarrassment in individuals, and this greatly increases the risk of self-harm. Studies have shown that excoriation disorder presented suicidal ideation in 12% of individuals with this condition, suicide attempts in 11.5% of individuals with this condition, and psychiatric hospitalizations in 15% of individuals with this condition.
- Prognosis
- Typically, individuals with excoriation disorder find that the disorder interferes with daily life. Hindered by shame, embarrassment, and humiliation, they may take measures to hide their disorder by not leaving home, wearing long sleeves and pants even in the heat, or covering visible damage to the skin with cosmetics and/or bandages. When untreated, excoriation disorder can last anywhere from 5 to 21 years. However, many doctors consider this disorder to be a permanent diagnosis. Excoriation has been documented as showing active from an onset in childhood and remaining active through adulthood.
- Onset
- Neurotic excoriation, also known as excoriation disorder or skin-picking disorder, often begins in adolescence or early adulthood. The onset can be triggered or exacerbated by stress, anxiety, or other psychological factors. The condition is characterized by repeated skin picking, leading to tissue damage and potential infection. The intensity and frequency of the behavior can vary among individuals.
- Prevalence
- The prevalence of neurotic excoriation, also known as excoriation disorder or skin-picking disorder, varies. It is estimated to affect around 1.4% to 5.4% of the general population. The condition is more common in women than men.
- Epidemiology
- The prevalence of excoriation disorder is not well understood.Estimates of the prevalence of the condition range from 1.4 to 5.4% in the general population. One U.S. telephone survey found that 16.6% of respondents "picked their skin to the point of noticeable tissue damage" and that 1.4% would qualify as meeting the requirements of excoriation disorder. Another community survey found a rate of 5.4% had excoriation disorder. A survey of college students found a rate of 4%. One study found that among non-disabled adults, 63% of individuals engaged in some form of skin picking and 5.4% engaged in serious skin picking. Lastly, a survey of dermatology patients found that 2% had excoriation disorder.In some patients, excoriation disorder begins with the onset of acne in adolescence, but the compulsion continues even after the acne has gone away. Skin conditions such as keratosis pilaris, psoriasis, and eczema can also provoke the behavior. In patients with acne, the grooming of the skin is disproportionate to the severity of the acne. Certain stressful events including marital conflicts, deaths of friends or family, and unwanted pregnancies have been linked to the onset of the condition. If excoriation disorder does not occur during adolescence another common age of onset is between the ages of 30 and 45. Additionally, many cases of excoriation disorder have been documented to begin in children under the age of 10. One small survey of patients with excoriation disorder found that 47.5% of them had an early onset of excoriation disorder that began before age 10. Traumatic childhood events may initiate the behavior.Excoriation disorder is statistically more common in females than in males.Excoriation disorder has a high rate of comorbidity with other psychiatric conditions, especially with mood and anxiety disorders . One survey of patients with excoriation disorder found that 56.7% also had a DSM-IV Axis-I disorder and 38% had substance use problems. Studies have shown the following rates of psychiatric conditions found in patients with excoriation disorder: trichotillomania (38.3%), substance use disorder (38%), major depressive disorder (approximately 31.7% to 58.1%), anxiety disorders (approximately 23% to 56%), obsessive-compulsive disorder (approximately 16.7% to 68%), and body dysmorphic disorder (approximately 26.8% to 44.9%). There are also higher rates of excoriation disorder in patients in psychiatric facilities; a study of adolescent psychiatric inpatients found that excoriation disorder was present in 11.8% of patients. It is also present at high rates with some other conditions: 44.9% of patients with body dysmorphic disorder also have excoriation disorder; 8.9% of patients with OCD have excoriation disorder; and 8.3% of patients with trichotillomania have excoriation disorder.Skin picking is also common in those with certain developmental disabilities; for example, Prader–Willi syndrome and Smith–Magenis syndrome. Studies have shown that 85% of people with Prader–Willi syndrome also engage in skin-picking. Children with developmental disabilities are also at an increased risk for excoriation disorder.Excoriation disorder also correlates with "social, occupational, and academic impairments, increased medical and mental health concerns (including anxiety, depression, obsessive–compulsive disorder) ... and financial burden". Excoriation disorder also has a high degree of comorbidity with occupational and marital difficulties.Substance use is often present, and individuals with excoriation disorder are twice as likely to have first-degree relatives who have substance use disorders than those without the condition.Some cases of body-focused repetitive behaviors found in identical twins also suggest a hereditary factor.In a 2020 Study of Excoriation to identify the variable's such as: demographics, SES, marital status and gender, more than 75 % of participants were identified as female, more than 45% of all participants were unemployed, and more than 60% had marital status which ranged from being single to divorced or widowed. With females accounting for diagnosis than any other group, future research should look to uncover reasons why women are more impacted by excoriation, and if excoriation has a correlation with marital status or happiness in life.
