Excoriation disorder: symptoms, causes and treatment

The relationship between skin diseases and our emotional states is often more than evident. An example of this is excoriation disorder or dermatillomania, which consists of an uncontrollable need to scratch, pick, or remove acne scabs until real, striking skin lesions appear.

We may have never heard of dermatillomania. On the contrary, we may have just been diagnosed with it or perhaps we belong to that sector of the population that is not yet fully aware that perhaps it suffers from this same problem. As strange as it may seem to us It is quite common, an effect very often associated with depression, anxiety disorders or obsessive-compulsive disorders (OCD).

Likewise, it is also interesting to know that medical literature has included this type of psychological condition for more than a century. It first appeared in 1875 under the name “neurotic excoriation.” Later, the French dermatologist Brocq described the striking case of a teenage patient who, almost constantly, scratched those areas where he had acne to the point of leaving his face almost disfigured.

There are extreme cases and there are patients with milder symptoms. where it is evident once again that a good part of dermatological problems have a psychiatric basis that must be detected and treated. For this reason, there are those who usually go through a whole journey of expensive treatments for these skin conditions without being previously diagnosed with the true root of the problem: excess stress, perhaps, high anxiety perhaps or hidden depression…

Let’s look at more data on galling disorder below.

Excoriation disorder: what is it and who does it affect?

Excoriation disorder or dermatillomania appears in the DSM-V (diagnostic and statistical manual of mental disorders) in the section on obsessive-compulsive disorder and related disorders. What does this mean? It means that we are dealing with someone who has a constant need to scratch, pinch, bite or rub acne without being able to control this behavior at any time. It carries it out automatically, persistently.

Who is usually affected?

The data is still striking: It is estimated that galling disorder affects 9% of the population. It appears in both sexes, however, it tends to be much more prevalent in women. Likewise, the age at which this disorder most usually appears is between 30 and 45 years.

Why is this behavior carried out?

Today, dermatillomania is still not understood in depth. One of the hypotheses is that Scratching the skin generates calm or serves to channel stress, anxiety, negative thoughts, fears, frustrations… However, such a habit is carried out automatically, to the point that it can be done while one reads, studies, watches television, etc.

Comorbidity

Depressive disorders: 16-58% Anxiety disorders: 20-30% Obsessive-compulsive disorder: 15-68% Body dysmorphic disorder: 15-68% Trichotillomania: 5-37% Onychophagia: 26%

On the other hand, something that should be taken into account is that In 40% of cases there is a genetic component. That is, this disorder has a hereditary pattern very similar to that of trichotillomania.

Evaluation and Treatment for Excoriation Disorder

At first glance, it may seem like just another hobby to more than one person, something innocuous and even innocent. It is necessary to emphasize once again that We are facing a psychiatric disorder where the patient’s seemingly innocent behavior ends up causing serious injuries.. Some people use their nails or teeth, others end up using tweezers or even needles. And the objective (the need) is always the same, to remove skin.

Assessment

Skin Picking Inventory. It is a self-administered inventory that collects antecedents, emotional aspects and impact on behavior.Skin Picking Scale (SPS). Self-administered scale to assess the severity of the disorder with respect to the frequency and intensity of impulses. As well as the time dedicated to the behavior and its consequences in the seven days prior to the evaluation.Skin Picking Impact Scale (SPIS). Self-administered scale that measures the impact of the disorder at a psychosocial level.Skin Picking Impact Scale – Short version (SPIS-S). Abbreviated version of the SPIS.Milwaukee Inventory for the Dimensions of Adult Skin Picking (MIDAS). It measures the different subtypes of the disorder: compulsive, impulsive and mixed.

Treatment

The therapeutic strategy in these cases, as we can deduce, is multidisciplinary.

On the one hand, A dermatological treatment will be carried out to heal these skin wounds. Likewise, and once a good diagnosis is made, both pharmacological and non-pharmacological therapies will be applied to the patient to address the psycho-emotional aspect.Cognitive-behavioral therapy, for example, is the one that generates the most success in these cases.On the other hand, the effectiveness of pharmacological treatments based on antidepressants, antipsychotics and anxiolytics has also been demonstrated. However, everything will undoubtedly depend on the personal characteristics of each patient.

As a curiosity: In recent years, gloves have been marketed for people with galling disorder.. It is a simple everyday accessory in which to channel desire, and where the person can entertain themselves by touching the ornaments embedded in the wool itself.

It’s just an example of how day by day these types of psychological realities are being visualized much morepersonal complexities that are increasingly understood much better and that have more effective strategies, treatments and therapies at their disposal.

Bibliographic references

Arenas R. (2005) Dermatology. Atlas, diagnosis and treatment. Mexico: McGraw-Hill; pp. 263-269.

Arnold L, Auchenbach M, McElroy S. (2001) Psychogenic excoriation. Clinical features, proposed diagnostic criteria, epidemiology and approaches to treatment. Central Nervous System Drugs. 15(5): 351-9.

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