Neurotic excoriation: A case report and literature review

Abstract

Background: On average, one-third of patients seeking treatment for skin problems have associated psychological stress or psychiatric disease. Most psychodermatologic patients visit a dermatologist instead of a psychiatrist. It is important to recognize the signs and symptoms immediately, make a prompt diagnosis and do a comprehensive treatment that involves multi-disciplinary approach, including dermatology, psychiatry and other discipline if necessary. Case Presentation: A 40-year-old female, visited the Dermatology and Venereology (DV) outpatient clinic of Dr. Cipto Mangunkusumo Hospital with a chief complaints of wound on her right ear since 2 weeks ago. The patient was also diagnosed with Chiari malformation type 1 and had undergone surgery twice. The patient confessed of having a habit of intentionally skin picking until they were chafed and bled when she was stressed. The patient was diagnosed as neurotic excoriations, treated with potent topical corticostreroid and consulted to the psychiatric department. Discussion: Neurotic excoriations is classified as primary psychiatric skin disorders. Symptoms usually occurred when the patient was in the depression state. At first the patient only followed the dermatologist treatment and had a poor compliance with psychiatric management. Therefore the patients keep manipulating the lesions and the outcome was not satisfactory because the underlying disease has not been well treated. After the dermatologist convinced her to see the psychiatrist regularly, accompanied by a good compliance in applying the corticosteroid cream, the result was satisfactory. Conclusion: The psychocutaneous disease need a comprehensive and multi-disciplinary approach. Dermato-venereologists should work together with the psychiatrist.