What is the role of medications in 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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Answer

There is currently no medication approved by the US Food and Drug Administration approved for the treatment of excoriation (skin picking) disorder. [16]  Attempts to treat it with a variety of psychotropic medication classes include antipsychotic agents, antianxiety agents, antidepressant agents, topical cortisone agents, and antiepileptic agents.

In 2005, Krishnan and Koo reported that pathology of the opioid neurotransmitter system and the central nervous system (CNS) is the neurologic basis for neurotic excoriations, which suggested that psychiatric medications that can normalize CNS pathology can abate neurotic excoriations. [17]  In line with this, glutamate, an excitatory CNS neurotransmitter, has been reported as being potentially helpful for treating picking disorders when other conventional therapies fail. [18]  A two-center randomized, double-blind trial with 66 adults with excoriation disorder assessed N-acetylcysteine against placebo for 12 weeks, with 47% of N-acetylcysteine group reporting improvement compared to 19% receiving placebo. N-acetylcysteine, an amino acid that appears to restore extracellular glutamate concentration in the nucleus accumbens, has been shown to significantly reduce skin-picking symptoms, and it is well tolerated. [16]

Studies have shown that the serotonergic effect of SSRIs produces an antipruritic effect. [19, 20] The relief of pruritus is unrelated to changes in the patient’s mood and happens faster than would be expected for antidepressant effects.

Olanzapine may be an effective adjunctive therapy in the management of acne excoriée. [21] Paroxetine was reportedly effective in a case of psychogenic pruritus and neurotic excoriations. [22] Lithium has been used to treat neurotic excoriations, but further study is needed. [23] Dereli et al found that gabapentin is a useful treatment for recalcitrant chronic prurigo nodularis. [24]


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