ABSTRACT
Objectives: Skin-picking disorder (SPD), also known as excoriation disorder, neurotic excoriation or dermatillomania, is characterized by repetitive and compulsive picking of skin leading to tissue damage. It is an obsessive-compulsive and related disorder that is classified with other body-focused repetitive-behavior disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The diagnostic criteria for SPD require recurrent picking, resulting in skin lesions that cause clinically significant distress or impairment in social, occupational or other important areas of functioning. Method:We present a case of a 12-years-old girl with one-year history of multiple pruritic papules, plaques and excoriations on the face, scalp, arms and legs. Skin changes appeared following COVID-19 infection, which patient described as extremely stressful. The patient did not admit scratching of the skin but examination showed a high level of shame and embarrassment associated with her skin appearance. Results: Laboratory findings were within normal rage. Skin biopsy was performed and histopathology results confirmed secondary skin lesions (iatrogenic excoriations). Based on clinical findings and psychological evaluation the patient was diagnosed with pathological skin picking. The skin lesions were treated with topical emollients under occlusion and the combination of topical corticosteroids and antibiotics. The patient also received Habit-reversal therapy (HRT). The evaluation on follow-up appointment showed favorable improvement in cognitive status and skin lesions and she remained under our supervision. Discussion: SPD often manifests in automatic or focused patterns. In automatic type, patients are unaware of their picking habits and have less conscious awareness than those with focused type. HRT is the core treatment and consists of awareness training (self-monitoring forms), stimulus control, competing-response training, social support and generalization of skills. A compassionate approach during the diagnostic and treatment could positively influence the treatment outcome.
ABSTRACT
The pandemic of COVID-19 is a global challenge for health care, and dermatologists are not standing apart from trying to meet this challenge. The European Academy of Dermatology and Venereology (EADV) has collected recommendations from its Task Forces (TFs) related to COVID-19. The Journal of the EADV has established a COVID-19 Special Forum giving free access to related articles. The psychosocial effects of the pandemic, an increase in contact dermatitis and several other skin diseases because of stress, disinfectants and protective equipment use, especially in healthcare workers, the temporary limited access to dermatologic care, the dilemma whether or not to pause immunosuppressive therapy, and, finally, the occurrence of skin lesions in patients infected by COVID-19 all contribute to significant quality of life (QoL) impairment. Here, we present detailed recommendations of the EADV TF on QoL and patient-oriented outcomes on how to improve QoL in dermatologic patients during the COVID-19 pandemic for several different groups of patients and for the general population.