Treatment of skin picking disorder: Interdisciplinary role of dermatologist and psychiatrist

Abstract

Skin picking disorder (excoriation disorder) is a common psychodermatological disorder characterized by irresistible urges to pick skin on dominant hand accessible parts of the body. There is no specific recommended treatment available. Various pharmacological agents particularly selective serotonin reuptake inhibitors and glutamatergic agents have been tried with variable success. Habit reversal therapy has been commonly employed in the treatment and has some evidence-based success. This review focuses on the interdisciplinary team approach consisting of a liaison with psychiatry, in the management of this disorder. The specific roles of dermatologist and psychiatrist are discussed in detail.

Skin Picking in Atopic Dermatitis and Psoriasis Patients: A Single-centre Cross-sectional Study in China

“…In particular, when the skin picking behaviour results in significant tissue damage, distress, and functional impairment, the doctor should provide therapeutic interventions including behavioural cognitive therapy and psychotropic drugs, such as fluoxetine, citalopram, and N-acetylcysteine ( 12 ). If necessary, the patient should be referred to a psychiatrist ( 13 ).…”

Appearance-related concerns in individuals with pathological skin picking—a comparison with individuals with dermatological conditions and skin-healthy controls

“…While PSP often leads to short-term relaxation and stress reduction, the repeated episodes elicit feelings of shame and guilt in the long term (16)(17)(18). In addition to the stressful experience that it is difficult to stop skin picking and to experience a lack of understanding from their social environment as well as from health care professionals [e.g., dermatologists; (18)(19)(20)], those affected often also suffer from the visible consequences of the behavior, for example scabs or scars. To avoid skin blemishes or to cover or treat skin picking wounds, many affected people undergo various cosmetic procedures (e.g., dermabrasion, laser therapy) and use camouflaging make-up (21,22).…”