How should a dermatologist approach the treatment of excoriation (skin-picking) disorder?

Updated: Jul 10, 2018
  • Author: Roxanne Graham, MD; Chief Editor: Dirk M Elston, MD  more...
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The patient’s denial of psychic distress and the possible negative feelings aroused in health care personnel make management of excoriation (skin-picking) disorder difficult. It is has been estimated that about 20% of patients with excoriation (skin-picking) disorder look for treatment. This is thought to be due to the belief that the condition is untreatable or considering it a “bad habit” or due to fear of social embarrassment. A dermatologist rather than a psychiatrist or psychologist often first sees those that do seek treatment. [1]

Setting limits for the protection of both the physician and patient; creating an accepting, empathic, and nonjudgmental environment; and closely supervising symptomatic dermatologic care permit the development of a therapeutic relationship in which psychological issues may be gradually introduced, which may occasionally permit referral to a psychiatrist. Issues of etiology should be sidestepped because confrontation is counterproductive.

If the patient refuses referral to a psychiatrist, psychotropic drug therapy prescribed by dermatologists is helpful and appropriate. The upper dose range of selective serotonin reuptake inhibitors (SSRIs) or low-dose atypical antipsychotic agents may be effective.

Using hypnosis to facilitate resolution of psychogenic excoriations in acne excoriée has been reported. 

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