How is excoriation (skin-picking) disorder differentiated from trigeminal trophic syndrome or acne excoriée?

Updated: Jul 10, 2018
  • Author: Roxanne Graham, MD; Chief Editor: Dirk M Elston, MD  more...
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Patients pick at areas until they can pull material from the skin. This may be referred to as "pulling a thread from the skin."

Setyadi et al noted that trigeminal trophic syndrome can result in ulcerations on the nose (in the nasal ala and paranasal locations), most commonly manifesting in older women after therapy for trigeminal neuralgia. [13]

Young women who pick at their faces may have a history of mild acne. Such cases are referred to as acne excoriée. This condition is not discussed in this article. The erosions can heal slowly because of recurrent picking.

It is helpful to ask patients which came first, the lesion or the urge to itch. When closely questioned, most patients say that they first scratched their skin and then saw a lesion. The lesions of neurotic excoriations have a component of an itch-scratch cycle, whereby the urge to scratch generates an even greater urge to scratch.

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