Neurotic excoriations is a skin condition arising from compulsive or habitual skin scratching or picking in the absence of underlying pathology. Unlike patients with dermatitis artefacta, those with neurotic excoriations will usually admit their involvement in creating the lesions. The disorder is predominantly seen in middle-aged females but can be seen in patients of almost any age. The continued scratching can lead to the itch-scratch-rash cycle, further perpetuating the condition.
Repetitive skin-picking results in few to several hundred excoriations, scars, and scabs. The lesions typically exhibit delayed healing due to recurrent scratching.
There is a strong relationship between neurotic excoriations and underlying psychiatric disease, most often obsessive-compulsive disorder (OCD), depression, anxiety, and substance use disorder. Individuals who use recreational drugs, especially methamphetamines (crystal meth), are prone to neurotic excoriations. Pruritus-inducing drugs such as narcotics, especially heroin, may result in neurotic excoriations as well.
In children and adults, skin picking is associated with developmental disabilities such as Prader-Willi syndrome. Systemic diseases such as type 2 diabetes mellitus and hepatitis C have also been reported to be associated with neurotic excoriations; however, the significance of this observation remains unclear.
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
Neurotic excoriations are scratches on the skin that are produced when a person compulsively and habitually scratches and picks at his or her skin. This is a common condition that is associated with emotional stress. Continued scratching prevents the lesions from healing, and it can also cause them to itch and scar.
Who’s At Risk
The disorder can be seen in people of almost any age, but is most often seen in young adult women. The onset of the lesions may be related to a specific event or to chronic stress. There is a strong relationship between neurotic excoriations and stress, most often seen in obsessive-compulsive disorder and depression.
Individuals who take street drugs, especially methamphetamines (ie, crystal meth) or heroin, are also prone to neurotic excoriations.
Signs & Symptoms
Lesions are most commonly found on the face, arms, legs, and scalp. They can range from millimeters to centimeters and are often in different stages of development or healing. When the scalp is involved, hair loss and scarring may occur.
Self-Care Guidelines
If the lesions are covered and protected, they will gradually heal. It may also help to keep your fingernails clipped very short. If covering and protecting the lesions cannot solve the problem, then referral to a psychologist or psychiatrist might be necessary. The mental health specialist may recommend life adjustments, therapy, and possibly medications to treat anxiety. Please seek care from a mental health professional or a drug treatment center if you are abusing drugs like amphetamines or heroin.
When to Seek Medical Care
Seek medical care from a primary care physician or a dermatologist if the lesions become infected. Please talk to a physician or mental health professional if you are depressed, anxious, or would like help with quitting addictive substances.
Treatments
Treatment is targeted at any underlying psychiatric issues. Your physician may prescribe a medication called a serotonin specific reuptake inhibitor (SSRI), which can help lessen anxiety and depression.
Topical and oral anti-itch medications can be used.
Cover the lesions with band-aids or gauze to prevent further scratching and to allow the lesions to heal.
Steroid injections may help existing lesions heal, but they will not prevent the formation of new lesions.
Oral antibiotics may be needed if the lesions are infected.
Patient Information for Neurotic excoriations in Child