Neurotic excoriations in Adult
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Synopsis

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.
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.
Codes
ICD10CM:
L98.1 – Factitial dermatitis
SNOMEDCT:
247444006 – Excoriation of skin
L98.1 – Factitial dermatitis
SNOMEDCT:
247444006 – Excoriation of skin
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Other causes of pruritus
- Scabies
- Contact dermatitis
- Irritant contact dermatitis
- Prurigo nodularis
- Dermatitis herpetiformis
- Factitial dermatitis
- Acne excoriée
- Vasculitis
- Impetigo
- Arthropod reaction
- Delusions of parasitosis
- Consider neuropathic injury in a localized area of large excoriation.
- Systemic disease, including neoplasms
- Factitious disorders or medical child abuse
- Burns (see thermal or electrical burn; chemical burns are covered separately, by chemical agent)
- Abuse
- Neuropathic (eg, injection of trigeminal ganglion)
- Lesch-Nyhan syndrome
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Therapy
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Drug Reaction Data
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.
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References
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Last Reviewed:03/28/2021
Last Updated:05/23/2023
Last Updated:05/23/2023

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Neurotic excoriations in Adult
See also in: Hair and Scalp