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Skin picking (excoriation) disorder and related disorders

Authors
Kelly KyungHwa Park, MD
John Koo, MD
Section Editor
Erik Stratman, MD
Deputy Editor
Rosamaria Corona, MD, DSc

INTRODUCTION

Skin picking disorder (SPD) is characterized by deliberate and repetitive manipulation of the skin, causing tissue damage. Excoriation disorder, psychogenic excoriation, lichen simplex chronicus, neurodermatitis, neurotic excoriation, acne excoriée, and dermatillomania (dermatotillomania) are synonyms of SPD.

This topic will discuss the clinical manifestations, diagnosis, and treatment of SPD and related conditions. Obsessive-compulsive disorder and body dysmorphic disorder are discussed separately. (See "Obsessive-compulsive disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis" and "Body dysmorphic disorder: Epidemiology, pathogenesis, and clinical features" and "Obsessive-compulsive disorder in children and adolescents: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis".)

DEFINITION AND CLASSIFICATION

Skin picking disorder (SPD) is defined as the repetitive picking, scratching, rubbing, digging, or squeezing of skin, resulting in visible tissue damage and impairment in social functioning [1]. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), SPD is included as a separate diagnosis in the group of the obsessive-compulsive and related disorders, along with trichotillomania and body dysmorphic disorder [2].

EPIDEMIOLOGY

The prevalence of SPD in the general population is unknown; it accounts for approximately 2 percent of all visits to the dermatology clinic [3,4]. In a telephone survey, 1.6 percent of a random sample of 2511 adults residing in the United States reported skin picking with noticeable skin damage [5]. These individuals also reported distress and psychosocial impact associated with skin picking. In another United States population-based study, 5.4 percent of 354 participants reported SPD and associated impairment in daily functioning [6].

In three samples of college students, the rates of severe, self-injurious skin picking ranged from 3.8 to 4.6 percent [7-9]. SPD was associated with high lifetime rates of affective disorders, anxiety disorders, eating disorders, substance abuse, and impulse control disorders and was usually triggered by cutaneous stimuli or specific emotional situations.

                                

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Literature review current through: Nov 2016. | This topic last updated: Wed Aug 03 00:00:00 GMT+00:00 2016.
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