Neurotic Excoriations

Key Points
Condition also known as compulsive skin picking, may affect various areas
May be caused by a variety of factors, but is often related to an associated psychological condition, such as anxiety or depression
Consists of varying degrees of skin damage due to constant scratching and picking

Neurotic excoriations, or compulsive skin picking, is a condition in which skin is damaged to varying degrees due to constant scratching and picking by the affected person. This damage may range from moderate to severe, and can be accompanied by bruising, bleeding, secondary infection, scarring and disfigurement. Larger lesions may require hospitalization.

Neurotic excoriations may be brought on by a variety of factors, but in the majority of cases the it is related to an associated psychological condition, commonly depression or anxiety disorders. Organic conditions such as uremia, anemia and liver disease may also trigger the condition and should be considered during diagnosis, as well as any history of drug use. Neurotic excoriations often follow periods of high stress or anxiety and are often associated with OCD (obsessive compulsive disorder). The condition is more common in women, and appears as early as adolescence.

Differential Diagnosis (Other conditions with similar appearance)
Delusions of parasitosis
Dermatitis Herpetiformis
Prurigo nodularis
Scabies
Dermatitis artefacta
Trigeminal trophic syndrome

Diagnosis
Key Points
Diagnosis based on clinical examination of lesions in conjunction with psychological testing
Other testing may be performed to rule out similar appearing conditions

Neurotic excoriations are typically diagnosed based on clinical examination of lesions in conjunction with psychological testing. Other tests, such as skin biopsies, may be performed to rule out other, similar appearing conditions.

Treatment
Treatment predicated on the cause of the condition
*Treatment may consist of psychological or medical therapies

Treatment of neurotic excoriation is predicated on the cause of the condition. In cases where it is the result of an associated psychological disorder, psychological treatments such as habit reversal training or exposure and response prevention may be used to combat the compulsive nature of the condition. Treatments with prescription medications, the same used to treat OCD, in conjunction with psychological therapy, may also be helpful.