Skin picking disorder

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.