What is the role of psychotropic 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

Excoriation (skin-picking) disorder is treated with a variety of psychotropic medications. Attempts to treat it with a variety of psychotropic medication classes include antipsychotic agents, antianxiety agents, antidepressant agents, topical cortisone agents, and antiepileptic agents.

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]

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]  Adding venlafaxine to a treatment regimen of aripiprazole abated a case of treatment-resistant excoriation disorder. [29]


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