- Intractability
- Neurotic excoriation, also known as psychogenic excoriation or dermatillomania, can be challenging to treat but is not necessarily intractable. Success in treatment often depends on addressing underlying psychological factors through cognitive-behavioral therapy (CBT), medication, and other supportive measures. Individual outcomes may vary, and while some individuals experience significant improvement, others may find it more difficult to manage.
- Disease Severity
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Neurotic excoriation, also known as skin-picking disorder or dermatillomania, is a condition where individuals compulsively pick at their skin.
Disease severity can vary widely among individuals:
- Mild: Occasional picking with minimal physical damage or social impact.
- Moderate: Frequent picking resulting in noticeable skin damage, scarring, and potential mild social or psychological impact.
- Severe: Compulsive picking causing significant skin damage, infections, substantial scarring, and considerable social, psychological, and functional impairments.
This condition often requires medical or psychological intervention for management and treatment. - Healthcare Professionals
- Disease Ontology ID - DOID:9165
- Pathophysiology
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Neurotic excoriation, also known as dermatillomania or skin-picking disorder, is characterized by repetitive, compulsive skin-picking that leads to tissue damage. The pathophysiology involves both psychological and biological factors:
1. **Psychological Factors**: Often linked to underlying anxiety, depression, or obsessive-compulsive disorder (OCD). The act of skin-picking serves as a coping mechanism to relieve emotional distress or tension.
2. **Biological Factors**: There may be abnormalities in the brain's neurotransmitter systems, particularly involving serotonin and dopamine, which affect mood and impulse control.
Understanding the interplay between these factors is essential for effective treatment, which may include behavioral therapy and medication. - Carrier Status
- Neurotic excoriation, also known as psychogenic excoriation or dermatillomania, is not a genetic disorder, so it does not have a carrier status. It is a psychological condition characterized by compulsive skin picking. Key features include recurrent skin picking resulting in skin lesions, repeated attempts to decrease or stop picking, and the behavior causing significant distress or impairment in daily functioning. Factors contributing to neurotic excoriation include psychological stress, anxiety, and other coexisting mental health conditions. Treatment often involves cognitive-behavioral therapy (CBT) and, in some cases, medications to address underlying anxiety or depression.
- Mechanism
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Neurotic excoriation, also known as psychogenic excoriation or skin-picking disorder, primarily involves the repetitive and compulsive picking of the skin, resulting in tissue damage. The condition is often associated with psychological factors and may be linked to anxiety, stress, or other emotional distress.
Mechanism:
The underlying mechanism of neurotic excoriation generally involves a psychological component where the individual feels a compulsion to pick at their skin. This behavior may serve as a coping mechanism for emotional regulation, stress relief, or sensory gratification. The repetitive action leads to sores and lesions, which can become infected and cause significant tissue damage over time.
Molecular Mechanisms:
The molecular mechanisms are not well understood and are likely complex, involving multiple biological pathways. Several factors may contribute, including:
1. Neurotransmitter Imbalance: There may be an imbalance in neurotransmitters like serotonin, dopamine, and glutamate. Serotonin, a key neurotransmitter in mood regulation, has often been implicated in compulsive behaviors.
2. Stress Response: Chronic stress can alter the hypothalamic-pituitary-adrenal (HPA) axis, impacting cortisol levels and influencing compulsive behaviors.
3. Genetic Factors: Genetic predisposition may play a role, as there is evidence suggesting familial occurrences of compulsive skin-picking behaviors.
