From the Guidelines
The first-line pharmacotherapy for dermatillomania (excoriation disorder) is selective serotonin reuptake inhibitors (SSRIs), which have been shown to be effective in treating obsessive-compulsive disorder (OCD) and are likely to be beneficial for dermatillomania due to the similar compulsive behaviors involved 1.
Pharmacotherapy Options
- SSRIs, such as fluoxetine, sertraline, or escitalopram, are recommended as the initial treatment due to their efficacy, tolerability, and safety profile 1.
- The dosage of SSRIs for dermatillomania may need to be higher than for other anxiety disorders or major depression, but should be carefully assessed for each patient to minimize adverse effects 1.
- Clomipramine, a non-selective SRI, may be considered as an alternative option, but its use is limited by its lower safety and tolerability profile compared to SSRIs 1.
Treatment Approach
- Treatment with SSRIs should typically begin with a lower dose and gradually increase over 4-6 weeks, with a recommended treatment duration of at least 12 weeks to evaluate effectiveness.
- Pharmacotherapy should ideally be combined with cognitive-behavioral therapy (CBT) or habit reversal training for optimal outcomes.
- Patients should be monitored for side effects, particularly during the initial weeks of treatment, and should understand that symptom improvement may take several weeks to become noticeable.
- Treatment may need to be continued for 6-12 months after symptom improvement to prevent relapse.
Key Considerations
- The choice of SSRI should take into account factors such as past treatment response, potential adverse events, and drug interactions, as well as the presence of comorbid medical conditions and cost and availability of medication 1.
- A careful assessment of SSRI adverse effects is crucial when establishing the best dose for each patient 1.
From the Research
Indicated Pharmacotherapy for Dermatillomania (Excoriation Disorder)
The indicated pharmacotherapy for Dermatillomania (Excoriation Disorder) includes:
- Selective serotonin reuptake inhibitors (SSRIs) which have proved to be the most effective in treating the psychiatric component of dermatillomania 2
- Other pharmacological interventions such as serotonin-norepinephrine reuptake inhibitors, antipsychotics, and glutaminergic-modulating agents have also been described to treat this condition in case reports and open and controlled trials 3
- N-acetylcysteine has been shown to be an effective pharmacological intervention 4, 3
Treatment Approach
The treatment of dermatillomania is a multipronged approach and should include:
- Treatment of the underlying psychiatric illness 2
- Treatment for pruritus 2
- Topical treatment of the lesions 2
- Non-pharmacological treatments such as behavioral therapy, habit reversal exercises, and support groups have also proved to be helpful and are well tolerated amongst patients suffering from dermatillomania 2, 3
Considerations
When prescribing medications for dermatillomania, it is essential to be aware of potential adverse cutaneous effects, such as those associated with SSRIs 5 A guide for dermatologists to use while prescribing these medications is recommended 6