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Neurotic Excoriation
Aka: Neurotic Excoriation, Psychogenic Excoriation, Dermatotillomania, Compulsive Skin Picking
- Symptoms
- Pruritus (intense at times)
- Itching awakens person from sound sleep
- Scabies and Rhus Dermatitis prevent getting to sleep
- Patient digs at skin
- Digs to relieve itch
- Digs to extract imaginary embedded materials in skin
- Rash
- Rash does not appear until after scratching starts
- Rash may appear spontaneously
- Signs
- Often in localized areas within reach of hand
- Occiput and Neck
- Shoulders
- Forearms
- Shins
- Spares middle of back
- Characteristics
- Linear excoriations, scabs and scars
- Scattered ulcerations
- Differential Diagnosis
- See Pruritus Causes
- Substance Use Disorder (esp. Cocaine, Methamphetamine) are common causes of Compulsive Skin Picking
- Other psychogenic skin disorders
- Neurodermatitis
- Delusions of Parasitosis
- Trichotillomania
- Dermatitis Artifacta
- Excoriation in patient who denies scratching
- Complications
- Lichen Simplex Chronicus
- Prurigo Nodularis
- Impetigo
- Associated Conditions
- Obsessive-Compulsive Disorder
- Management
- Similar management to Neurodermatitis
- See Pruritus Management
- Frequent application of Skin Lubricants
- Replaces the habit of scratching
- Bedtime Antihistamines
- Doxepin (Sinequan) 10 to 30 mg qhs
- Topical antipruritics
- Zonalon (topical doxepin)
- Risk of drowsiness if widespread use
- Risk of contact allergy
- Menthol and Phenol (Sarna lotion)
- Pramoxine (PrameGel, Pramosone)
- Selective Serotonin Reuptake Inhibitors (SSRI)
- Very effective in Pruritus of Neurotic Excoriation
- Effect immediate and independent of Antidepressant
- Olanzapine (Zyprexa) has been used with some success
- Blanch (2004) Br J Derm 151:714-5 [PubMed]
- Consider mental health counseling
- Topical Corticosteroids
- Indicated for inflammatory dermatitis
- References
- Habif (1996) Clinical Dermatology, Mosby, p. 72
- Cyr (2001) Am Fam Physician 64(12):1981-4 [PubMed]
- Tennyson (2001) Dermatol Clin 19(1):179-97 [PubMed]