4. Neural Circuitry: Abnormalities in brain regions related to impulse control and emotional regulation, such as the prefrontal cortex and the striatum, may be involved.
Overall, neurotic excoriation is a multifactorial condition with contributions from psychological, genetic, and neurobiological factors. Effective treatment typically requires a multidisciplinary approach, including behavioral therapy and sometimes pharmacological interventions. - Treatment
- Knowledge about effective treatments for excoriation disorder is sparse, despite the prevalence of the condition. There are two major classes of therapy for excoriation disorder: pharmacological and behavioral.Individuals with excoriation disorder often do not seek treatment for their condition, largely due to feelings of embarrassment, alienation, lack of awareness, or belief that the condition cannot be treated. One study found that only 45% of individuals with excoriation disorder ever sought treatment, and only 19% ever received dermatological treatment. Another study found that only 30% of individuals with this disorder sought treatment.
- Compassionate Use Treatment
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Neurotic excoriation, also known as skin-picking disorder, is a condition where individuals compulsively pick at their skin, leading to noticeable damage. Given the lack of specifically approved treatments for this condition, compassionate use, off-label, and experimental treatments can be considered in some cases. These may include:
1. **Compassionate Use Treatments:**
- Rarely applicable for neurotic excoriation and typically reserved for life-threatening diseases. However, certain severe cases might involve the use of investigational therapies.
2. **Off-label Treatments:**
- **Selective Serotonin Reuptake Inhibitors (SSRIs):** Medications like fluoxetine or sertraline, primarily used for depression and anxiety, have shown some efficacy in reducing compulsive behaviors.
- **N-acetylcysteine (NAC):** An amino acid supplement that may help reduce the urge to pick by modulating glutamate levels in the brain.
- **Antipsychotics:** Low doses of medications such as risperidone or olanzapine may be prescribed to manage impulsivity and reduce picking behavior.
- **Cognitive-Behavioral Therapy (CBT):** While not a pharmacological treatment, CBT is often recommended to address the underlying psychological triggers of skin-picking disorder.
3. **Experimental Treatments:**
- **Transcranial Magnetic Stimulation (TMS):** A non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain, currently being studied for its potential to reduce compulsive behaviors.
- **Ketamine Therapy:** While more commonly investigated for mood disorders, ketamine infusions are being explored for their impact on compulsive and repetitive behaviors.
It's important for patients to consult with a healthcare provider to determine the most appropriate treatment plan based on their specific condition and overall health. - Lifestyle Recommendations
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For managing neurotic excoriation, also known as dermatillomania or skin-picking disorder, the following lifestyle recommendations can be beneficial:
1. **Behavioral Therapy**: Engage in cognitive-behavioral therapy (CBT), which can help address underlying psychological triggers.
2. **Stress Reduction**: Practice stress-relief techniques such as mindfulness, yoga, and meditation to manage anxiety and reduce the urge to pick.
3. **Healthy Skin Care**: Maintain a regular skincare routine to keep your skin moisturized and minimize irritation that might trigger picking.
4. **Occupational Therapy**: Occupy your hands with activities like knitting, drawing, or using stress balls to prevent picking.
5. **Support Groups**: Join support communities where you can share experiences and strategies with others facing similar challenges.
6. **Diet & Nutrition**: Consume a balanced diet to support overall health, which can positively impact skin healing.
7. **Regular Exercise**: Engage in physical activities to improve your mood and reduce stress levels.
8. **Limit Skin Exposure**: Wear gloves or keep nails trimmed to minimize damage to the skin during episodes of picking.
9. **Environment Modification**: Remove mirrors or other triggers from your environment to reduce opportunities for picking.
10. **Medical Consultation**: Regularly consult with a dermatologist or mental health professional to monitor and manage the condition effectively.
