From the Guidelines
Excoriation disorder is a mental health condition characterized by recurrent picking of one's own skin, leading to skin lesions, and is accompanied by unsuccessful attempts to decrease or stop the behavior. This condition is also known as skin-picking disorder or dermatillomania, and people with this disorder repeatedly pick, scratch, or dig at their skin, often targeting perceived imperfections like pimples, scabs, or rough patches, resulting in tissue damage 1. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), excoriation disorder is classified as an obsessive-compulsive related disorder, reflecting the underlying neurobiological mechanisms involving disrupted impulse control and reward circuitry in the brain 1.
Key Characteristics of Excoriation Disorder
- Recurrent picking of one's own skin, leading to skin lesions
- Unsuccessful attempts to decrease or stop the behavior
- Often targets perceived imperfections like pimples, scabs, or rough patches
- Results in tissue damage and can lead to skin infections, scarring, and social isolation if left untreated
Treatment Options
- Cognitive-behavioral therapy (CBT), particularly habit reversal training
- Medication such as selective serotonin reuptake inhibitors (SSRIs) like fluoxetine or sertraline
- N-acetylcysteine has also shown effectiveness in reducing picking behaviors
- Immediate self-help measures include keeping hands busy with fidget toys, covering vulnerable skin areas with bandages, and identifying triggers to manage urges.
Classification and Neurobiological Mechanisms
- Classified as an obsessive-compulsive related disorder in psychiatric diagnostic manuals
- Underlying neurobiological mechanisms involve disrupted impulse control and reward circuitry in the brain 1.
From the Research
Definition and Classification of Excoriation Disorder
- Excoriation disorder, also known as skin-picking disorder or psychogenic skin excoriations, is an obsessive-compulsive and related disorder classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) 2, 3, 4.
- It is characterized by recurrent picking of skin, leading to skin lesions and significant distress or functional impairment 4.
Symptoms and Demographics
- The disorder is associated with significant comorbidity and psychosocial dysfunction, with a female predominance across studies 2.
- The average age of onset is variable but commonly in adolescence and adulthood 2.
- Patients with excoriation disorder often present with excessive or inappropriate skin picking, and may first present to dermatology 3.
Treatment Options
- There is no specific or recommended treatment option, but cognitive-behavioral therapy, particularly habit-reversal therapy and acceptance and commitment therapy, have shown promise 2, 4.
- Various pharmacological interventions have also been described, including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors, antipsychotics, and glutaminergic-modulating agents 2, 5, 6.
- SSRIs and N-acetylcysteine have been shown to be the most effective of the pharmacological interventions 2, 4, 6.
Diagnosis and Management
- A full clinical and dermatologic examination and multidisciplinary approach is important in the diagnosis of this condition 2.
- Patient presentation, DSM-5 criteria, and management approaches are reviewed, and a combined dermatologic and psychiatric approach to diagnosing, differentiating, and managing excoriation disorder is recommended 3.