Differential Diagnosis for Compulsive Skin Picking on Bilateral Lower Legs
Single Most Likely Diagnosis
- Excoriation Disorder (Skin-Picking Disorder): Characterized by recurrent skin picking resulting in skin lesions, with repeated attempts to stop or reduce the behavior. The location on the bilateral lower legs is consistent with areas that can be easily accessed and picked, fitting the compulsive nature of the disorder.
Other Likely Diagnoses
- Psychotic Disorder with Self-Mutilation: In some cases, skin picking can be a symptom of a psychotic disorder, where the individual may have delusions or hallucinations leading to self-harm.
- Body Focused Repetitive Behavior (BFRB): This category includes conditions like trichotillomania (hair pulling) and excoriation disorder, suggesting that the skin picking could be part of a spectrum of body-focused repetitive behaviors.
- Anxiety or Stress-Related Disorder: Skin picking can sometimes be a coping mechanism for anxiety or stress, indicating that the behavior might be secondary to an underlying anxiety disorder.
Do Not Miss Diagnoses
- Neurodevelopmental Disorders (e.g., Autism Spectrum Disorder): Individuals with neurodevelopmental disorders may exhibit self-soothing behaviors, including skin picking, which could be a red flag for an underlying condition.
- Substance-Induced Psychosis: Certain substances can induce psychotic episodes that might include self-mutilation or skin picking, making it crucial to assess for substance use.
- Infection or Infestation (e.g., Scabies, Folliculitis): While less likely to cause compulsive picking, infections or infestations can lead to discomfort and subsequent picking, which would require immediate medical attention.
Rare Diagnoses
- Neuroacanthocytosis: A group of rare genetic disorders characterized by abnormal red blood cells and neurological symptoms, which can include self-mutilation.
- Prader-Willi Syndrome: A rare genetic disorder that can include skin picking as one of its many symptoms, alongside obesity, short stature, and intellectual disability.
- Lesch-Nyhan Syndrome: A rare inherited disorder caused by a deficiency of the enzyme hypoxanthine-guanine phosphoribosyltransferase (HPRT), leading to self-mutilation among other symptoms.