Implementing these lifestyle changes can help reduce the frequency and severity of skin-picking behaviors. - Medication
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There are several different classes of pharmacological treatment agents that have some support for treating excoriation disorder: SSRIs; opioid antagonists; anti-epileptic agents; and glutamatergic agents. In addition to these classes of drugs, some other pharmacological products have been tested in small trials as well.Antipsychotic, antianxiety, antidepressant, and antiepileptic medications have all been used to treat skin picking, with varying degrees of success.SSRIs have shown to be effective in the treatment of OCD, which serves as an argument in favor of treating excoriation disorder with the same therapy. Unfortunately, clinical studies have not provided clear support for this, because there have not been large double-blind placebo-controlled trials of SSRI therapy for excoriation disorder. In fact, in a meta-analysis of pharmacological treatments of excoriation disorders, it was found that selective serotonin reuptake inhibitors (SSRIs) and lamotrigine were no more effective than a placebo for longterm effects.
Reviews of treatment of excoriation disorder have shown that the following medications may be effective in reducing picking behavior: doxepin, clomipramine, naltrexone, pimozide, and olanzapine. Small studies of fluoxetine, an SSRI, in treating excoriation disorder showed that the drug reduced certain aspects of skin picking compared with a placebo, but full remission was not observed. One small study of patients with excoriation disorder treated with citalopram, another SSRI, showed that those who took the drug significantly reduced their scores on the Yale –Brown Obsessive Compulsive Scale compared with a placebo, but that there was no significant decrease on the visual-analog scale of picking behavior.While there have been no human studies of opioid antagonists for the treatment of excoriation disorder, there have been studies showing that these products can reduce self-chewing in dogs with acral lick, which some have proposed is a good animal model for body-focused repetitive behavior. Furthermore, case reports support the use of these opioid antagonists to treat excoriation disorder. Opioid antagonists work by affecting dopamine circuitry, thereby decreasing the pleasurable effects of picking.Another class of possible pharmacological treatments is glutamatergic agents such as N-acetyl cysteine (NAC). These products have shown some ability to reduce other problematic behaviors such as cocaine addiction and trichotillomania. Some case studies and some small studies of NAC have shown a decrease in picking by treatment with NAC compared with placebo.Excoriation disorder and trichotillomania have been treated with inositol.Topiramate, an anti-epileptic drug, has been used to treat excoriation disorder; in a small study of individuals with Prader–Willi syndrome, it was found to reduce skin picking. - Repurposable Drugs
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Neurotic excoriation, also known as skin picking disorder or excoriation disorder, involves recurrent, compulsive picking of one's own skin leading to tissue damage. Here are some repurposable drugs that have been studied or used off-label for treating this condition:
1. **Selective Serotonin Reuptake Inhibitors (SSRIs):** Medications like fluoxetine, sertraline, and escitalopram are commonly used for their efficacy in treating obsessive-compulsive and related disorders.
2. **N-Acetylcysteine (NAC):** An amino acid supplement that has shown promise in reducing symptoms by modulating glutamate levels in the brain.
3. **Lamotrigine:** An anticonvulsant that has demonstrated some effectiveness in reducing the urge to pick by stabilizing mood.
Always consult a healthcare professional before starting any treatment. - Metabolites
- For neurotic excoriation, often termed skin-picking disorder, specific metabolites directly involved with the condition are not well-defined. The disorder is primarily a behavioral condition characterized by repetitive skin picking, leading to tissue damage. Research indicates that neurotransmitter imbalances, particularly involving serotonin, dopamine, and glutamate, may play a role. However, there are no specific metabolites uniquely associated with neurotic excoriation. Treatment typically focuses on behavioral therapy and medications that influence neurotransmitter systems rather than targeting specific metabolic pathways.
- Nutraceuticals
- Nutraceuticals have not been specifically proven to treat neurotic excoriation (also known as dermatillomania or skin-picking disorder). This condition generally requires comprehensive management, which may include psychological treatments such as cognitive-behavioral therapy (CBT) and sometimes medications to address underlying psychiatric conditions. Any consideration of nutraceuticals should be done in consultation with a healthcare professional, particularly since their efficacy and safety may not be well-established for this specific condition.
- Peptides
- Neurotic excoriation, also known as dermatillomania or skin-picking disorder, is a condition where an individual compulsively picks at their skin, leading to skin lesions. It involves psychological factors more than specific peptides or nanotechnology. Treatment typically includes behavioral therapy, counseling, and sometimes medications like SSRIs to address underlying anxiety or obsessive-compulsive tendencies. There is no established link between specific peptides or nanotechnology (nan) and the treatment or understanding of neurotic excoriation.