Excoriation disorder

WikiDoc Resources for Excoriation disorder
Articles
Most recent articles on Excoriation disorder Most cited articles on Excoriation disorder Review articles on Excoriation disorder Articles on Excoriation disorder in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Excoriation disorder Images of Excoriation disorder Photos of Excoriation disorder Podcasts & MP3s on Excoriation disorder Videos on Excoriation disorder
Evidence Based Medicine
Cochrane Collaboration on Excoriation disorder Bandolier on Excoriation disorder TRIP on Excoriation disorder
Clinical Trials
Ongoing Trials on Excoriation disorder at Clinical Trials.gov Trial results on Excoriation disorder Clinical Trials on Excoriation disorder at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Excoriation disorder NICE Guidance on Excoriation disorder NHS PRODIGY Guidance FDA on Excoriation disorder CDC on Excoriation disorder
Books
Books on Excoriation disorder
News
Excoriation disorder in the news Be alerted to news on Excoriation disorder News trends on Excoriation disorder
Commentary
Blogs on Excoriation disorder
Definitions
Definitions of Excoriation disorder
Patient Resources / Community
Patient resources on Excoriation disorder Discussion groups on Excoriation disorder Patient Handouts on Excoriation disorder Directions to Hospitals Treating Excoriation disorder Risk calculators and risk factors for Excoriation disorder
Healthcare Provider Resources
Symptoms of Excoriation disorder Causes & Risk Factors for Excoriation disorder Diagnostic studies for Excoriation disorder Treatment of Excoriation disorder
Continuing Medical Education (CME)
CME Programs on Excoriation disorder
International
Excoriation disorder en Espanol Excoriation disorder en Francais
Business
Excoriation disorder in the Marketplace Patents on Excoriation disorder
Experimental / Informatics
List of terms related to Excoriation disorder

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2] Yashasvi Aryaputra[3]

Synonyms and keywords: Compulsive skin picking; CSP; dermatillomania; neurotic excoriation; psychogenic excoriation

Overview

Excoriation disorder (also known as dermatillomania, compulsive skin picking, neurotic excoriation, psychogenic excoriation, or CSP) is an impulse control disorder and form of self-injury characterized by the repeated urge to pick at one's own skin, often to the extent that damage is caused. Excoriation disorder may be related to body dysmorphic disorder (BDD).

Compulsive picking of the knuckles (via mouth) illustrating disfiguration of the distal and proximal joints of the middle and little fingers.

Sufferers of dermatillomania find skin picking to be stress relieving or gratifying, though it can still be as physically painful as it would be for a non-skin picker.

Historical Perspective

• Lous-Anne-Jean Brocq was the first person to mention excoriation disorder on paper. She used the term in 1898 to describe a patient who uncontrollably picked their acne.

Classification

• The DSM-5 changed excoriation disorder's classification from "impulse control disorder" to "excoriation (skin-picking) disorder.

• Excoriation disorder was originally known as "dermatillomania" before the DSM-5.

• The inability to control the urge to pick is similar to trichotillomania. Recent research suggests that, like trichotillomania, dermatillomania may be an impulse control disorder. This is part of the obsessive compulsive disorder spectrum.

• In some animal models, it has been shown that animals that who excessively pull their hairs have more endorphin receptors in their brain than animals who do not. Endorphin receptors enable endorphins to have an effect on the brain. If this is true for humans, people who are particularly compulsive about their repetitive habits may have more endorphin receptors in their brain as well. This may explain why sufferers get more enjoyment out of picking their scabs than others.

Pathophysiology

• Those suffering from excoriation disorder have very damaged skin, as a result of picking at it constantly.

Skin Picking results on arms, shoulders and chest are visible. While this look can be a social disturbance, it is also a time-consuming habit.

Differential Diagnosis

Excoriation disorder must be differentiated from:

• Neurodevelopmental disorders

• Prader-Willi syndrome
• Tourette's disorder

• Other obsessive-compulsive and related disorders

• Body dysmorphic disorder

• Other disorders
• Other medical conditions

• Acne
• Scabies

• Psychotic disorder

• Delusion
• Tactile hallucination

• Somatic symptom and related disorders

• Factitious disorder

• Substance/medication-induced disorders

• Cocaine

Epidemiology and Demographics

Prevalence

• The prevalence of excoriation (skin-picking) disorder is approximately 1,400 per 100,000 (1.4%) individuals worldwide.
• About 2% of dermatology patients suffer from excoriation disorder.

Age

• The age of onset for excoriation disorder is likely either under 10 years old or between 30 and 45 years old.

Risk Factors

Common risk factors in the development of excoriation disorder include:

• Genetic predisposition
• Obsessive-compulsive disorder(OCD)

Natural History, complications, and prognosis

Natural History

• The symptoms of excoriation disorder usually develop either under 10 years of age or between 30 and 45 years old.

Complications

• There are no known complications associated with excoriation disorder.

Prognosis

• Those who suffer from this disorder tend to wear long sleeved clothing, even in warm weather, to hide any damaged skin. They are hindered by embarrassment when going out in public. If excoriation disorder is left untreated, it can last as long as 21 years.

Diagnostic Criteria

DSM-V Diagnostic Criteria for Excoriation (Skin-Picking) Disorder

“

A. Recurrent skin picking resulting in skin lesions. AND B. Repeated attempts to decrease or stop skin picking. AND C. The skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. AND D. The skin picking is not attributable to the physiological effects of a substance (e.g.,cocaine) or another medical condition (e.g., scabies). AND E. The skin picking is not better explained by symptoms of another mental disorder (e.g., delusions or tactile hallucinations in a psychotic disorder, attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder, stereotypies in stereotypic movement disorder, or intention to harm oneself in non suicidal self-injury).

”

History and Symptoms

• History of picking at the the skin
• History of personal issues such as abuse that may lead to these behaviors.
• Acne already preexisting on the body.

Laboratory Findings

• There are no diagnostic laboratory findings associated with excoriation disorder.

Other Imaging Studies

• There are no other imaging findings associated with excoriation disorder.

Other Diagnostic Studies

There are no other diagnostic studies associated with excoriation disorder.

Medical Therapy

• SSRIs, glutamateric agents, and opioid antagonists can all help in treating excoriation disorder.
  • SSRIs are effective in treating obsessive-compulsive disorder, which is closely related to excoriation disorder.
• Skin picking, which is the defining symptom of excoriation disorder, can be treated by using antidepressant, anti-anxiety, anti-epileptic, and antipsychotic medications.

Psychotherapy

• Habit reversal training, acceptance and commitment therapy, acceptance-enhanced behavioral therapy, and cognitive behavioral therapy were all used to help treat excoriation disorder.

• These strategies help reduce skin picking behavior in individuals with excoriation disorder, but no psychological issues.

Brain Stimulation Therapy

• There is no brain stimulation therapy associated with excoriation disorder.

References

Template:WikiDoc Sources